“…Physiological, integrinmediated cell-ECM communication is critical not only normal -cell function and indeed survival, as discussed here, but also for insulin action on its target tissues. Pathological modification of the ECM in type 2 diabetes, for example by high-fat diet, hyperglycemia-induced advanced glycation end-products (AGEs), or inflammatory cytokine-induced fibrosis, has thus been shown to participate in the insulin resistance state of insulin-targeted tissues (muscle, adipose tissue, and liver) and could impair -cell function in a similar fashion (4,50,59,107,138,146,147). Deleterious cytokines that are elevated in the circulation of individuals with type 2 diabetes directly affect the expression of proteins of different functional classes including the actin cytoskeleton in -cells (103); perhaps this may also occur in target cells to modulate their insulin sensitivity.…”