Type 2 diabetes is a complex disease in which genetic and environmental factors interact to produce alterations in insulin action and insulin secretion, leading to hyperglycemia. To evaluate the influence of genetic background on development of diabetes in a genetically susceptible host, we generated mice that are double heterozygous (DH) for knockout of the insulin receptor and insulin receptor substrate-1 on three genetic backgrounds (C57BL/6 [B6], 129Sv, and DBA). Although DH mice on all backgrounds showed insulin resistance, their phenotypes were dramatically different. B6 DH mice exhibited marked hyperinsulinemia and massive islet hyperplasia and developed early hyperglycemia, with 85% overtly diabetic by 6 months. By contrast, 129Sv DH mice showed mild hyperinsulinemia and minimal islet hyperplasia, and <2% developed diabetes. DBA mice had slower development of hyperglycemia, intermediate insulin levels, and evidence of islet degeneration, with 64% developing diabetes. Thus, mice carrying the same genetic defects on different backgrounds exhibited the full spectrum of abnormalities observed in humans with type 2 diabetes, which allowed for identification of potential loci that promote development of the diabetic phenotype. Diabetes 52: 1528 -1534, 2003 S everal common human disorders, including obesity, diabetes, hyperlipidemia, atherosclerosis, and hypertension, have complex patterns of inheritance with superimposed effects created by diet, level of exercise, and other environmental factors (1-3). Several monogenic forms of diabetes, including mutations in genes for insulin (4), the insulin receptor (5), maturity-onset diabetes of the young (6), and mitochondrial diabetes (7), have been identified and constitute Ͻ5% of all cases of type 2 diabetes. The genetic basis for the more common form(s) of type 2 diabetes remains elusive but is thought to be the result of interactions between genes controlling insulin resistance and -cell function, environmental factors, and variations in other background genes (8).One approach toward defining the primary and background genes involved in type 2 diabetes and obesity is the use of naturally occurring rodent models (9,10) and inbred strains of mice (11-13). Indeed, Hummel et al. (9) and Coleman and Hummel (14) have shown that when mutations in leptin found in the ob/ob mouse are bred into different backgrounds, there is a difference in the severity of obesity and diabetes. A more recent strategy to define the role of genetic alterations and candidate genes for type 2 diabetes has been the creation of transgenic and knockout mice with alterations in insulin action (15) and in insulin secretion (16). Whereas knockout and transgenic mice often show diabetic or insulin-resistant phenotypes, by their very nature, the development of knockout mice leads to progeny that are born with a mixed genetic background and provide a unique tool for evaluation of the impact of background genes on phenotype (17,18).We have reported the creation and characterization of mice double h...