diabetestalk.net

Progression Of Type 2 Diabetes Mellitus

Diabetes Mellitus Type 2

Diabetes Mellitus Type 2

What is Diabetes Mellitus Type 2? Type 2 Diabetes Mellitus is a condition in which the body fails to metabolise glucose (sugar) correctly. This causes levels of sugar in the blood to increase, a state known as hyperglycaemia. When a person does not have diabetes, a gland called the pancreas produces and secretes a hormone called insulin. The hormone is used by the body’s tissues to metabolise glucose. Usually the amount of insulin secreted increases in relation to the amount of carbohydrate (sugar) a person consumes. In people with type 2 diabetes, insulin secretion from the pancreas often decreases. This is referred to as reduced insulin secretion. In addition the body tissues do not respond adequately to the insulin which is produced. Normally the insulin would be used by the body to draw glucose into the cells, where it could be stored as energy which could be used by the body later (e.g. when exercising or any of the other activities which involve energy expenditure). In type 2 diabetes, the glucose is not taken into the cells. This is referred to as insulin resistance. It causes glucose to stay in the blood stream and hyperglycaemia is the result. Type 2 diabetes mellitus was previously called non-insulin dependent diabetes mellitus (NIDDM) and late onset diabetes mellitus. These names are no longer used because they are inaccurate. Insulin is often used in the management of type 2 diabetes. The condition is increasingly diagnosed in young people. Statistics Almost one in 20 Australians, or one million people, were diagnosed with type 2 diabetes mellitus in 2008. The actual proportion of Australians with the condition may be higher as many people are not diagnosed until they develop complications, for example diabetic retinopathy. Of those who have been diagnosed Continue reading >>

Type 2 Diabetes

Type 2 Diabetes

Print Overview Type 2 diabetes, once known as adult-onset or noninsulin-dependent diabetes, is a chronic condition that affects the way your body metabolizes sugar (glucose), your body's important source of fuel. With type 2 diabetes, your body either resists the effects of insulin — a hormone that regulates the movement of sugar into your cells — or doesn't produce enough insulin to maintain a normal glucose level. More common in adults, type 2 diabetes increasingly affects children as childhood obesity increases. There's no cure for type 2 diabetes, but you may be able to manage the condition by eating well, exercising and maintaining a healthy weight. If diet and exercise aren't enough to manage your blood sugar well, you also may need diabetes medications or insulin therapy. Symptoms Signs and symptoms of type 2 diabetes often develop slowly. In fact, you can have type 2 diabetes for years and not know it. Look for: Increased thirst and frequent urination. Excess sugar building up in your bloodstream causes fluid to be pulled from the tissues. This may leave you thirsty. As a result, you may drink — and urinate — more than usual. Increased hunger. Without enough insulin to move sugar into your cells, your muscles and organs become depleted of energy. This triggers intense hunger. Weight loss. Despite eating more than usual to relieve hunger, you may lose weight. Without the ability to metabolize glucose, the body uses alternative fuels stored in muscle and fat. Calories are lost as excess glucose is released in the urine. Fatigue. If your cells are deprived of sugar, you may become tired and irritable. Blurred vision. If your blood sugar is too high, fluid may be pulled from the lenses of your eyes. This may affect your ability to focus. Slow-healing sores o Continue reading >>

Nutrients | Free Full-text | Taiwanese Green Propolis Ethanol Extract Delays The Progression Of Type 2 Diabetes Mellitus In Rats Treated With Streptozotocin/high-fat Diet

Nutrients | Free Full-text | Taiwanese Green Propolis Ethanol Extract Delays The Progression Of Type 2 Diabetes Mellitus In Rats Treated With Streptozotocin/high-fat Diet

