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Insulin Resistance Treatment & Management

  • Author: Samuel T Olatunbosun, MD, FACP, FACE; Chief Editor: George T Griffing, MD  more...
 
Updated: Jan 30, 2015
 

Approach Considerations

Evaluate patients for comorbid conditions; this is generally feasible on an outpatient basis. Admission for laboratory studies and treatment of acute complications may be warranted for patients whose conditions require urgent or emergent intervention. The metabolic syndrome requires aggressive control of cardiovascular and metabolic risk factors. Tailor therapy for optimal benefits.

Potential medicolegal pitfalls include the following:

  • Failure to recognize the related conditions—insulin resistance, glucose intolerance, obesity, hypertension, atherosclerosis, hypercoagulability, and dyslipidemia
  • Failure to make use of appropriate and effective treatment
  • Failure to exclude malignancy-related acanthosis nigricans in a small group of patients

Go to Diabetes Mellitus, Type 1 and Diabetes Mellitus, Type 2 for complete information on these topics.

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Pharmacologic Therapy

Medications that reduce insulin resistance (insulin-sensitizing and antihyperglycemic effects) include metformin and the thiazolidinediones.[54]

Metformin is a biguanide; it reduces hepatic glucose output and increases the uptake in the peripheral tissues (muscle and adipocytes). Metformin is a major drug in the treatment of patients who are obese and have type 2 diabetes. The drug enhances weight reduction and improves lipid profile and vascular integrity.[55]

Thiazolidinediones lower plasma insulin levels and treat type 2 diabetes associated with insulin resistance.[56, 57, 58]

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Surgical Treatment of Underlying Causes

Improvement in insulin resistance occurs after bariatric surgery, such as gastric banding, sleeve gastrectomy, and gastric bypass, when carried out in carefully selected morbidly obese patients.[59] Bariatric surgery may be appropriate for patients with a body mass index (BMI) greater than 40 kg/m2 or greater than 35 kg/m2 in combination with high-risk comorbidities. It is the most effective treatment for obesity that is currently available, but it is reserved for patients who are unable to attain weight reduction after attempting noninvasive or less intense options. In severe cardiovascular disease, procedures such as coronary artery bypass graft and peripheral vascular surgery may be necessary.

Cosmetic and palliative treatments may be indicated in the treatment of many patients with insulin resistance syndrome, depending on the type and severity of physical anomalies (eg, epilation and electrolysis for hirsutism in patients with PCOS).

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Dietary Measures

Weight reduction improves insulin sensitivity in cases of obesity and in most of the obesity-related insulin-resistant states. Restriction of caloric intake is indicated. Dietary indiscretion, such as consumption of a diet high in cholesterol and sodium, should be avoided. Alcohol use should be limited. Smoking cessation is indicated.[60, 61]

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Modification of Activity

Avoid physical inactivity.[62] Exercise improves insulin sensitivity via the following[63, 64] :

  • Increased oxidative enzymes
  • Increased GLUT-4
  • Increased capillarity
  • Reduced central adiposity
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Consultations

Consultation with an endocrinologist is indicated in insulin resistance. Referral to a medical weight management program is usually needed. Consultation with a cardiologist is also usually indicated. Other specialists, such as a dermatologist, gynecologist, cardiothoracic surgeon, and ophthalmologist, may need to be consulted based on the nature of the disease and the prevailing pathology.

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Long-Term Monitoring

In patients with insulin resistance, diligent monitoring of metabolic profile, general status, medications, and side effects is indicated. Transfer may be indicated for diagnostic evaluation and for the treatment of major primary conditions and complications.

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Contributor Information and Disclosures
Author

Samuel T Olatunbosun, MD, FACP, FACE Endocrinology Service, SAMMC/59th Medical Wing and Uniformed Services University of the Health Sciences, F Edward Hebert School of Medicine

Samuel T Olatunbosun, MD, FACP, FACE is a member of the following medical societies: American Association of Clinical Endocrinologists, American Diabetes Association, Endocrine Society, American College of Physicians-American Society of Internal Medicine

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Don S Schalch, MD Professor Emeritus, Department of Internal Medicine, Division of Endocrinology, University of Wisconsin Hospitals and Clinics

Don S Schalch, MD is a member of the following medical societies: American Diabetes Association, American Federation for Medical Research, Central Society for Clinical and Translational Research, Endocrine Society

Disclosure: Nothing to disclose.

Chief Editor

George T Griffing, MD Professor Emeritus of Medicine, St Louis University School of Medicine

George T Griffing, MD is a member of the following medical societies: American Association for the Advancement of Science, International Society for Clinical Densitometry, Southern Society for Clinical Investigation, American College of Medical Practice Executives, American Association for Physician Leadership, American College of Physicians, American Diabetes Association, American Federation for Medical Research, American Heart Association, Central Society for Clinical and Translational Research, Endocrine Society

Disclosure: Nothing to disclose.

