Type 2 Diabetes
Type 2 Diabetes
The heterogeneous nature of type 2 diabetes has become increasingly evident over the last 60 years, and particularly so in the last decade with the increased use of genetic fingerprinting techniques and understanding of environmental influences on the genome. The last decade has seen the expansion of the pharmacological options for the treatment of type 2 diabetes and the burgeoning of large randomized controlled trials. Whilst these trials have been designed to address important issues, many have generated more conundrums, highlighting the need for a diversity of approaches to investigate the pathophysiology of type 2 diabetes and its treatment.
In 2002, I reviewed the advances in our understanding and treatment of type 2 diabetes that had occurred in the previous 50 years. We had learned how glucose stimulates insulin secretion; that insulin resistance is a significant factor in the progression of prediabetes to diabetes; that intensive treatment of hyperglycemia decreases the microvascular complications of type 2 diabetes; that new treatments were likely to hold great promise for both the prevention and treatment of type 2 diabetes; and that addressing the management of cardiovascular risk factors is an integral part of the treatment of type 2 diabetes. It appeared that we were well on the way to reducing the devastating impacts of this disease.
The last ten years have presented new challenges and provided new focuses on the battle against type 2 diabetes. The worldwide increase in obesity is leading to enormous increases in the incidence and prevalence of diabetes. It has revealed that the genetic abnormalities that predispose to type 2 diabetes are present in a very high percentage of all populations, but that changing environmental factors are responsible for the increasing clinical expression of type 2 diabetes in those with the predisposition. Increasing evidence indicates that the insulin resistance and metabolic syndromes are the primary drivers of cardiovascular disease and that hyperglycaemia is the primary driver of microvascular disease.
The challenge in the coming years is to stop the epidemic of type 2 diabetes and to develop strategies and treatments to prevent the complications in those who already have the disease.
Abstract and Introduction
Abstract
The heterogeneous nature of type 2 diabetes has become increasingly evident over the last 60 years, and particularly so in the last decade with the increased use of genetic fingerprinting techniques and understanding of environmental influences on the genome. The last decade has seen the expansion of the pharmacological options for the treatment of type 2 diabetes and the burgeoning of large randomized controlled trials. Whilst these trials have been designed to address important issues, many have generated more conundrums, highlighting the need for a diversity of approaches to investigate the pathophysiology of type 2 diabetes and its treatment.
Introduction
In 2002, I reviewed the advances in our understanding and treatment of type 2 diabetes that had occurred in the previous 50 years. We had learned how glucose stimulates insulin secretion; that insulin resistance is a significant factor in the progression of prediabetes to diabetes; that intensive treatment of hyperglycemia decreases the microvascular complications of type 2 diabetes; that new treatments were likely to hold great promise for both the prevention and treatment of type 2 diabetes; and that addressing the management of cardiovascular risk factors is an integral part of the treatment of type 2 diabetes. It appeared that we were well on the way to reducing the devastating impacts of this disease.
The last ten years have presented new challenges and provided new focuses on the battle against type 2 diabetes. The worldwide increase in obesity is leading to enormous increases in the incidence and prevalence of diabetes. It has revealed that the genetic abnormalities that predispose to type 2 diabetes are present in a very high percentage of all populations, but that changing environmental factors are responsible for the increasing clinical expression of type 2 diabetes in those with the predisposition. Increasing evidence indicates that the insulin resistance and metabolic syndromes are the primary drivers of cardiovascular disease and that hyperglycaemia is the primary driver of microvascular disease.
The challenge in the coming years is to stop the epidemic of type 2 diabetes and to develop strategies and treatments to prevent the complications in those who already have the disease.
Source...