Pathogenesis and Management of Non-Insulin-Dependent Diabetes Mellitus

The pathogenesis of non-insulin-dependent diabetes mellitus (NIDDM) remains uncertain. Although over the past few years many of the abnormalities present in the disease have been identified, the mechanism or mechanisms by which these develop have not been established (Table 4.1). The two major abnormalities that are present in essentially all patients with overt NIDDM are insulin resistance and defective insulin secretion.1 Which of these is primary remains an area of considerable controversy. Since both are essentially present in all patients with NIDDM, the assumption may be that both are required for the clinical expression of this disease. In populations in which there is a high occurrence of NIDDM, such as the Pima Indians or South Pacific islanders, insulin resistance can be detected prior to the development of overt glucose intolerance or prior to detectable abnormalities in insulin secretion.2 This suggests that in these groups, insulin resistance might be the primary abnormality, and in susceptible individuals this could ultimately result in abnormalities in insulin secretion and the full development of NIDDM.