ABSTRACT
Type 2 diabetes mellitus is a common metabolic disorder that is characterized by hyperglycemia without absolute insulin deficiency, and the triad of impaired glucose uptake into insulin-sensitive tissues, with skeletal muscle most affected, increased glucose production by the liver, and impaired insulin secretion. It is typically accompanied by other metabolic disorders that share defective insulin action as part of their pathogenesis (metabolic syndrome or syndrome X), such as central obesity, hypertriglyceridemia, atherosclerosis, hypertension, and hyper- androgenism in women secondary to polycystic ovaries (PCO). In the past, type 2 diabetes was often portrayed as the "mild" form of diabetes, with little prognostic significance. We now know that nothing could be farther from the truth. Diabetes has the dubious distinction of being the number 1 cause of adult blindness, kidney failure, and nontraumatic limb amputation in much of the industrialized world; type 2 diabetes makes up the majority of these statistics because of the 10:1 ratio of affected persons versus type 1 diabetes. Moreover, the worldwide incidence of type 2 diabetes and associated illnesses is skyrocketing, which has led the World Health Organization (WHO) to designate diabetes as a health crisis. A positive development is the availability of antidiabetic drugs that act at many different sites in the glucose homeostasis system. Thus, we now have the ability to use multidrug regimens that allow most patients to attain their target goal for glycemia, and the onus is on practicing physicians to be familiar with their use.
