Type II Diabetes: New Drugs and new Perspectives
Type 2 DM differs from type one in several distinct ways: It is ten tomes more common and has a great genetic component, occurs most commonly in adults, increasing with prevalence in age (20-25% occurring over the age of 65) and more commonly occurring with Native Americans, Mexican Americans, and African Americans, and is associated with increased resistance to the effects of insulin secretion by the pan crease, unlike its counterpart (DM1) where b cell destruction is usually the leading cause to absolute insulin deficiency. DMII is often, >80% of the cases, associated with obesity, an additional factor that increases insulin resistance. Because these patients always have a residual amount of insulin secretion the patient is usually a symptomatic and are diagnosed long after the onset of the disease by the elevation of fasting glucose during a routine screening. Because of the classification of DMII the mainstay of therapy remains diet and exercise, but as is well known lifestyle changes are extremely difficult in such patients leading to the development of pharmacological interventions. The only pharmacologic treatments were oral sulfonylureas or insulin by injection, both of which act to heighten the patient’s already elevated but insufficient insulin levels. Today, physicians can choose from among a variety of medications targeting numerous facets of the disease ; the drugs augment pancreatic insulin secretion, improve peripheral glucose disposal (as occurs in muscle and adipose tissue), decrease glucose release from the liver, or limit absorption of carbohydrate and fat from the gut