Type 2 diabetes mellitus: epidemiology, pathophysiology, unmet needs and therapeutical perspectives

• Published in: Diabetes & metabolism 2007-09, Vol.33 (4), p.231-244
• Main Authors: Virally, M, Blicklé, J.-F, Girard, J, Halimi, S, Simon, D, Guillausseau, P.-J
• Format: Article
• Language: English
• Subjects: Analogues du GLP-1; Antidiabétiques oraux; Biological and medical sciences; Cardiovascular Diseases - epidemiology; Cardiovascular Diseases - prevention & control; Cardiovascular Diseases - therapy; Diabetes Mellitus, Type 2 - complications; Diabetes Mellitus, Type 2 - epidemiology; Diabetes Mellitus, Type 2 - physiopathology; Diabetes Mellitus, Type 2 - therapy; Diabetes. Impaired glucose tolerance; Diabetic Angiopathies - therapy; Diabète de type 2; Disease Progression; DPP-IV inhibitors; Endocrine pancreas. Apud cells (diseases); Endocrinology & Metabolism; Endocrinopathies; Epidemiology; Etiopathogenesis. Screening. Investigations. Target tissue resistance; France; France - epidemiology; General and cellular metabolism. Vitamins; Glinides; GLP1 analogues; Humans; Inhibiteurs du DPPIV; Insulin - metabolism; Insulin Resistance; Insulin Secretion; Insulin-Secreting Cells - physiology; Internal Medicine; Medical sciences; Metabolic diseases; Metformin; Metformine; Muscle, Skeletal - physiopathology; Obesity; Obésité; Pathogenesis; Pharmacology. Drug treatments; Physiopathologie; Prevalence; Review; Revue générale; Sulfonylureas; Sulfonylurées; Traitement; Treatment antidiabetic oral agents; Type 2 diabetes mellitus; Épidémie de diabète; Épidémiologie du diabète
• ISSN: 1262-3636; 1878-1780
• DOI: 10.1016/j.diabet.2007.07.001

Abstract In France, prevalence of drug-treated diabetes reached 3.60% in 2005, with 92% of type 2 diabetic patients. In 2007, there are probably nearly 3 000 000 diagnosed or undiagnosed diabetic patients. Ageing of the population and increase in obesity are the main causes of this “diabetes epidemic”. Type 2 diabetes is a multifactorial disease, defined as resulting from defects in insulin secretion (including abnormalities in pulsatility and kinetics, quantitative and qualitative abnormalities of insulin, β-cell loss progressing with time) associated with insulin resistance (affecting liver, and skeletal muscle) and increased glucagon secretion. The lack of compensation of insulin resistance by augmented insulin secretion results in rise in blood glucose. To achieve satisfactory glycaemic control in order to prevent diabetes related complications, drug therapy is generally required in addition to life style changes. Currently available oral therapies offer a large panel of complementary drugs, but they have several contraindications and side effects. In spite of major advances in the management of type 2 diabetes, and the strictness of new guidelines, some goals remain unachieved and the new family of insulin-secretors (DPP-IV inhibitors, GLP-1 analogues) should enrich therapeutic approaches.