Why is Blood Glucose Elevated in T2D Subjects

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The main reason for the elevation of blood glucose in diabetes is reduced insulin-mediated glucose metabolism due to reduced insulin secretion and insulin resistance. Due to these defects in insulin-mediated

Any end point related to diabetes

Any end point related to diabetes

Death related to diabetes

P<0.0001 Í

P<0.0001

All cause mortality

P<0.0001

Updated mean haemoglobin concentration (%)

Fig. 1. Hazard ratios, with 95% confidence intervals as floating absolute risks, as estimate of association between category of update mean HbAlc concentration and any end point or deaths related to diabetes and all cause mortality. Reference category (hazard ratio 1.0) is HbAlc <6% with log-linear scales. p-value reflects contribution of glycaemia to multivariate model. Data adjusted for age at diagnosis of diabetes, sex, ethnic group, smoking, presence of albuminuria, systolic blood pressure, high- and low-density lipoprotein cholesterol and triglycerides [2].

Updated mean haemoglobin concentration (%)

Fig. 1. Hazard ratios, with 95% confidence intervals as floating absolute risks, as estimate of association between category of update mean HbAlc concentration and any end point or deaths related to diabetes and all cause mortality. Reference category (hazard ratio 1.0) is HbAlc <6% with log-linear scales. p-value reflects contribution of glycaemia to multivariate model. Data adjusted for age at diagnosis of diabetes, sex, ethnic group, smoking, presence of albuminuria, systolic blood pressure, high- and low-density lipoprotein cholesterol and triglycerides [2].

glucose disposal, blood glucose values increase until reaching a level where glucose itself - glucose-mediated glucose disposal - is able to compensate for the reduced insulin-mediated glucose metabolism, resulting in normal glucose disposal. in other words, the increase in blood glucose in T2D is a compensation for the reduced insulin-mediated glucose disposal. Thus, the degree of hyperglycaemia depends on the degree of impairment of insulin secretion and action. Due to this compensation, diabetic subjects do survive (which is often forgotten), but they pay the price of chronic hypergly-caemia (which may lead to severe diabetic complications). Therefore, we must try to correct this devastating situation by improving the insulinmediated glucose metabolism. This can be done by improving insulin secretion and action or both.

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