With the type 2 diabetes pandemic it is essential to fully understand the exact pathogenesis of the disease, in order to establish an adequate prevention and treatment. In the last decades it was well established that insulin resistance will lead to diabetes only in the presence of beta cell failure and a multitude of other elements. The aim of the above presentation is to make a brief review of the emerging multiple causes of type 2 diabetes, beyond insulin resistance. Type 2 diabetes is a disease with great heterogeneity regarding its genotype and phenotype. There are now 62 genetic loci known related to diabetes, but intrauterine, and later epigenetic modifications seem to have a stronger predictive value. Glucagon hypersecretion, decreased incretin levels, obesity and malfunctioning adipose tissue, increased tubular glucose reabsorbtion, modified gut microbiota, and maybe most importantly the central nervous system, especially the hypothalamus have a very important role in the etiology of diabetes.
Keywords: type 2 diabetes, epigenetics, incretins