Nutrients 2018, 10(4), 503; Taiwanese Green Propolis Ethanol Extract Delays the Progression of Type 2 Diabetes Mellitus in Rats Treated with Streptozotocin/High-Fat Diet Graduate Institute of Biomedical Electronics and Bioinformatics, National Taiwan University, Taipei City 10617, Taiwan School of Nutrition and Health Sciences, Taipei Medical University, Taipei City 11031, Taiwan Research Center of Geriatric Nutrition, College of Nutrition, Taipei Medical University, Taipei City 11031, Taiwan Graduate Institute of Metabolism and Obesity Science, Taipei Medical University, Taipei City 11031, Taiwan Department of Food Science, Nutrition, and Nutraceutical Biotechnology, Shih Chien University, Taipei City 10462, Taiwan Department of Research & Development, NatureWise Biotech & Medicals Corporation, Taipei City 10559, Taiwan Author to whom correspondence should be addressed. Received: 6 March 2018 / Revised: 10 April 2018 / Accepted: 17 April 2018 / Published: 18 April 2018 Full-Text | PDF [17049 KB, uploaded 3 May 2018] | Taiwanese green propolis ethanol extract (TGPE) is produced only in Taiwan and has a different composition from other types of propolis. TGPE is known for its anti-inflammation, anti-oxidation, and anti-microbial properties, but the effects and mechanisms of TGPE in the modulation of diabetes are unclear. In this study, we investigated the effects of TGPE on type 2 diabetes mellitus (T2DM) in a streptozotocin/high-fat-diet (STZ/HFD)-induced T2DM rat model. The results revealed that TGPE delayed the development and progression of T2DM and reduced the severity of -cell failure. TGPE also attenuated inflammation and reactive oxygen species ROS in the rats. Moreover, there were higher levels of oxidant cytokines, leptin, and adiponectin in the serum of the T Continue reading >>

The Natural History Of Type 2 Diabetes: Practical Points To Consider In Developing Prevention And Treatment Strategies

The Natural History Of Type 2 Diabetes: Practical Points To Consider In Developing Prevention And Treatment Strategies

CLINICAL DIABETES VOL. 18 NO. 2 Spring 2000 PRACTICAL POINTERS Type 2 diabetes, previously referred to as adult-onset or non-insulin-dependent diabetes, progresses from an early asymptomatic stage with insulin resistance to mild postprandial hyperglycemia to frank diabetes requiring pharmacological intervention. Understanding this natural history of type 2 diabetes will guide primary care providers in formulating effective treatment regimens that reflect the pathological differences between these stages of the disease. The optimal medication regimen, when used in conjunction with dietary changes and exercise, will require modifications for each patient as the disease progresses. The term impaired glucose tolerance (IGT) or pre-diabetes was first coined in 1979 by the World Health Organization and the National Diabetes Data Group to replace the terms borderline, chemical, and asymptomatic diabetes mellitus. In 1997, an expert committee of the American Diabetes Association recommended the following criteria for IGT: a normal fasting plasma glucose (<126 mg/dl) with a postprandial plasma glucose of >140 mg/dl but <200 mg/dl 2 h after a 75-g oral glucose challenge.1 This stage of mild postprandial hyperglycemia is an extremely useful marker of patients at risk for the eventual development of type 2 diabetes. Patients with IGT may benefit from timely patient education and perhaps even more aggressive forms of intervention, such as diet, exercise, or medication. An estimated 15.7 million Americans have type 2 diabetes, representing 5.9% of the population. Only two-thirds of those affected are diagnosed and are being actively treated. Although these numbers are staggering, there are even more potential diabetic patients waiting in the wings: the prevalence of IGT is estimated Continue reading >>

Type 2 Diabetes

Type 2 Diabetes

Whether you have type 2 diabetes, are a caregiver or loved one of a person with type 2 diabetes, or just want to learn more, the following page provides an overview of type 2 diabetes. New to type 2 diabetes? Check out “Starting Point: Type 2 Diabetes Basics” below, which answers some of the basic questions about type 2 diabetes: what is type 2 diabetes, what are its symptoms, how is it treated, and many more! Want to learn a bit more? See our “Helpful Links” page below, which provides links to diaTribe articles focused on type 2 diabetes. These pages provide helpful tips for living with type 2 diabetes, drug and device overviews, information about diabetes complications, nutrition and food resources, and some extra pages we hope you’ll find useful! Starting Point: Type 2 Diabetes Basics Who is at risk of developing type 2 diabetes? What is the risk of developing type 2 diabetes if it runs in the family? What is type 2 diabetes and prediabetes? Behind type 2 diabetes is a disease where the body’s cells have trouble responding to insulin – this is called insulin resistance. Insulin is a hormone needed to store the energy found in food into the body’s cells. In prediabetes, insulin resistance starts growing and the beta cells in the pancreas that release insulin will try to make even more insulin to make up for the body’s insensitivity. This can go on for a long time without any symptoms. Over time, though, the beta cells in the pancreas will fatigue and will no longer be able to produce enough insulin – this is called “beta burnout.” Once there is not enough insulin, blood sugars will start to rise above normal. Prediabetes causes people to have higher-than-normal blood sugars (and an increased risk for heart disease and stroke). Left unnoticed or Continue reading >>

