Stages in the development of type 2 DM from a pre-diabetic, insulin-resistant state. As insulin sensitivity decreases, insulin-mediated glucose disposal.

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Diabetes Mellitus Type 2

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Volume 373, Issue 9682, Pages (June 2009)

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Stages in the development of type 2 DM from a pre-diabetic, insulin-resistant state. As insulin sensitivity decreases, insulin-mediated glucose disposal after a meal is impaired due to insulin resistance in skeletal muscle despite increased pancreatic secretion of insulin. With continued insulin resistance, as pancreatic insulin secretion begins to fail, fasting glucose increases because insulin activity is now insufficient to suppress hepatic glucose output. Time 0 refers to the time of diagnosis of diabetes. Data are from the British Whitehall II study of 505 diabetes cases. (Adapted from Tabak AG et al. Trajectories of glycemia, insulin sensitivity and insulin secretion before diagnosis of type 2 diabetes: an analysis from the Whitehall II study. Lancet. 2009 June 27;373(9682):2215–21.) Source: Disorders of the Endocrine Pancreas, Pathophysiology of Disease: An Introduction to Clinical Medicine, 7e Citation: Hammer GD, McPhee SJ. Pathophysiology of Disease: An Introduction to Clinical Medicine, 7e; 2013 Available at: https://accesspharmacy.mhmedical.com/DownloadImage.aspx?image=/data/Books/961/Ham007_Fig_18-07.png&sec=53632665&BookID=961&ChapterSecID=53555699&imagename= Accessed: October 17, 2017 Copyright © 2017 McGraw-Hill Education. All rights reserved