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Pathways

Type 2 Diabetes Pathway Suite

It is a well-known fact that Type 2 Diabetes, once considered a disease which only struck people in middle age and older, is increasing in frequency—not only in the age groups traditionally thought of as at-risk, but also in children, teens and young adults.  According to the CDC, in 2006 “diabetes was the sixth leading cause of death on U.S. death certificates, and overall, the risk for death among people with diabetes is about twice that of people without diabetes of similar age”.

Research into Type 2 Diabetes has elucidated several pathways which appear to contribute to the development, severity and progression of this often debilitating and deadly disease.  Use the links below to explore how the pathways associated with T2D can interact, how the normal pathways function, how they can be altered in the diabetic state, and how several anti-diabetic drugs can affect these altered pathways.
To link to the Diabetes Disease Portal, click here

Disease Pathway

Type 2 diabetes mellitus pathway

  Although Type 2 Diabetes Mellitus is reaching epidemic proportions, its genetic components remain elusive.  Several pathways important for proper glucose homeostasis have been shown to be altered. Their possibly cumulative effects, in conjunction with lifestyle aspects, may contribute to both the onset and progression of the condition. Click here to explore the altered pathways associated with T2D, including links to other candidate genes, potentially important miRNAs and some of the drugs used for its treatment.
 

Normal Pathways

Altered Pathways

Insulin secretion pathway

Altered insulin secretion pathway

In response to elevated glucose, pancreatic beta cells release insulin.  Insulin secretion is biphasic:  an initial “triggering” phase dependent on ATP-sensitive potassium channels is followed by an “amplifying” phase largely independent of KATP channels. Click here to explore this vital and complex regulatory pathway. Altered insulin secretion has long been known to be associated with T2D. Insulin secretion is biphasic:  an initial “triggering” phase dependent on ATP-sensitive potassium channels is followed by an “amplifying” phase largely independent of KATP channels.  In T2D patients, the first phase is almost completely lost while the second is severely diminished. Click here to explore alterations in this vital pathway.

Insulin signaling pathway

Altered insulin signaling pathway

Secreted insulin binds to its receptor to initiate a signaling pathway which plays essential roles in both glucose and energy homeostasis. The pathway activates two intracellular cascades – the PI3K-Akt and the Raf/Mek/Erk MAPK pathways – to ultimately carry out insulin’s downstream effects. Click here to explore this important signaling pathway and the cascades it triggers. Alterations in insulin signaling and subsequent effects on the pathways downstream of it have been associated with insulin resistance. Click here to explore the variety of ways this important pathway may be affected.

Insulin responsive facilitated sugar transporter mediated glucose transport pathway

Uptake of glucose in the heart, skeletal muscle and adipose tissues is mediated by the Slc2a4/Glut4 transporter.  Insulin prompts trafficking of transporter-containing vesicles to the plasma membrane where exocytosis increases the Glut4 at the membrane.  The PI3K-Akt pathway downstream of the insulin receptor may play a role via Akt2. Click here to explore this essential component of glucose homeostasis.

Drug Pathways

Anti-diabetic drug pathway

The meglitinide family of anti-diabetic drugs target the ATP-sensitive
potassium channel. By blocking the channel they stimulate insulin
secretion thereby lowering blood glucose levels. Click here
to see an overview from which the nateglinide and repaglinide
pharmacokinetics pathways and the potassium channel inhibitor
pharmacodynamics pathway can be explored.

               Metformin drug pathway

Metformin is an anti- hyperglycemic drug used in the first-line treatment of Diabetes Mellitus Type 2 (T2D). Click here to study the overall metformin drug pathway.


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RGD is funded by grant HL64541 from the National Heart, Lung, and Blood Institute on behalf of the NIH.