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Reinventing Type 2 Diabetes

Reinventing Type 2 Diabetes COMMENTARY Pathogenesis, Treatment, and Prevention overweight individuals with normal glucose levels have Roger H. Unger, MD higher insulin levels than normal-weight individuals. The coexistence of hyperinsulinemia and normoglycemia HE CONVENTIONAL GLUCOCENTRIC PERSPECTIVE OF implied resistance to the action of insulin. This interpreta- type 2 diabetes views hyperglycemia as a primary tion was soon confirmed with the development of tech- disease caused by an etiologically uncertain combi- niques for precise measurement of insulin action on Tnation of obesity-associated insulin resistance and glucose metabolism, and along with other studies demon- beta cell loss (a disease of glucose metabolism to be treated strated a relationship between obesity and insulin resis- 9,10 with antihyperglycemic agents, including high-dose insu- tance. However, the mechanism of this relationship and lin, if necessary). By contrast, the novel lipocentric view its clinical consequences continued to be a matter of some depicts the hyperglycemia of type 2 diabetes, and the controversy, despite a relative consensus that insulin resis- underlying insulin resistance and beta cell loss, as being tance is related to overt type 2 diabetes and the other mor- secondary to the metabolic trauma caused by ectopic lipid bidities of the metabolic syndrome. deposition or lipotoxicity. If this is http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png JAMA American Medical Association

Reinventing Type 2 Diabetes

JAMA , Volume 299 (10) – Mar 12, 2008

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Publisher
American Medical Association
Copyright
Copyright 2008 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Restrictions Apply to Government Use.
ISSN
0098-7484
eISSN
1538-3598
DOI
10.1001/jama.299.10.1185
pmid
18334695
Publisher site
See Article on Publisher Site

Abstract

COMMENTARY Pathogenesis, Treatment, and Prevention overweight individuals with normal glucose levels have Roger H. Unger, MD higher insulin levels than normal-weight individuals. The coexistence of hyperinsulinemia and normoglycemia HE CONVENTIONAL GLUCOCENTRIC PERSPECTIVE OF implied resistance to the action of insulin. This interpreta- type 2 diabetes views hyperglycemia as a primary tion was soon confirmed with the development of tech- disease caused by an etiologically uncertain combi- niques for precise measurement of insulin action on Tnation of obesity-associated insulin resistance and glucose metabolism, and along with other studies demon- beta cell loss (a disease of glucose metabolism to be treated strated a relationship between obesity and insulin resis- 9,10 with antihyperglycemic agents, including high-dose insu- tance. However, the mechanism of this relationship and lin, if necessary). By contrast, the novel lipocentric view its clinical consequences continued to be a matter of some depicts the hyperglycemia of type 2 diabetes, and the controversy, despite a relative consensus that insulin resis- underlying insulin resistance and beta cell loss, as being tance is related to overt type 2 diabetes and the other mor- secondary to the metabolic trauma caused by ectopic lipid bidities of the metabolic syndrome. deposition or lipotoxicity. If this is

Journal

JAMAAmerican Medical Association

Published: Mar 12, 2008

References