Expert Blog

Treating Beta Cell Dysfunction: The Basic Lesion In T2DM

Irl B. Hirsch, MD

As an endocrinologist at a large diabetes clinic, I see many patients with type 2 diabetes. However, I see very few patients early after their diagnosis--the typical patient seen by most primary care physicians. Due to a tremendous amount of new information on the impact of beta cell dysfunction in this population of patients, I saw my participation in this project as an important opportunity to work with my primary care colleagues.

I also appreciate the difficulty and frustration.

The amount of new information is overwhelming, but I see “” as a mechanism to provide concise and relevant information about how to use our new information and translate that into treatment decisions. Still, I appreciate the frustration all clinicians experience while trying to do their best for their patients.  If “keeping up” with new information was our only challenge we would have a much better chance in assisting our patients to reach their metabolic targets. But unfortunately, our systems are not ideal for best management practices. Resources such as nurses, nutritionists, and clinical pharmacists are often not available. Just as importantly, we have so many pressures to see as many patients as possible that we often do not allow adequate time to counsel our patients. Some of these are barriers that are true of all chronic disease states seen by the primary care physician which we will not be able to change.

Still, what we can do is explain our current treatment options based on the basic lesion in type 2 diabetes, the dysfunctional beta cell. What makes this fun for me is that even though in many clinical situations there may be an obvious answer about "best therapy," there are others where even the experts may disagree. This is what makes fun and interesting. I have no doubt that you will find this as stimulating as I have.