The Beta Cell in Type 2 Diabetes

Purpose of Review This review summarizes the alterations in the beta-cell observed in type 2 diabetes (T2D), focusing on changes in beta-cell identity and mass and changes associated with metabolism and intracellular signaling. Recent Findings In the setting of T2D, beta-cells undergo changes in gene expression, reverting to a more immature state and in some cases transdifferentiating into other islet cell types. Alleviation of metabolic stress, ER stress, and maladaptive prostaglandin signaling could improve beta-cell function and survival. The beta-cell defects leading to T2D likely differ in different individuals and include variations in beta-cell mass, development, beta-cell expansion, responses to ER and oxidative stress, insulin production and secretion, and intracellular signaling pathways. The recent recognition that some beta-cells undergo dedifferentiation without dying in T2D suggests strategies to revive these cells and rejuvenate their functionality.