How Type 2 Diabetes Can Change Over Time

How Type 2 Diabetes Can Change Over Time

You probably already know that type 2 diabetes can cause long-term damage if you don’t control it, but it’s also important to understand that even well-controlled diabetes progresses over time — meaning you may have to adjust your treatment plan more than once. The key to learning about the progression of diabetes is to understand the role of your pancreas, which produces insulin. For people with type 1 diabetes, the pancreas does not make any insulin, so they must take it through injections. With type 2, the pancreas doesn’t make enough insulin or the cells don’t respond to it adequately, according to the American Academy of Family Physicians. This means that the body has trouble moving sugar from the blood into cells to be used for energy. Diet, exercise, and medication, if prescribed, can all help those with type 2 diabetes lower their blood sugar levels and help their bodies use insulin made by the pancreas, according to the American Diabetes Association (ADA). If blood sugar levels remain high, the ADA says, you may be at risk for such diabetes complications as vision loss, heart disease, nerve damage, foot or leg amputation, and kidney disease. However, proper diabetes management can help prevent or delay the onset of these complications. How Your Diabetes Treatment Plan Might Change Over time, your medications, diet, and exercise goals may need to be adjusted. “Initially the pancreas produces extra insulin to make up for insulin resistance, but in most people, the pancreas eventually is unable to make the extra insulin to keep blood sugar levels normal,” says Marc Jaffe, MD, a San Francisco endocrinologist in practice with Kaiser Permanente in Northern California. After a type 2 diabetes diagnosis, your doctor will set blood sugar goals for you, rec Continue reading >>

Role Of Serum Vaspin In Progression Of Type 2 Diabetes: A 2-year Cohort Study

Role Of Serum Vaspin In Progression Of Type 2 Diabetes: A 2-year Cohort Study

Role of Serum Vaspin in Progression of Type 2 Diabetes: A 2-Year Cohort Study Contributed equally to this work with: Weixia Jian, Wenhui Peng Affiliation Department of Endocrinology, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China Contributed equally to this work with: Weixia Jian, Wenhui Peng Affiliation Department of Cardiology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China Affiliation Department of Medicine, Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong Affiliation Department of Cardiology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China Affiliation Department of Endocrinology, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China Affiliation Department of Endocrinology, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China Affiliation Department of Endocrinology, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China Affiliation Department of Endocrinology, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China Role of Serum Vaspin in Progression of Type 2 Diabetes: A 2-Year Cohort Study Vaspin is a novel adipocytokine that has potential insulin-sensitizing effects. The aim of this study is to explore the role of vaspin in the progression of type 2 diabetes mellitus (T2DM) in humans through a longitudinal process. This was a 2-year follow-up study that included 132 patients with T2DM and 170 non-diabetic subjects. The serum vaspin and adiponectin levels were determined with ELISA. Anthropometric measurements, circulating glucose, hemoglobin A1c, insulin level, liver function, kidney function, and lipid profile were meas Continue reading >>

Natural Progression Of Type 2 Diabetes

Natural Progression Of Type 2 Diabetes

Type 2 diabetes is not a stable disease—it is progressive in nature. In fact, by the time someone is diagnosed with type 2 diabetes, many changes may have already occurred in the body, including the start of heart disease. These changes continue over the years, potentially making the complications of diabetes more difficult to control. For this reason, you need to know what changes to expect when you have type 2 diabetes. This article will help you and your health care provider manage your diabetes every step of the way. A LONG TIME COMING Experts today believe that people who are diagnosed with type 2 diabetes have had blood glucose levels that were high enough to diagnose diabetes, on average, seven to 10 years earlier. That’s bad news because high blood glucose levels for so long can cause damage to the heart, kidneys, eyes and nerves. So in reality, people with “newly” diagnosed type 2 diabetes may already have diabetes-related problems. But what happens during this period leading up to a diagnosis of diabetes? Initially, the pancreas produces the correct amount of insulin the body needs to keep blood glucose levels where they ought to be. However, at some point, cells begin to resist this naturally occurring insulin. This is referred to as “insulin resistance,” meaning the cells have a hard time using the insulin the body produces. The pancreas, in turn, receives a message that even more insulin is needed, and it begins to produce more than before to overcome this resistance. At some point, the pancreas is not able to keep up and blood glucose levels begin to increase. This is what’s known as pre-diabetes. Pre-diabetes means that blood glucose levels are higher than normal, but not high enough to be classified as diabetes. It is in this stage that 10 Continue reading >>

