Although type 2 diabetes has been traditionally understood as a metabolic disorder initiated by insulin resistance, it has
recently become apparent that an impairment in insulin secretion contributes to its manifestation and may play a prominent
role in its early pathophysiology. The genetic dissection of Mendelian and, more recently, polygenic types of diabetes confirms
the notion that primary defects in insulin synthesis, processing and/or secretion often give rise to the common form of this
disorder. This concept, first advanced with the discovery and physiological characterisation of various genetic subtypes of
MODY, has been extended to other forms of monogenic diabetes (e.g. neonatal diabetes). It has also led to the identification
of common risk variants via candidate gene approaches (e.g. the E23K polymorphism in
KCNJ11 or common variants in the MODY genes), and it has been validated by the description of the robust physiological effects conferred
by polymorphisms in the
TCF7L2 gene. More recently, the completion and integration of genome-wide association scans for this disease has uncovered a number
of heretofore unsuspected variants, several of which also affect insulin secretion. This review provides an up-to-date account
of genetic loci that influence risk of common type 2 diabetes via impairment of beta cell function, outlines their presumed
mechanisms of action, and places them in the context of gene–gene and/or gene–environment interactions. Finally, a strategy
for the analogous discovery of insulin resistance genes is proposed.
Keywords Genetic associations - Genome-wide association study - Insulin secretion - Pancreatic beta cell - Single nucleotide polymorphisms
At the time this paper was undergoing final review, a meta-analysis of three high-density GWAS for type 2 diabetes followed
by replication in ~80,000 independent samples was published online [Zeggini E, Scott LJ, Saxena R, Voight BF for the Diabetes
Genetics Replication And Meta-analysis (DIAGRAM) Consortium (2008) Meta-analysis of genome-wide association data and large-scale
replication identifies additional susceptibility loci for type 2 diabetes. Nat Genet DOI:10.1038/ng.120]. This meta-analysis
identified six new loci (JAZF1, CDC123-CAMK1D, TSPAN8-LGR5, THADA, ADAMTS9 and NOTCH2-ADAM30) associated with type 2 diabetes at genome-wide statistical significance. Although their effect on beta cell function is
not yet known, several of these genes are expressed in the pancreas.