Type 2 diabetes and remission: practical management guided by pathophysiology

Abstract

Type 2 diabetes and remission: practical management guided by pathophysiology (Review).

Pioglitazone Reverses Markers of Islet Beta-Cell De-Differentiation in db/db Mice While Modulating Expression of Genes Controlling Inflammation and Browning in White Adipose Tissue from Insulin-Resistant Mice and Humans

“…Strategies to protect total islet β-cell mass, insulin production, and insulin secretion are therefore sought to prevent onset of such metabolic diseases. Both pharmacological and lifestyle interventions can be successful at preventing or restoring metabolic tissue function to combat onset of hyperglycemia, a critical defining feature of T2D [7,8]. Lifestyle interventions typically target weight reduction, leading to decreases in tissue lipid content that restore organ function [7,9].…”

“…Both pharmacological and lifestyle interventions can be successful at preventing or restoring metabolic tissue function to combat onset of hyperglycemia, a critical defining feature of T2D [7,8]. Lifestyle interventions typically target weight reduction, leading to decreases in tissue lipid content that restore organ function [7,9]. Alternatively, weight reduction is not typically required for the therapeutic effects of many pharmaceutical approaches, such as administration of metformin or thiazolidinediones (TZDs).…”

The Cause-and-Effect Link Between Obesity and Insulin Resistance

“…Based on this hypothesis, chronic consumption of high-calorie foods leads to liver fat accumulation, which in turn spills over into the pancreas. Both liver and pancreas cycles reinforce each other's effects, which ultimately result in hyperglycemia, hyperinsulinemia, and type 2 diabetes (6). Altogether, this point of view on the cause-andeffect relationship between obesity and IR considers obesity as the cause of IR.…”

“…In other words, this viewpoint considers weight gain as the cause of IR. Insulin action (insulin sensitivity) and insulin secretion (beat cell-secreting function) are subject to impairment, which is induced by overeating (6). The insulin-secreting function of the pancreas is negatively associated with a fat threshold (6).…”

“…Insulin action (insulin sensitivity) and insulin secretion (beat cell-secreting function) are subject to impairment, which is induced by overeating (6). The insulin-secreting function of the pancreas is negatively associated with a fat threshold (6). Once one's fat levels go beyond their fat threshold, diabetes type 2 develops.…”