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Message: <blockquote data-quote="SimonCrox" data-source="post: 1803976" data-attributes="member: 388174">Regarding the effect of different tablets on beta cells, the best I can think of is ADOPT; this compared the time to tablet failure of sulphonylurea, metformin and rosiglitazone; rosi lasted longest and the sulphonylurea the shortest; we presume that this was the SU flogging the beta cells, but I do not think that measures of beta cell function wer performed.<a href="https://www.nejm.org/doi/full/10.1056/nejmoa066224" target="_blank">https://www.nejm.org/doi/full/10.1056/nejmoa066224</a>Folk are all individuals, so one should health care professional should know the drugs so can discuss with patient and make teh best choice; sulphonylureas worked in UKPDS and have helped a lot of folk over the years; there are better agents now, but if working fine shows a good choiceI agree that we used to believe in progression of T2DM to insulin, but this was in the time that a lot of folk were being left on tablets for several years with awful control instead of add in insulin; I think that progression is still likely, but with aggressive dieting and/or GLP-1 RAs, it is not inevitable.I agree about the NAFLD - a dangerous problem; it is likely that one inital problem with T2DM is insulin resistance, particularly in the liver, and this insulin resistance leads to a bit of fat in the liver (NASH) which can lead to problematic faty liver (NAFLD) which can lead to real problems for liver and blood vessels. Pioglitazone decreases insulin resistance and improves the fatty liver, GLP-1 RAs help insulin resistance a bit and help fatty liver, but lifestyle of diet, weight loss and exercise which decrease the insulin resistance are possibly the most effective.Best wishes</blockquote>

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