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Naomi Berrie Diabetes Center, Department of Medicine, College of Physicians & Surgeons of Columbia University, New York, New York 10032
The hallmarks of type 2 diabetes are
impaired insulin action in peripheral tissues and decreased pancreatic
-cell function. Classically, the two defects have been viewed as
separate entities, with insulin resistance arising primarily from
impaired insulin-dependent glucose uptake in skeletal muscle, and
-cell dysfunction arising from impaired coupling of glucose sensing
to insulin secretion. Targeted mutagenesis and transgenesis involving
components of the insulin action pathway have changed our understanding
of these phenomena. It appears that the role of insulin signaling in
the pathogenesis of type 2 diabetes has been overestimated in classic insulin target tissues, such as skeletal muscle, whereas it has been
overlooked in liver, pancreatic
-cells, and brain, which had been
thought not to be primary insulin targets. We review recent progress
and try to reconcile areas of apparent controversy surrounding insulin
signaling in skeletal muscle and pancreatic
-cells.
knockout mice; genetics;
-cells; hormone receptors
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