Pathophysiology and treatment of type 2 diabetes

Perspectives on the past, present, and future

Steven E. Kahn, Mark E. Cooper, Stefano Del Prato

Research output: Contribution to journalReview ArticleResearchpeer-review

Abstract

Glucose metabolism is normally regulated by a feedback loop including islet β cells and insulin-sensitive tissues, in which tissue sensitivity to insulin aff ects magnitude of β-cell response. If insulin resistance is present, β cells maintain normal glucose tolerance by increasing insulin output. Only when β cells cannot release suffi cient insulin in the presence of insulin resistance do glucose concentrations rise. Although β-cell dysfunction has a clear genetic component, environmental changes play an essential part. Modern research approaches have helped to establish the important role that hexoses, aminoacids, and fatty acids have in insulin resistance and β-cell dysfunction, and the potential role of changes in the microbiome. Several new approaches for treatment have been developed, but more eff ective therapies to slow progressive loss of β-cell function are needed. Recent fi ndings from clinical trials provide important information about methods to prevent and treat type 2 diabetes and some of the adverse eff ects of these interventions. However, additional long-term studies of drugs and bariatric surgery are needed to identify new ways to prevent and treat type 2 diabetes and thereby reduce the harmful eff ects of this disease.

Original languageEnglish
Pages (from-to)1068-1083
Number of pages16
JournalThe Lancet
Volume383
Issue number9922
DOIs
Publication statusPublished - Mar 2014
Externally publishedYes

Cite this

Kahn, Steven E. ; Cooper, Mark E. ; Prato, Stefano Del. / Pathophysiology and treatment of type 2 diabetes : Perspectives on the past, present, and future. In: The Lancet. 2014 ; Vol. 383, No. 9922. pp. 1068-1083.
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abstract = "Glucose metabolism is normally regulated by a feedback loop including islet β cells and insulin-sensitive tissues, in which tissue sensitivity to insulin aff ects magnitude of β-cell response. If insulin resistance is present, β cells maintain normal glucose tolerance by increasing insulin output. Only when β cells cannot release suffi cient insulin in the presence of insulin resistance do glucose concentrations rise. Although β-cell dysfunction has a clear genetic component, environmental changes play an essential part. Modern research approaches have helped to establish the important role that hexoses, aminoacids, and fatty acids have in insulin resistance and β-cell dysfunction, and the potential role of changes in the microbiome. Several new approaches for treatment have been developed, but more eff ective therapies to slow progressive loss of β-cell function are needed. Recent fi ndings from clinical trials provide important information about methods to prevent and treat type 2 diabetes and some of the adverse eff ects of these interventions. However, additional long-term studies of drugs and bariatric surgery are needed to identify new ways to prevent and treat type 2 diabetes and thereby reduce the harmful eff ects of this disease.",
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Pathophysiology and treatment of type 2 diabetes : Perspectives on the past, present, and future. / Kahn, Steven E.; Cooper, Mark E.; Prato, Stefano Del.

In: The Lancet, Vol. 383, No. 9922, 03.2014, p. 1068-1083.

Research output: Contribution to journalReview ArticleResearchpeer-review

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