Insulin resistance is worsened by a number of factors including obesity and physical inactivity. If insulin resistance is severe enough, IGT will appear. When IGT is present, the risk of progressing to Type 2 diabetes is very high in all populations. A major factor in determining progression from IGT to diabetes is the inability of the beta cell to secrete enough insulin to compensate sufficiently for the level of insulin resistance. Its capacity and ability to do so is further decreased by persistent and increasing glycemia. In summary, the development of Type 2 diabetes is characterized 1) by development of insulin resistance, followed by 2) impaired glucose tolerance, and 3) insulin secretory failure.