The Rate Of Progression Of Type 2 Diabetes Mellitus To End Stage Renal Disease A Single Centred Retrospective Study From Malaysia - Sciencedirect

The Rate Of Progression Of Type 2 Diabetes Mellitus To End Stage Renal Disease A Single Centred Retrospective Study From Malaysia - Sciencedirect

Volume 12, Issue 6 , November 2018, Pages 1025-1030 The rate of progression of type 2 diabetes mellitus to end stage renal disease A single centred retrospective study from Malaysia To date Information is still lacking on the rate of progression of T2DM to ESRD in Asian population especially in Malaysia. This study examined the rate of progression of T2DM to ESRD in Malaysian population. This study also investigated the differences in rate of progression of T2DM to ESRD between the patients receiving Renal-Angiotensin-Angiotensinogen-System (RAAS) blocker at time of diagnosis of T2DM and those who did not as well as the costs incurred. In Malaysia, 61% of dialysis cases are secondary to diabetes. To date, we are still lacking of data on the rate of progression of type 2 diabetes mellitus (T2DM) to end stage renal disease (ESRD) in Malaysia. This was a retrospective study conducted at nephrology unit of a tertiary hospital in Kedah. All diabetic ESRD patients who fulfilled the inclusion criteria were identified and recruited for analysis. The mean duration of DM to ESRD was found to be 14.374.42 years. Mean duration for the onset of diabetic nephropathy was 8.733.37 years. There was a relative short duration from diabetic nephropathy to ESRD noted, which was 5.632.06 years. The mean duration of DM to ESRD for patients receiving RAAS blocker was found to be 18.232.38 years as compared to 11.412.94 years for those who did not (95% CI: -0.64 to -2.46). For different type of RAAS blockers, namely ACE inhibitor and angiotensin receptor blocker (ARB), there was no significant difference observed pertaining to mean duration of DM to ESRD; 17.891.97 years for ACEi and 19.004.16 years for ARB (95% CI: -4.74 to 2.52). Time frame from diabetic nephropathy to ESRF among Malaysian p Continue reading >>

Interventions To Modify The Progression To Type 2 Diabetes Mellitus In Women With Gestational Diabetes: A Systematic Review Of Literature

Interventions To Modify The Progression To Type 2 Diabetes Mellitus In Women With Gestational Diabetes: A Systematic Review Of Literature

Interventions to modify the progression to type 2 diabetes mellitus in women with gestational diabetes: A systematic review of literature Citation: Morton S., Kirkwood S., & Thangaratinam S. (2014). Interventions to modify the progression to type 2 diabetes mellitus in women with gestational diabetes: A systematic review of literature. Current Opinion in Obstetrics & Gynecology, 26(6), 476-486. PURPOSE OF REVIEW: Gestational diabetes mellitus (GDM) increases the lifetime risk of developing type 2 diabetes mellitus (T2DM) in the mother. We undertook a systematic review to assess the effectiveness of interventions that delay or prevent the onset of T2DM in women with previous gestational diabetes. RECENT FINDINGS: Diet and lifestyle interventions show differing effects on women with GDM and their long-term risk of T2DM. Pharmacological interventions, such as metformin, appear to have a beneficial role. Breastfeeding may have a protective role by reducing the risk of progression to T2DM. The findings were limited by the small number of heterogeneous studies that varied in their population, intervention, outcome and duration of follow-up. SUMMARY: Women with GDM should be informed about the future risk of T2DM and the potential benefit with lifestyle interventions. Further studies are needed prior to routine use of metformin as a preventive strategy for T2DM in women with GDM. Keywords: Behaviour Modification (e.g., provision of item/tool, incentives, goal setting), Diabetes, Female, Reproductive Health & Healthy Families Continue reading >>

Novel Tubular Biomarkers Predict Renal Progression In Type 2 Diabetes Mellitus: A Prospective Cohort Study

Novel Tubular Biomarkers Predict Renal Progression In Type 2 Diabetes Mellitus: A Prospective Cohort Study

