[The role of adipose tissue in pathogenesis of type 2 diabetes mellitus]

The incidence of metabolic diseases, mainly obesity, type 2 diabetes mellitus (T2DM) and cardiovascular diseases is significantly increasing. Worldwide it is spoken of emerging epidemics, even pandemics, of obesity and T2DM with serious health and socioeconomic impact. There is also a shift in incidence of metabolic diseases to younger age groups. These facts have emerged extensive research effort focused on deeper understanding and eventual therapeutic influence of insulin resistance (IR), the key moment in etiopathogenesis of T2DM. The pathogenesis of IR is very complicated and still not fully understood. Well known are environmental factors (lack of physical activity, energy-rich diet). Key player in development of IR is adipose tissue, mainly visceral adipose tissue (VAT). Disturbances of VAT metabolism and subclinical inflammation are considered as important factors leading to development of IR. VAT is producer of biologically active substances and pro-inflammatory cytokines that are linked to development of IR and T2DM as well. Another factor influencing formation of IR and function of pancreatic β-cells is mitochondrial oxidative capacity together with oxidative stress. Discussed is being also the role of intestinal microbiome.