type 2 diabetes

It has long been assumed that type 2 diabetes is caused by the combined effects of insulin resistance and loss of pancreatic islet beta cells. Much therapeutic effort has been directed towards decreasing insulin resistance even though results have been generally disappointing. Now that type 2 diabetes can be understood as a simple reversible condition, its component parts can be examined during the period of return to normal glucose tolerance.

The rapid growth of noncommunicable diseases represents a formidable global health challenge. Here we use type 2 diabetes as a case study to illustrate the rise of noncommunicable diseases and call attention to the important role of primary care systems in addressing these diseases in low- and middle-income countries. Comprehensive screening for diabetes should be implemented through primary care systems to increase early detection of prediabetes and undiagnosed diabetes – a first step to diabetes prevention and management.

Queen Maria de’ Medici (1573–1642) died in a miserable, marasmic state. Infections, gangrene, weight loss, fatigue and respiratory problems suggest a progressive decompensation of a previously existing Type 2 diabetes. The lack of biochemical data, however, permits only circumstantial evidence of this hypothesis. The author proposes that the queen developed subclinical diabetes after the age of 45, when she became obese due to excessive eating and lack of exercise. With a clear familial predisposition, she could have become insulin resistant and chronically hyperglycaemic.

Controlling blood glucose in type 2 diabetes remains challenging. All existing drugs have significant limitations and side effects, with some causing weight gain and thereby exacerbating the condition. This short review looks at new groups of drugs on the market and under development, and discusses their potential in the management of type 2 diabetes.

Keywords DPP-IV inhibitors, hypoglycaemia, incretin mimetics, obesity, thiazolidinediones, type 2 diabetes, weight loss drugs