A 55-year-old obese woman (body mass index =33 kg/m2) complains of declining visual acuity Funduscopic examination shows peripheral retinal microaneurysms. Urinalysis reveals 3+ proteinuria and 3+ glucosuria. Serum albumin is 3 g/dL, and serum cholesterol is 350 mg/dL. These clinicopathologic findings are best explained by which of the following mechanisms of disease?

Type 2 diabetes mellitus results from a complex interplay between underlying resistance to the action of insulin in its metabolic target tissues (liver, skeletal muscle, and adipose tissue) and a reduction in glucose-stimulated insulin secretion, which fails to compensate for the increased demand for insulin. In obese persons, the release of inhibitory mediators from adipose tissue interferes with intracellular signaling by insulin. Hyperinsulinemia secondary to insulin resistance also downregulates the number of insulin receptors on the plasma membrane. The other choices have not been related to the pathogenesis of type 2 diabetes.Diagnosis: Diabetes mellitus, type 2