Diabetes

Abstract

Diabetes is a disease of dys-regulation of glucose and lipid homeostasis that does not only affect the insulin production in the β cells but also the metabolism in organs such as liver, muscle and fat. Worldwide, the prevalence of T2D is rapidly increasing, which, when not properly treated, ultimately leads to reduced life expec- tancy due to microvascular (retinopathy, nephropathy and neuropathy) and macro- vascular (heart disease and stroke (Chap. 11 ) complications. Like in obesity (Chap. 8 ), both genetic and environmental factors contribute to the development of diabe- tes. For example, persons at high risk for developing T2D should benefi t from life- style changes involving healthy diet, moderate weight loss and increased physical activity. Despite large GWAS screening for risk genes, at present less than 10 % of the inheritance of T2D is understood. Therefore, in addition, epigenome-wide changes, both pre-natal as well as in adult life, are intensively investigated. In this chapter, we will describe the different forms of diabetes, their diagnosis and the worldwide prevalence of the disease. We will discuss the dys-regulation of glucose homeostasis in T2D. In this context, we will present the genetic and physi- ologic basis of the disease and again we will highlight chronic infl ammation as the core of the disease, this time affecting islets of the pancreas. We will realize that the present understanding of T2D risk genes is insuffi cient and that most likely epi- genetics plays an important role in the disease, as examplifi ed through the thrifty gene hypothesis. Keywords