Additional Contributors

David S Schade, MD Chief, Division of Endocrinology and Metabolism, Professor, Department of Internal Medicine, University of New Mexico School of Medicine and Health Sciences Center

David S Schade, MD is a member of the following medical societies: American College of Physicians, American Diabetes Association, American Federation for Medical Research, Endocrine Society, New Mexico Medical Society, New York Academy of Sciences, Society for Experimental Biology and Medicine

Disclosure: Nothing to disclose.

Acknowledgements

Samuel Dagogo-Jack, MD, MBBS, MSc, FRCP Professor of Medicine, Program Director, Division of Endocrinology, Diabetes and Metabolism, University of Tennessee Health Science Center

Samuel Dagogo-Jack, MD, MBBS, MSc, FRCP is a member of the following medical societies: American College of Physicians, American Diabetes Association, American Federation for Medical Research, Royal College of Physicians, and The Endocrine Society

Disclosure: Eli Lilly None Speaking and teaching; GlaxoSmithKline None Speaking and teaching; Merck None Speaking and teaching

References
  1. Ahrén B, Pacini G. Islet adaptation to insulin resistance: mechanisms and implications for intervention. Diabetes Obes Metab. 2005 Jan. 7(1):2-8. [Medline].

  2. Mari A, Ahrén B, Pacini G. Assessment of insulin secretion in relation to insulin resistance. Curr Opin Clin Nutr Metab Care. 2005 Sep. 8(5):529-33. [Medline].

  3. Reaven GM. Pathophysiology of insulin resistance in human disease. Physiol Rev. 1995 Jul. 75(3):473-86. [Medline].

  4. Kim JA, Wei Y, Sowers JR. Role of mitochondrial dysfunction in insulin resistance. Circ Res. 2008 Feb 29. 102(4):401-14. [Medline]. [Full Text].

  5. Lee SH, Park SA, Ko SH, Yim HW, Ahn YB, Yoon KH, et al. Insulin resistance and inflammation may have an additional role in the link between cystatin C and cardiovascular disease in type 2 diabetes mellitus patients. Metabolism. 2010 Feb. 59(2):241-6. [Medline].

  6. Klok MD, Jakobsdottir S, Drent ML. The role of leptin and ghrelin in the regulation of food intake and body weight in humans: a review. Obes Rev. 2007 Jan. 8(1):21-34. [Medline].

  7. Reaven G, Abbasi F, McLaughlin T. Obesity, insulin resistance, and cardiovascular disease. Recent Prog Horm Res. 2004. 59:207-23. [Medline].

  8. de Luca C, Olefsky JM. Inflammation and insulin resistance. FEBS Lett. 2008 Jan 9. 582(1):97-105. [Medline]. [Full Text].

  9. Tilg H, Moschen AR. Inflammatory mechanisms in the regulation of insulin resistance. Mol Med. 2008 Mar-Apr. 14(3-4):222-31. [Medline]. [Full Text].

  10. Grant PJ. Inflammatory, atherothrombotic aspects of type 2 diabetes. Curr Med Res Opin. 2005. 21 Suppl 1:S5-12. [Medline].

  11. Florez H, Castillo-Florez S, Mendez A, Casanova-Romero P, Larreal-Urdaneta C, Lee D, et al. C-reactive protein is elevated in obese patients with the metabolic syndrome. Diabetes Res Clin Pract. 2006 Jan. 71(1):92-100. [Medline].

  12. Laaksonen DE, Niskanen L, Nyyssönen K, Punnonen K, Tuomainen TP, Salonen JT. C-reactive protein in the prediction of cardiovascular and overall mortality in middle-aged men: a population-based cohort study. Eur Heart J. 2005 Sep. 26(17):1783-9. [Medline].

  13. Rifai N. High-sensitivity C-reactive protein: a useful marker for cardiovascular disease risk prediction and the metabolic syndrome. Clin Chem. 2005 Mar. 51(3):504-5. [Medline].

  14. Semple RK, Cochran EK, Soos MA, Burling KA, Savage DB, Gorden P, et al. Plasma adiponectin as a marker of insulin receptor dysfunction: clinical utility in severe insulin resistance. Diabetes Care. 2008 May. 31(5):977-9. [Medline].

  15. Brabant G, Müller G, Horn R, Anderwald C, Roden M, Nave H. Hepatic leptin signaling in obesity. FASEB J. 2005 Jun. 19(8):1048-50. [Medline].

  16. Fuke Y, Fujita T, Satomura A, Wada Y, Matsumoto K. Alterations of insulin resistance and the serum adiponectin level in patients with type 2 diabetes mellitus under the usual antihypertensive dosage of telmisartan treatment. Diabetes Technol Ther. 2010 May. 12(5):393-8. [Medline].

