To the Editor: In his Commentary, Dr Unger1 raises many important issues regarding the pathophysiology of type 2 diabetes mellitus based on epidemiological, clinical, metabolic, and molecular information. His lipocentric schema is consistent with the known effects of overnutrition on insulin secretion, as well as the effects of insulin on the disposition of unused calories: initially as fat in adipocytes but ultimately as ectopic fat in nonadipocytes, such as beta cells and myocytes.1
Marfella R, Barbieri M, Paolisso G. Insulin Therapy and Lipid Overload in Type 2 Diabetes. JAMA. 2008;300(7):788–790. doi:10.1001/jama.300.7.789
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