mechanisms of type 2 diabetes

Mechanisms of Type Diabetes Receptor + postreceptor defects Glucose Insulin resistance Liver Increased glucose production Pancreas Impaired insulin secretion Adapted from Saltiel et al Diabetes 1996; 45:1661-1669 Peripheral Tissues (Muscle and Adipose) Natural History of Type Diabetes Glucose mmol/L Post-prandial glucose 20 17 14 11 Fasting glucose At risk for diabetes Beta-cell dysfunction Relative to normal (%) 250 200 150 100 50 Insulin resistance Insulin level -10 -5 10 Years 15 20 25 30 R.M Bergenstal, International Diabetes Center Diabetic complications: 1.Diabetic Nephropathy Diabetic Neuropathy Diabetic Retinopathy Diabetic Nephropathy  Over 40% of new cases of endstage renal disease (ESRD) are attributed to diabetes  In 2001, 41,312 people with diabetes began treatment for endstage renal disease  In 2001, it cost $22.8 billion in public and private funds to treat patients with kidney failure  Minorities experience higher than average rates of nephropathy and kidney disease Diabetic Neuropathy • About 60-70% of people with diabetes have mild to severe forms of nervous system damage, including: − Impaired sensation or pain in the feet or hands − Slowed digestion of food in the stomach − Carpal tunnel syndrome − Other nerve problems • More than 60% of nontraumatic lowerlimb amputations in the United States occur among people with diabetes Diabetic Retinopathy • Diabetic retinopathy is the most common cause of new cases of blindness among adults 20-74 years of age • Each year, between 12,000 to 24,000 people lose their sight because of diabetes • During the first two decades of disease, nearly all patients with type diabetes and over 60% of patients with type diabetes have retinopathy Proportion of patients with cardiovascular disease increases with duration of type diabetes 48% 29% 21% 24% 15%