Challenges in identifying genetic variation affecting susceptibility to type 2 diabetes: Examples from studies of the calpain-10 gene

Type 2 diabetes is a classic example of a complex disorder. It is strongly familial, but clearly arises as a consequence of the actions and interactions of many genetic and non-genetic factors. Type 2 diabetes is a common disorder, affecting 16 million Americans. It has a major impact on public health expenditures with more than 1 in 10 health care dollars spent on treating diabetes and its complications. Although a variety of therapies can be useful in treatment of type 2 diabetes, we remain sufficiently ignorant of the genetic risk factors to believe that identifying them will lead to better understanding of the primary physiology of the disorder, as well as to more specific and effective therapies. Moreover, identification of genetic risk factors may improve our ability to characterize more specific non-genetic risk factors for this disease that could be the targets for cost-effective prevention strategies. This manuscript reviews the challenges we face in moving from the linkage mapping of susceptibility genes for type 2 diabetes toward the identification of the genetic variation that actually affects risk to this disorder. I illustrate many of the challenges in designing, conducting and interpreting these studies by reviewing recent research conducted on the calpain-10 gene, implicated in positional cloning studies as a candidate gene for type 2 diabetes.