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Type 2 DM globally affects 18–20 % of adults over the age of 65 years.It is estimated that approximately 285 million people, between 20 and 79 years old, currently have DM, 70 % of whom live in middle- and low-income countries.Glucose homeostasis is extremely altered in patients with DKD, who are exposed to a high risk of both hyperglycemia and hypoglycemia.Both high and low glycemic levels are associated with increased morbidity and shortened survival in this group of patients.When hyperinsulinemia can no longer compensate for IR and insulin secretion begins to decline, the disruption of these variables results in hyperglycemia and a diagnosis of DM.In the early stages of DM2, the clinical picture of hyperinsulinemia persists.Several studies show that insulin has an anorexigenic action in the central nervous system [].

Diabetic kidney disease (DKD) is one of the most frequent and dangerous complications of DM2, affecting about one-third of the patients with DM2.

In addition to the increasing complexity of outpatient care for patients with DM, DKD results in increased hospitalizations and mortality rates, especially due to cardiovascular complications.

DKD also increases the demand for renal replacement therapies, such as dialysis and kidney transplants.

On the other hand, the Matsuda index can estimate hepatic and peripheral insulin sensitivity, using glycemia and insulinemia values obtained through an oral glucose tolerance test [].

In addition to IR, insulin deficiency is essential to manifest hyperglycemia in DM2.




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