MOUNT SINAI JOURNAL OF MEDICINE 76:215, 2009 215 THEME INTRODUCTION Type 2 Diabetes Mellitus: New Evidence, More Controversy Dina Green, MD Division of Endocrinology, Mount Sinai School of Medicine New York, NY The theme of this issue of the Mount Sinai Journal of Medicine is ‘‘New Evidence, More Controversy.’’ Over the past 20 years, there has been an accumulating body of evidence that treatment of type 2 diabetes with meticulous blood glucose control averts many of the dreaded microvascular and macrovascular complications of the disease. As both the prevalence of type 2 diabetes and the demand for treatment have increased, many questions have arisen. These questions largely revolve around treatment strategies for diabetes and the precise goals of treatment. This issue opens with a description of the pathophysiology of type 2 diabetes, with a particular focus on the incretin hormones and their role in potentiating insulin action. The incretin system has recently been harnessed to produce an entirely novel class of antidiabetic agents: the incretin mimetics and dipeptidyl peptidase IV inhibitors. The mechanism of action and clinical utility of these drugs are discussed in detail in another review. Also of interest is a discussion of other oral antidiabetic agents, including the thiazolidinediones, whose side effect profile has recently come under fire. The highlight of the issue is an elegant discussion of the recent literature that asks Address Correspondence to: Dina Green Division of Endocrinology Mount Sinai School of Medicine New York, NY Email: [email protected] what constitutes an optimal level of glycemic control and what degree of glycemic control is needed to avert long-term complications. Also of interest are reviews of the role of bariatric surgery, particularly as a long-term solution to diabetes, the role of nutritional management in diabetes, and the rising prevalence of diabetes in pregnancy. It is humbling to remember that only 90 years ago Frederick Banting and Charles Best performed early translational research when they successfully treated type 1 diabetes with insulin and transformed the natural history of the disease. In this issue, we also highlight the importance in type 2 diabetes of translational medicine, that is, the concept of applying principles of basic science to further our understanding of disease processes and treatment strategies. We can only hope that the work discussed here and other discoveries emerging from the laboratory will similarly transform our understanding of and treatment options for type 2 diabetes. DISCLOSURES Potential conflict of interest: Nothing to report. Published online in Wiley InterScience (www.interscience.wiley.com). DOI:10.1002/msj.20108 2009 Mount Sinai School of Medicine

Type 2 Diabetes Mellitus: New Evidence, More Controversy

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Page 1: Type 2 Diabetes Mellitus: New Evidence, More Controversy

MOUNT SINAI JOURNAL OF MEDICINE 76:215, 2009 215

THEME INTRODUCTION

Type 2 Diabetes Mellitus:New Evidence, More Controversy

Dina Green, MD

Division of Endocrinology, Mount Sinai School of MedicineNew York, NY

The theme of this issue of the Mount SinaiJournal of Medicine is ‘‘New Evidence, MoreControversy.’’ Over the past 20 years, there has beenan accumulating body of evidence that treatmentof type 2 diabetes with meticulous blood glucosecontrol averts many of the dreaded microvascular andmacrovascular complications of the disease. As boththe prevalence of type 2 diabetes and the demandfor treatment have increased, many questions havearisen. These questions largely revolve aroundtreatment strategies for diabetes and the precise goalsof treatment.

This issue opens with a description of thepathophysiology of type 2 diabetes, with a particularfocus on the incretin hormones and their role inpotentiating insulin action. The incretin system hasrecently been harnessed to produce an entirely novelclass of antidiabetic agents: the incretin mimetics anddipeptidyl peptidase IV inhibitors. The mechanism ofaction and clinical utility of these drugs are discussedin detail in another review. Also of interest is adiscussion of other oral antidiabetic agents, includingthe thiazolidinediones, whose side effect profile hasrecently come under fire. The highlight of the issue isan elegant discussion of the recent literature that asks

Address Correspondence to:

Dina GreenDivision of Endocrinology

Mount Sinai School of MedicineNew York, NY

Email: [email protected]

what constitutes an optimal level of glycemic controland what degree of glycemic control is needed toavert long-term complications. Also of interest arereviews of the role of bariatric surgery, particularly asa long-term solution to diabetes, the role of nutritionalmanagement in diabetes, and the rising prevalenceof diabetes in pregnancy.

It is humbling to remember that only 90 yearsago Frederick Banting and Charles Best performedearly translational research when they successfullytreated type 1 diabetes with insulin and transformedthe natural history of the disease. In this issue, wealso highlight the importance in type 2 diabetesof translational medicine, that is, the concept ofapplying principles of basic science to further ourunderstanding of disease processes and treatmentstrategies. We can only hope that the work discussedhere and other discoveries emerging from thelaboratory will similarly transform our understandingof and treatment options for type 2 diabetes.

DISCLOSURES

Potential conflict of interest: Nothing to report.

Published online in Wiley InterScience (www.interscience.wiley.com).DOI:10.1002/msj.20108

2009 Mount Sinai School of Medicine