Novel Tubular Biomarkers Predict Renal Progression in Type 2 Diabetes Mellitus: A Prospective Cohort Study Division of Nephrology, Department of Medicine, Phramongkutklao Hospital and College of Medicine, Bangkok, Thailand Received 6 May 2016; Revised 20 July 2016; Accepted 23 August 2016 Copyright 2016 Bancha Satirapoj et al. This is an open access article distributed under the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Background. Tubulointerstitial injury is both a key feature of diabetic nephropathy and an important predictor of renal dysfunction. Novel tubular biomarkers related to renal injury in diabetic nephropathy could improve risk stratification and prediction. Methods. A total of 303 type 2 diabetic patients were followed up. The baseline urine values of cystatin-C to creatinine ratio (UCCR), angiotensinogen to creatinine ratio (UANG), NGAL to creatinine ratio (UNGAL), and KIM-1 to creatinine ratio (UKIM-1) were measured. The primary outcome was a decline in estimated GFR of 25% yearly from baseline. Results. Urine tubular biomarkers of UCCR, UANG, UNGAL, and UKIM-1 were significantly higher according to the degree of albuminuria and all were significantly higher among patients with rapid decline in estimated GFR of 25% yearly from baseline. All biomarkers predicted primary outcomes with ROC for UCCR of 0.72; 95% CI 0.640.79, for UANG of 0.71; 95% CI 0.630.79, for UNGAL of 0.64; 95% CI 0.560.72, and for UKIM-1 of 0.71; 95% CI 0.630.79. Using multivariate Cox regression analysis, the number of patients with rapid renal progression was higher among those in the upper quartiles of all biomarkers than in those in the lower quartiles. Conclusio Continue reading >>

Relevance Of Uric Acid In Progression Of Type 2 Diabetes Mellitus | Auevi | Bosnian Journal Of Basic Medical Sciences

Relevance Of Uric Acid In Progression Of Type 2 Diabetes Mellitus | Auevi | Bosnian Journal Of Basic Medical Sciences

DOI: |Full Text: [PDF] Relevance of Uric Acid in Progression of Type 2 Diabetes Mellitus Adlija auevi, Sabina Semiz, Amra Maci-Dankovi, Bakira Cico, Tanja Duji, Maja Malenica, Tamer Bego Recent studies have introduced serum uric acid (UA) as a potential risk factor for developing diabetes, hypertension, stroke, and cardiovascular diseases. The value of elevated levels of UA in serum as a risk factor for diabetes development is still under scrutiny. Recent data suggest that clearance of UA is being reduced with increase in insulin resistance and UA as a marker of prediabetes period. However, conflicting data related to UA in serum of patients with Type 2 diabetes prompted us to study the urine/serum ratio of UA levels (USRUA) in these patients and healthy controls. All subjects included in the study were free of evidence of hepatitis B or C viral infection or active liver and kidney damage. Patients receiving drugs known to influence UA levels were also excluded from this study. Analysis of glucose and uric acid were performed on Dade Behring analyzer using standard IFCC protocols. Interestingly, our data demonstrated about 2.5 fold higher USRUA values in diabetic patients as compared to control subjects. Furthermore, there was a trend of correlation of USRUA value with the blood glucose levels in diabetic patients, which was more prominent in diabetic men than in women. With aging, levels of uric acid increased in serum of diabetic patients, and this effect was also more profound in male than in female diabetics. In conclusion, this study showed significantly elevated USRUA levels in patients with Type 2 diabetes, a negative USRUA correlation with the blood glucose levels in diabetic patients, and an effect of sex and age on the uric acid levels. Since literature data Continue reading >>