  17. Meilleur KG, Doumatey A, Huang H, Charles B, Chen G, Zhou J, et al. Circulating adiponectin is associated with obesity and serum lipids in West Africans. J Clin Endocrinol Metab. 2010 Jul. 95(7):3517-21. [Medline]. [Full Text].

  18. de Souza Batista CM, Yang RZ, Lee MJ, Glynn NM, Yu DZ, Pray J, et al. Omentin plasma levels and gene expression are decreased in obesity. Diabetes. 2007 Jun. 56(6):1655-61. [Medline].

  19. Tan BK, Adya R, Farhatullah S, Lewandowski KC, O'Hare P, Lehnert H, et al. Omentin-1, a novel adipokine, is decreased in overweight insulin-resistant women with polycystic ovary syndrome: ex vivo and in vivo regulation of omentin-1 by insulin and glucose. Diabetes. 2008 Apr. 57(4):801-8. [Medline].

  20. Moreno-Navarrete JM, Catalán V, Ortega F, Gómez-Ambrosi J, Ricart W, Frühbeck G, et al. Circulating omentin concentration increases after weight loss. Nutr Metab (Lond). 2010 Apr 9. 7:27. [Medline]. [Full Text].

  21. Hug C, Lodish HF. The role of the adipocyte hormone adiponectin in cardiovascular disease. Curr Opin Pharmacol. 2005 Apr. 5(2):129-34. [Medline].

  22. Diamant M, Tushuizen ME. The metabolic syndrome and endothelial dysfunction: common highway to type 2 diabetes and CVD. Curr Diab Rep. 2006 Aug. 6(4):279-86. [Medline].

  23. Dushay J, Abrahamson MJ. Insulin resistance and type 2 diabetes: a comprehensive review. Medscape Today [serial online]. Apr 8 2005. [Full Text].

  24. Uruska A, Araszkiewicz A, Zozulinska-Ziolkiewicz D, Uruski P, Wierusz-Wysocka B. Insulin resistance is associated with microangiopathy in type 1 diabetic patients treated with intensive insulin therapy from the onset of disease. Exp Clin Endocrinol Diabetes. 2010 Aug. 118(8):478-84. [Medline].

  25. Lutsey PL, Steffen LM, Stevens J. Dietary intake and the development of the metabolic syndrome: the Atherosclerosis Risk in Communities study. Circulation. 2008 Feb 12. 117(6):754-61. [Medline].

  26. van Raalte DH, Brands M, van der Zijl NJ, et al. Low-dose glucocorticoid treatment affects multiple aspects of intermediary metabolism in healthy humans: a randomised controlled trial. Diabetologia. 2011 Aug. 54(8):2103-12. [Medline].

  27. Baudrand R, Campino C, Carvajal CA, Olivieri O, Guidi G, Faccini G, et al. High sodium intake is associated with increased glucocorticoid production, insulin resistance and metabolic syndrome. Clin Endocrinol (Oxf). 2014 May. 80(5):677-84. [Medline].

  28. De Wit S, Sabin CA, Weber R, Worm SW, Reiss P, Cazanave C, et al. Incidence and risk factors for new-onset diabetes in HIV-infected patients: the Data Collection on Adverse Events of Anti-HIV Drugs (D:A:D) study. Diabetes Care. 2008 Jun. 31(6):1224-9. [Medline]. [Full Text].

  29. Wierzbicki AS, Purdon SD, Hardman TC, Kulasegaram R, Peters BS. HIV lipodystrophy and its metabolic consequences: implications for clinical practice. Curr Med Res Opin. 2008 Mar. 24(3):609-24. [Medline].

  30. Yu IC, Lin HY, Sparks JD, Yeh S, Chang C. Androgen receptor roles in insulin resistance and obesity in males: the linkage of androgen-deprivation therapy to metabolic syndrome. Diabetes. 2014 Oct. 63(10):3180-8. [Medline]. [Full Text].

  31. Moadab MH, Kelishadi R, Hashemipour M, Amini M, Poursafa P. The prevalence of impaired fasting glucose and type 2 diabetes in a population-based sample of overweight/obese children in the Middle East. Pediatr Diabetes. 2010 Mar. 11(2):101-6. [Medline].

  32. Sarti C, Gallagher J. The metabolic syndrome: prevalence, CHD risk, and treatment. J Diabetes Complications. 2006 Mar-Apr. 20(2):121-32. [Medline].

  33. Levy-Marchal C, Arslanian S, Cutfield W, Sinaiko A, Druet C, Marcovecchio ML, et al. Insulin resistance in children: consensus, perspective, and future directions. J Clin Endocrinol Metab. 2010 Dec. 95(12):5189-98. [Medline].

  34. Beck-Nielsen H. General characteristics of the insulin resistance syndrome: prevalence and heritability. European Group for the study of Insulin Resistance (EGIR). Drugs. 1999. 58 Suppl 1:7-10; discussion 75-82. [Medline].

