**1. Introduction**

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118 Treatment of Type 2 Diabetes

Today in the clinical practice Diabetes Mellitus (DM) has supplanted syphilis and tuberculosis as the big masquerade. Now, from the professional view, many physicians are involved in hard challenges, controversies concerning diabetic patients: insulin resistance, management of the disease, diabetic pregnant women, carbohydrate disorders, diabetic foot, diabetes and surgery, pharmacological aspects, psychological and sociological problems, new modalities of treatment and many others and important clinical questions. Diabetes mellitus, the most common endocrine disorder, is characterized by several metabolic abnormalities and numer‐ ous long-term complications affecting mostly the kidneys, peripheral nerves, blood vessels, organ vision, and central nervous system; also, we must not forget that it is the main cause of morbidity and mortality in the Western and developed countries.

Since the discovery of insulin in 1921 by Banting and Best, and McLeod, it has been employed in the treatment of DM [1]. By the time, the manufacturing process of insulin has improved becoming free of impurities or associated to hormonal products (glucagon, polypeptide pancreatic, proinsulin) until obtaining purified insulin.

Insulin was obtained from a bovine source; and particularly porcine insulin differs only from the human insulin in one aminoacid. Later in the clinical practice, biosynthetic and semisynthetic human insulin were introduced, having a structure identical to the native human insulin, and, for that circumstance without antigenic power. The semi-synthetic insulin comes from laboratory transpeptidation of porcine insulin (exchange of alanine by threonine of aminoacid B30), while biosynthetic insulin is obtained by means of genetic recombination process from bacterias (*Escherichia coli*) or yeasts. Today, biosynthetic insulin is the most frequently used in some countries.

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On the other hand, insulin is a polypeptide hormone synthesized in the beta cells of the islets of Langerhans of the endocrine pancreas, and it is necessary for normal metabolization of glucose by most cells of the body. In diabetic persons the capacity of body cells to use glucose is inhibited, thereby increasing blood sugar levels (hyperglycemia). When high levels of glucose are present in the blood, the excess must be excreted in the urine (glycosuria). The symptoms derived from the disease are increased urinary volume, thirst, itching, hunger, weight loss, and weakness; in medical expression the classical findings are well known: polyuria, polydipsia, polyphagia, slimming, and asthenia [2, 3].

Diabetes affects an estimate of 366 million people worldwide, with type 2 diabetes mellitus (T2DM) accounting for more than 90% of the cases. Renal insufficiency is a common comor‐ bidity condition in T2DM patients with chronic kidney disease (CKD,) defined as kidney damage or an estimated glomerular filtration rate (eGFR) < 60 mL/min/1.73m2 for > 3 months. The kidney is both the origin and victim of elevated blood pressure. Hypertension is a pathogenic factor that contributes to the deterioration of kidney function. Therefore, manage‐ ment of hypertension (salt reduction intake adequate diet, exercise and antihypertensive drugs) has become the most important intervention control all modalities of chronic kidney disease (CKD). The role of hypertension in renal disease is crucial. The aged world population is increasing. The ageing is the most common risk factor for the development of hypertension and diabetes, as well as CKD [4].
