Recent advances in pathophysiology of diabetes: Beyond the dirty dozen

Advances in our understanding of the pathophysiology have spurred improvements in the way we approach and manage the disease. From being considered a disease of insulin deficiency, to one of insulin resistance (mediated by the liver, muscle and fat cell) and deficiency combined, to the multifaceted syndrome we now know it to be, diabetes has evolved significantly. This review describes the recently identified mechanisms linked with the causation and development of diabetes. It includes the newer players listed in the Ominous Octet (the alpha cell, the gastrointestinal tract, kidney and brain) and describes four hormones which complete the Dirty Dozen (dopamine, testosterone, renin-angiotensin system, Vitamin D). The article goes on to discuss fresh research incriminating iron and gut-derived serotonin in the etiopathogenesis of diabetes, and suggests therapeutic implications of pathophysiologic advances.