**Conflict of interest**

The authors declare that they have no conflict of interest associated with this chapter.

**39**

Chile

Chile, Santiago, Chile

**Author details**

Pilar Durruty1,2\*, María Sanzana2

Hospital, University of Chile, Santiago, Chile

provided the original work is properly cited.

*Pathogenesis of Type 2 Diabetes Mellitus DOI: http://dx.doi.org/10.5772/intechopen.83692*

© 2019 The Author(s). Licensee IntechOpen. This chapter is distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/ by/3.0), which permits unrestricted use, distribution, and reproduction in any medium,

and Lilian Sanhueza3,4

1 Diabetes Unit, Department of Medicine, Faculty of Medicine, San Juan de Dios

2 Endocrinology and Diabetes Section, Department of Medicine, Clinical Hospital

3 Diabetes Unit, Internal Medicine Service, San Juan de Dios Hospital, Santiago,

4 Department of Medicine, Faculty of Medical Sciences, University of Santiago of

of the Faculty of Medicine, University of Chile, Santiago, Chile

\*Address all correspondence to: padurrutya@yahoo.es

*Pathogenesis of Type 2 Diabetes Mellitus DOI: http://dx.doi.org/10.5772/intechopen.83692*

*Type 2 Diabetes - From Pathophysiology to Modern Management*

of reducing IR, especially in adipose tissue. They act by binding to the PPAR-Ύ nuclear receptors, also known as glitazone receptors. Their use is restricted and has been questioned because of their adverse effects, among others, heart failure and

In 2005, GLP-1 receptor agonists (GLP-1 RA) were incorporated. These are drugs that improve the diminished incretin effect of DM2 patients. They are resistant to the action of dipeptidyl peptidase-4 (DPP-4) enzyme which degrades native GLP-1 in 1–2 minutes. Through an action similar to GLP-1, they stimulate insulin secretion. GLP-1 RA are injectable and very expensive, and, in addition to their

One year later DPP-4 inhibitors (DPP-4i) appeared, which are at present extensively used. DPP-4i also act restoring the diminished incretin effect; they inhibit the rapid degradation of GLP-1 by the enzyme and indirectly favor insulin

The most recently incorporated group of hypoglycemic drugs (2013) are the SGLT2 inhibitors that partially block renal glucose reabsorption which is increased in DM2 patients. Their effect is to lower glycemia by causing glucosuria independently of insulin. Several of these drugs are available, and other benefits have been described

**Figure 3** shows, together with the main pathogenic alterations of DM2, the cor-

We hope that in the near future, even better new drugs will be developed that will be able to stop the natural evolution of DM2, slowing down the destruction of the β cell mass and thus reducing the important public health problem of this

The authors declare that they have no conflict of interest associated with this

for them, the most important being a lower risk of cardiovascular disease [45].

responding hypoglycemic drugs employed in the usual clinical practice [44].

hypoglycemic action, they have other effects as mentioned above.

*Pathogenic alterations of type 2 diabetes and pharmacotherapy.*

**38**

chapter.

possible vesical cancer.

secretion.

**Figure 3.**

pathology.

**Conflict of interest**
