Redefining the clinical management of type 2 diabetes: matching therapy to pathophysiology

Conventional treatments for type 2 diabetes do not provide adequate glycaemic control to prevent the long-term progression of the disease. The introduction of increasingly intensive therapeutic regimens in stepwise management strategies aims to maintain glycaemic control in the face of progressive deterioration in beta-cell function. However, such an approach does not entirely address the underlying disease mechanisms. Although much remains unclear about the aetiology of type 2 diabetes, both beta-cell dysfunction and insulin resistance play important roles, and there is a complex, dynamic interaction between these two abnormalities. Growing evidence suggests that treatments that can reverse insulin resistance and improve beta-cell function may be able to slow or prevent the progression of the disease. The clinical management of type 2 diabetes therefore needs to be re-examined and redefined to reflect new insights into the underlying pathogenetic mechanisms, including consideration of the potential benefits of early, aggressive intervention to counter both beta-cell dysfunction and insulin resistance.