Which of the following best characterizes the early natural history of type 2 diabetes, distinguishing it from type 1?

• A. Immediate and complete autoimmune destruction of beta cells at onset, which always precedes any insulin resistance and is the hallmark of early type 2 disease.
• B. Type 2 begins with viral infection of alpha cells causing hyperinsulinemia which then converts to insulin deficiency within days.
• C. Type 2 is defined by exclusively impaired appetite control without any alteration in insulin secretion or sensitivity until very late stages.
• D. An early phase of insulin resistance with compensatory increased insulin secretion before eventual beta-cell dysfunction, unlike the autoimmune beta-cell loss seen in type 1.

Answer: (D)