ReviewContributions of Insulin-Resistance and Insulin-Secretory Defects to the Pathogenesis of Type 2 Diabetes Mellitus
Section snippets
TYPE 2 DIABETES MELLITUS AS AN INSULIN-RESISTANT CONDITION
Insulin resistance is associated with a cluster of metabolic abnormalities known collectively as the insulin resistance syndrome, the metabolic syndrome, or syndrome X.36, 37, 38, 39, 40 Recently, the Third Report of the National Cholesterol Education Program Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III) published criteria to identify the syndrome according to the following major components: abdominal obesity, hypertension,
ROLE OF IMPAIRED INSULIN SECRETION IN TYPE 2 DIABETES MELLITUS
The vast majority of patients with type 2 diabetes exhibit some degree of insulin resistance, but type 2 diabetes can occur in the absence of insulin resistance.20, 22, 65, 88, 89, 90, 91, 92 Furthermore, most obese individuals who are insulin resistant do not develop type 2 diabetes.12, 93 These individuals remain normoglycemic because they compensate for the reduction in insulin sensitivity by increasing their insulin secretion.24, 93, 94, 95 Therefore, insulin resistance per se is an
TYPE 2 DIABETES MELLITUS AS A HETEROGENEOUS DISORDER: IMPLICATIONS FOR TREATMENT
Although impaired insulin secretion and insulin resistance have both been proposed as the primary pathophysiologic defect in type 2 diabetes, at the present time the body of literature suggests that these 2 phenomena should be considered interrelated elements rather than competing explanations. Both defects are logical therapeutic targets. Therefore, optimal management of type 2 diabetes demands an individualized approach to treatment that considers the heterogeneous nature of this disorder and
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