Abstract
Hyperglycemia is a pathophysiologic state that can perpetuate and sustain the elevated blood glucose levels in type 2 diabetes mellitus by worsening the underlying insulin resistance and impairing insulin secretion. Prolonged hyperglycemia leads to retinopathy, nephropathy, neuropathy, and other vascular disorders. The hexosamine signaling pathway is now known to detect hyperglycemic conditions and mediate induction of insulin resistance and regulation of gene expression. However, the mechanism(s) underlying this novel glucose-sensing pathway require elucidation. The prevailing hypothesis is that the cellular actions of hexosamine signaling are closely linked to O-linked glycosylation of cytosolic and nuclear proteins. In this review, the author discusses recent advances in the field and highlights potential pitfalls in the design and interpretation of some current hexosamine studies. The author also offers suggestions on terminology to facilitate future studies. Understanding the cellular mechanisms underlying hyperglycemia-induced insulin resistance and the progressive development of glucose-mediated diabetic complications will facilitate the discovery of novel drugs to treat diabetes.

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