Type 2 diabetes mellitus: Isn’t it time to update the terminology?

Table 1 Why to update the terminology?

Why to update the terminology
The term diabetes mellitus gives the impression that it is only a disease of high blood sugar, with the excretion of sugar in the urine
Acute and chronic complications, including microvascular and macrovascular complications, are common in T2DM
The glucocentric approach is replaced by overall risk reduction (multi-risk strategy), and the organ protective approach indicates our knowledge about the pathophysiology of the illness
Multidirectional interaction between metabolic diseases such as T2DM, cardiovascular disease, and chronic kidney disease is well established
Cardiovascular and renal complications are integral parts of T2DM
Long-term remission of T2DM was achievable through weight reduction
Weight reduction is associated with improvement/remission of hypertension, dyslipidemia, metabolic dysfunction associated fatty liver disease, and other obesity-associated conditions in addition to T2DM
“Twin cycle hypothesis”: Chronic excess fat accumulation leads to hepatic and pancreatic dysfunction, leading to the development of T2DM
The strong pathophysiological link between diabetes and obesity is well described by the term ‘diabesity’
T2DM in people with normal body weight and even in lean individuals, develops when the “personal fat threshold” is crossed
“Thin fat obesity” indicates that even in people with a normal body mass index can have increased fat deposition in the visceral organs
Term for non-alcoholic fatty liver disease has been updated to metabolic dysfunction associated fatty liver disease/metabolic dysfunction associated steatotic liver diseases
The new terminology reflects the pathophysiological basis of T2DM from other types of diabetes

T2DM: Type 2 diabetes mellitus.

Table 2 Classification of adiposity-induced metabolic dysfunction associated disease

Classification of adiposity-induced metabolic dysfunction associated disease
Metabolic dysfunction associated endocrine diseases
Metabolic dysfunction associated hyperglycemic diseases
Metabolic dysfunction associated cardiovascular diseases
Metabolic dysfunction associated gastrointestinal diseases
Metabolic dysfunction associated hepatobiliary diseases
Metabolic dysfunction associated fatty liver diseases/metabolic dysfunction associated steatotic liver diseases
Metabolic dysfunction associated neurological diseases
Metabolic dysfunction associated genitourinary diseases
Metabolic dysfunction associated circulatory diseases
Metabolic dysfunction associated respiratory diseases
Metabolic dysfunction associated musculoskeletal diseases
Metabolic dysfunction associated immune diseases
Metabolic dysfunction associated sexual diseases/dysfunction
Metabolic dysfunction associated integumentary diseases

Table 3 Advantages and disadvantages of replacing the term “type 2 diabetes mellitus” with “metabolic dysfunction associated hyperglycemic disease”

Advantages of updating to MAHD	Limitations/ arguments
The new terminology reflects the pathophysiological basis of the disease	Terms “associated disease” and “metabolic dysfunction” lack clear and standardized definitions
The new terminology (AMAD and MAHD) echoes with the existing terminology with similar pathophysiological mechanisms. e.g., Metabolic dysfunction associated fatty liver diseases
The new terminology is honest and transparent of the major pathophysiological mechanism, thereby providing clarity in care	The new terminology simply exchanges one form of stigma (sugar-related) for another (weight-related)
It groups all the currently considered different diseases with the same pathology into an umbrella of a single disease
It helps in early diagnosis of other components of AMAD
It helps multidisciplinary collaboration and holistic care
It conveys a message of hope and empowerment, reinforcing the idea that early intervention can halt or even reverse the course of the disease
It reflects the interconnections between various metabolic disease and CVD, CKD, necessitating early screening for associated problems
It emphasizes the central role of lifestyle medicine in the promotion of overall health from multiple diseases due to excess fat accumulation
It helps to differentiate other types of diabetes with different pathophysiological mechanisms into different categories

MAHD: Metabolic dysfunction associated hyperglycemic disease; AMAD: Adiposity-induced metabolic dysfunction associated disease; CVD: Cardiovascular disease; CKD: Chronic kidney disease.