British Medical Bulletin 2001;60: 21–32 The British Council 2001 Type 2 diabetes, the thrifty phenotype – an

Searching for the causes of type 2 diabetes Diabetes mellitus is a group of metabolic disorders characterized by chronic hyperglycaemia1. Within this group, type 2 diabetes describes the form of the disease usually with onset in adult life, and associated with insulin resistance and relative insulin deficiency, as opposed to the absolute deficiency found in type 1 diabetes1. Type 2 diabetes is of great importance to public health due to the burden of morbidity and mortality associated with this common disease2. Type 2 diabetes is a complex disorder likely to have multiple genetic and environmental causes. Enormous efforts are being made to discover the genetic determinants of the disease. Recently, important additions have been made to our knowledge of the physiology of glucose and energy homeostasis at the molecular level – major advances have been made in our understanding of the mechanisms of insulin action, insulin secretion and control of appetite and energy balance3,4. In addition, th