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Its prevalence is particularly striking in societies that have made a rapid transition from a traditional to an affluent lifestyle, a process sometimes referred to as 'Coca-Colonisation'.
Many 19th century clinicians knew that there were two forms of diabetes.
Young, thin patients became acutely ill and soon died from uncontrolled diabetes.
Older overweight individuals, in contrast, often lived for years with the help of a strict diet.
The discovery of insulin showed that the first type of patient relied on insulin for health and survival, whereas insulin was not essential for the remainder; the two varieties were sometimes called juvenile-onset and maturity-onset diabetes.
The genes most strongly associated with type 2 diabetes are gene increases diabetes susceptibility indirectly by contributing to weight gain.
The current pay-off of genetic research in type 2 diabetes is limited by modest effect sizes (only 5–10% of susceptibility is currently explained), limited knowledge of the underlying biological pathways, and limited predictive ability.If one member of a twin pair develops diabetes, however, the risk of diabetes in the unaffected twin is much greater in monozygotic (identical) than in dizygotic (non-identical) twin pairs, underlining the importance of the genetic contribution.The extent to which the genes conferring susceptibility to type 2 diabetes will be expressed depends upon environmental factors such as obesity.Diabetes was at that time considered to favour people of European extraction, but this was mainly because they enjoyed a more affluent lifestyle.Globalisation and economic development have created a worldwide epidemic of obesity and of type 2 diabetes, which is now more common among people of Asian, African or Hispanic American origin than among Europeans.Type 2 diabetes has achieved pandemic proportions and affects some 300 million people worldwide.It arises because insulin production is inadequate relative to the demands of the body, which may be increased by obesity or other factors.Hyperglycaemia therefore develops earlier in the course of beta cell failure, and in association with a greater beta cell mass, in insulin-resistant compared with insulin-sensitive individuals (see Figure).The relative importance of reduced secretion of insulin and increased demand (insulin resistance) ranges along a spectrum from one individual or population to the next.Improved clinical translation and personalized disease profiling and therapy remain important targets of research [Mc Carthy].Diabetes, however caused, results when the beta cells of the pancreas are no longer able to meet the body’s requirement for insulin.