Which description most accurately summarizes the progressive nature of type 2 diabetes pathophysiology over time?

• A. A sudden autoimmune-mediated loss of all beta cells at disease onset without any preceding insulin resistance, followed by spontaneous recovery of beta-cell function in late stages.
• B. Primary liver disease causing irreversible glycogen overproduction that is independent of insulin action or beta-cell function and never responds to weight loss or exercise.
• C. An inherited absence of glucose transporters in intestinal epithelium causing lifelong hypoglycemia that then flips into hyperglycemia only in the presence of exogenous insulin therapy.
• D. An initial period of peripheral insulin resistance with compensatory hyperinsulinemia that, over time, leads to beta-cell exhaustion and declining insulin secretion, resulting in combined insulin resistance and insulin deficiency.

Answer: (D)