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Review: Mechanisms contributing to the development of type 2 diabetes

Mark Walker

School of Clinical Medical Sciences, 4th Floor William Leech Block, The Medical School, Framlington Place, Newcastle-upon-Tyne, NE2 4HH, UK, mark.walker{at}ncl.ac.uk

We are in the midst of an explosion in the prevalence of type 2 diabetes with a key concern that this will translate into a major future burden of diabetes-related complications. To develop rational and effective means of preventing type 2 diabetes and its complications, we need to understand the mechanisms that predispose to the development of diabetes in at-risk individuals. In this brief review, we provide an overview of the principal metabolic changes that have been identified in at-risk individuals and how they contribute to the progression from normal glucose tolerance (NGT) through to type 2 diabetes. Specifically, both impaired insulin action and defective insulin secretion are key predictors of type 2 diabetes, and both are evident in at-risk individuals well before the development of frank diabetes. These changes are associated with an increased prevalence of adverse cardiovascular risk factors. It is clear, therefore, that the identification of at-risk individuals provides the opportunity to introduce measures to try to prevent the development of type 2 diabetes and the associated cardiovascular disease.

Key Words: type 2 diabetes • impaired glucose tolerance • impaired fasting glycaemia • insulin resistance • beta-cell dysfunction.

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The British Journal of Diabetes & Vascular Disease, Vol. 4, No. 4, 227-231 (2004)
DOI: 10.1177/14746514040040040201


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