A team of researchers has identified the link between inflammation and type 2 diabetes.
Researchers at Yale School of Medicine have identified the molecular mechanism by which insulin normally inhibits production of glucose by the liver and why this process stops working in patients with type 2 diabetes, leading to hyperglycemia.
Gerald I. Shulman said that in the study, they set out to examine how insulin normally works to turn off production of glucose by the liver and why this process goes awry in patients with type 2 diabetes.
Many experts have asserted that insulin's suppression of glucose production was due to the direct action of insulin on the liver, but the Yale-led team uncovered a different process that challenges current theories and may lead to new targets for treatment.
Yale researchers hypothesized that insulin suppressed glucose production by the liver by inhibiting the breakdown of fat, which would result in a reduction in hepatic acetyl CoA, a key molecule that they showed was critical in regulating the conversion of amino acids and lactate to glucose.
They also found that reversal of this process, due to inflammation in adipose (fatty) tissue, led to increased hepatic glucose production and hyperglycemia in high-fat-fed rodents and obese, insulin-resistant adolescents.
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Shulman explained that these studies identify hepatic acetyl CoA as a key mediator of insulin action on the liver and link it to inflammation-induced hepatic insulin resistance and type 2 diabetes.
This new insight into insulin resistance paves the way for exploring new treatments. None of the drugs people currently use to treat type 2 diabetes target the root cause and by understanding the molecular basis for hepatic insulin resistance they now can design better and more effective drugs for its treatment, said Shulman.
The findings are published in the journal Cell.