Defining And Characterizing The Progression Of Type 2 Diabetes

Defining And Characterizing The Progression Of Type 2 Diabetes

Go to: Progression from pre-diabetes to overt diabetes Because glucose is a continuous variable, the use of thresholds to make a diagnosis is somewhat arbitrary. The term “pre-diabetes” has become well established and implies a risk of progression to overt diabetes. However, although such progression is well studied in prevention trials, little is known about the rate of progression and the characteristics of such progression in the population at large. Table 1 summarizes some of the factors associated with such progression. Nichols et al. (2) studied the progression of pre-diabetes to overt disease and observed that 8.1% of subjects whose initial abnormal fasting glucose was 100–109 mg/dl and 24.3% of subjects whose initial abnormal fasting glucose was 110–125 mg/dl developed diabetes over an average of 29.0 months (1.34 and 5.56% per year, respectively). A steeper rate of increasing fasting glucose; higher BMI, blood pressure, and triglycerides; and lower HDL cholesterol predicted diabetes development. The Baltimore Longitudinal Study of Aging (3) concluded that although phenotypic differences in rates of progression are partly a function of diagnostic thresholds, fasting and postchallenge hyperglycemia may represent phenotypes with distinct natural histories in the evolution of type 2 diabetes. Does hyperglycemia evolve from normoglycemia gradually over time or as a step increase? Ferrannini et al. (4) measured plasma glucose and insulin levels during oral glucose testing at baseline and after 3 and 7 years of follow-up. In subjects with normal glucose tolerance on all three occasions (nonconverters), FPG increased only slightly over 7 years. In contrast, conversion to both impaired glucose tolerance (IGT) and diabetes among normal glucose tolerance subjects Continue reading >>

Defining And Characterizing The Progression Of Type 2 Diabetes

Defining And Characterizing The Progression Of Type 2 Diabetes

Type 2 diabetes is a progressive disease in which the risks of myocardial infarction, stroke, microvascular events, and mortality are all strongly associated with hyperglycemia (1). The disease course is primarily characterized by a decline in β-cell function and worsening of insulin resistance. The process is manifested clinically by deteriorations in multiple parameters, including A1C, fasting plasma glucose (FPG), and postprandial glucose levels. In this review, we will evaluate our current understanding of the role played by deteriorating β-cell function and other abnormalities linked with the progression of type 2 diabetes. An improved understanding of these abnormalities may provide the scientific groundwork for novel therapies that may help achieve and maintain good glycemic control. CHARACTERISTICS OF DISEASE PROGRESSION Progression from pre-diabetes to overt diabetes Because glucose is a continuous variable, the use of thresholds to make a diagnosis is somewhat arbitrary. The term “pre-diabetes” has become well established and implies a risk of progression to overt diabetes. However, although such progression is well studied in prevention trials, little is known about the rate of progression and the characteristics of such progression in the population at large. Table 1 summarizes some of the factors associated with such progression. Nichols et al. (2) studied the progression of pre-diabetes to overt disease and observed that 8.1% of subjects whose initial abnormal fasting glucose was 100–109 mg/dl and 24.3% of subjects whose initial abnormal fasting glucose was 110–125 mg/dl developed diabetes over an average of 29.0 months (1.34 and 5.56% per year, respectively). A steeper rate of increasing fasting glucose; higher BMI, blood pressure, and triglycer Continue reading >>

Importance Of -cell Failure In The Development And Progression Of Type 2 Diabetes | The Journal Of Clinical Endocrinology & Metabolism | Oxford Academic

Importance Of -cell Failure In The Development And Progression Of Type 2 Diabetes | The Journal Of Clinical Endocrinology & Metabolism | Oxford Academic

The pathogenesis of type 2 diabetes is complex and in most instances clearly requires defects in both -cell function and insulin sensitivity ( 1 ). Together, these abnormalities result in increased rates of glucose release by the liver and kidney as well as decreased clearance from the circulation ( 2 , 3 ). For the last decade, a great deal of attention has been directed at further understanding the role of insulin resistance as an important contributor to the development and maintenance of the hyperglycemia of type 2 diabetes. During this same period, the well described vital role of the pancreatic islet, and specifically the -cell, in this process has been largely neglected. Perhaps one of the most striking and sobering findings of the United Kingdom Prospective Diabetes Study (UKPDS) was the reaffirmation of the clinically recognized progressive nature of type 2 diabetes ( 4 ). Every day clinicians all over the world find themselves struggling to maintain good glycemic control in subjects with type 2 diabetes, and the results of this study clearly confirm that, even with the use of algorithmic approaches aimed at maintaining superb glucose control, it is very difficult to maintain individuals at the desired levels of glycemia. In fact, in the UKPDS after 9 yr only 25% of the subjects in the intensive treatment arm were achieving a HbA1c less than 7% with monotherapy alone ( 5 ). When one examines the outcome in the different groups based on their initial assignment, this goal was attained in 8% of subjects given dietary therapy, 13% receiving metformin, 24% taking sulfonylureas, and 42% of individuals using insulin. The reason(s) for the progressive deterioration in glycemic control observed in the UKPDS have been addressed using the Homeostasis Model Assessment (H Continue reading >>

More in diabetes