Cerebral regulation of insulin secretion and the development of insulin resistance in type 2 diabetes

Abstract

Type 2 diabetes (T2DM) is a metabolic disorder that still constitutes a significant clinical problem due to its numerous micro- and macroangiopathic complications. Although many pathogenic factors for T2DM have been established to date, along with many methods of control and compensation, diabetes is still a subject of intense research aimed at finding new therapeutic regimens. Established protocols of management are based on the modification of risk factors and the administration of hypoglycemic agents, which act at the level of the pancreas or in target tissues for insulin. However, in recent years research has more and more frequently been centered upon the superior role of the central nervous system in the maintenance of the widely understood energy balance of the body, including carbohydrate metabolism. In this review the authors present current evidence confirming an association between the central nervous system (CNS) and insulin release, and discuss the potential risk of developing insulin resistance, obesity and diabetes in states of impaired CNS function. The key point of this review is to provide an analysis of a system of selected neuropeptides of central origin that act both at the level of the brain and in the periphery, playing an important role in the control of energy balance. The conclusions derived from the experimental studies and clinical trials discussed in this review undoubtedly suggest that impairment of the hereby presented system of central regulators can result in metabolic disorders.