The cornerstone of effective diabetes management is maintaining good glycemic control.Compelling evidence indicates that long term glycemic control can prevent or delay the development of complications .The DCCT Trial demonstrated definitely the value of intensive therapy of Type 1 Diabetes in delaing the onset and progression of microvascular complications of diabetes . The UKPDS demonstrated the same for the type 2 Diabetes.
It is likely that no single genetic defect willemerge to explain type 2 diabetes , thus the disease is heterogenous and possibly multigenetic , and likely has a complex etiology.Even though the disease is genetically heterogenous, there appears to be a fairly consistent phenotype once the disease is fully menifested. Most patients with type 2 diabetes and fasting hyperglycemia are characterised by:
Although these metabolic abnormalities have been well studied ,the etiologic sequence has only recently come into focus.It is clear that the increased hepatic glucose production of type 2 diabetes is secondary and can be fully researved with a variety of antidiabetic treatment options.
The proposed etiological sequence is that insulin resistance is manifested initially , leading to increased insulin secretion to maintain the compensated IGT state .Later the compensation fails and beta cell functon declines ,leading to hyperglycemia .In addition , the conversion of IGT to type 2 diabetes can be influenced by:
Obese patient with recent diabetes with / without Dyslipidemia