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Pathogenesis, Treatment, and Prevention

Roger H. Unger, MD

JAMA. 2008;299(10):1185-1187.

	Since this article does not have an abstract, we have provided the first 150 words of the full text and any section headings.

The conventional glucocentric perspective of type 2 diabetes views hyperglycemia as a primary disease caused by an etiologically uncertain combination of obesity-associated insulin resistance and beta cell loss (a disease of glucose metabolism to be treated with antihyperglycemic agents, including high-dose insulin, if necessary). By contrast, the novel lipocentric view depicts the hyperglycemia of type 2 diabetes, and the underlying insulin resistance and beta cell loss, as being secondary to the metabolic trauma caused by ectopic lipid deposition or lipotoxicity.¹ If this is in fact the case, hyperglycemia should be corrected by eliminating the lipid overload. The study by Dixon et al² provides support for this lipocentric hypothesis, by demonstrating that weight loss that follows gastric banding is accompanied by remission of diabetes in 73% of obese patients with type 2 diabetes. This finding supports 45 years of biochemical, physiological, and clinical research pointing to lipid . . . [Full Text of this Article]

History of the Lipocentric Concept

Author Affiliations: Touchstone Center for Diabetes Research, University of Texas Southwestern Medical Center, and Veterans Affairs Medical Center, Dallas, Texas.