  35. Hirschler V, Ruiz A, Romero T, Dalamon R, Molinari C. Comparison of different anthropometric indices for identifying insulin resistance in schoolchildren. Diabetes Technol Ther. 2009 Sep. 11(9):615-21. [Medline].

  36. Savino A, Pelliccia P, Chiarelli F, Mohn A. Obesity-related renal injury in childhood. Horm Res Paediatr. 2010. 73(5):303-11. [Medline].

  37. Einhorn D, Reaven GM, Cobin RH, Ford E, Ganda OP, Handelsman Y, et al. American College of Endocrinology position statement on the insulin resistance syndrome. Endocr Pract. 2003 May-Jun. 9(3):237-52. [Medline].

  38. American Association of Clinical Endocrinologists Position Statement on Metabolic and Cardiovascular Consequences of Polycystic Ovary Syndrome. Endocr Pract. 2005 Mar-Apr. 11(2):126-34. [Medline].

  39. Essah PA, Nestler JE. The metabolic syndrome in polycystic ovary syndrome. J Endocrinol Invest. 2006 Mar. 29(3):270-80. [Medline].

  40. Pasquali R, Patton L, Pagotto U, Gambineri A. Metabolic alterations and cardiovascular risk factors in the polycystic ovary syndrome. Minerva Ginecol. 2005 Feb. 57(1):79-85. [Medline].

  41. Cheng AY, Leiter LA. Metabolic syndrome under fire: weighing in on the truth. Can J Cardiol. 2006 Apr. 22(5):379-82. [Medline]. [Full Text].

  42. Daskalopoulou SS, Athyros VG, Kolovou GD, Anagnostopoulou KK, Mikhailidis DP. Definitions of metabolic syndrome: Where are we now?. Curr Vasc Pharmacol. 2006 Jul. 4(3):185-97. [Medline].

  43. Reaven GM. The metabolic syndrome: is this diagnosis necessary?. Am J Clin Nutr. 2006 Jun. 83(6):1237-47. [Medline].

  44. Kahn R, Buse J, Ferrannini E, Stern M. The metabolic syndrome: time for a critical appraisal: joint statement from the American Diabetes Association and the European Association for the Study of Diabetes. Diabetes Care. 2005 Sep. 28(9):2289-304. [Medline].

  45. De Taeye B, Smith LH, Vaughan DE. Plasminogen activator inhibitor-1: a common denominator in obesity, diabetes and cardiovascular disease. Curr Opin Pharmacol. 2005 Apr. 5(2):149-54. [Medline].

  46. Sjöholm A, Nyström T. Endothelial inflammation in insulin resistance. Lancet. 2005 Feb 12-18. 365(9459):610-2. [Medline].

  47. Matthews DR, Hosker JP, Rudenski AS, Naylor BA, Treacher DF, Turner RC. Homeostasis model assessment: insulin resistance and beta-cell function from fasting plasma glucose and insulin concentrations in man. Diabetologia. 1985 Jul. 28(7):412-9. [Medline].

  48. Katz A, Nambi SS, Mather K, et al. Quantitative insulin sensitivity check index: a simple, accurate method for assessing insulin sensitivity in humans. J Clin Endocrinol Metab. 2000 Jul. 85(7):2402-10. [Medline].

  49. Muniyappa R, Lee S, Chen H, Quon MJ. Current approaches for assessing insulin sensitivity and resistance in vivo: advantages, limitations, and appropriate usage. Am J Physiol Endocrinol Metab. 2008 Jan. 294(1):E15-26. [Medline].

  50. Antuna-Puente B, Faraj M, Karelis AD, et al. HOMA or QUICKI: is it useful to test the reproducibility of formulas?. Diabetes Metab. 2008 Jun. 34(3):294-6. [Medline].

  51. Vaccaro O, Masulli M, Cuomo V, et al. Comparative evaluation of simple indices of insulin resistance. Metabolism. 2004 Dec. 53(12):1522-6. [Medline].

  52. Rossner SM, Neovius M, Mattsson A, Marcus C, Norgren S. HOMA-IR and QUICKI: decide on a general standard instead of making further comparisons. Acta Paediatr. 2010 Nov. 99(11):1735-40. [Medline].

  53. Sobngwi E, Kengne AP, Echouffo-Tcheugui JB, Choukem S, Sobngwi-Tambekou J, Balti EV, et al. Fasting insulin sensitivity indices are not better than routine clinical variables at predicting insulin sensitivity among Black Africans: a clamp study in sub-Saharan Africans. BMC Endocr Disord. 2014 Aug 9. 14:65. [Medline]. [Full Text].

  54. Jensterle M, Janez A, Mlinar B, Marc J, Prezelj J, Pfeifer M. Impact of metformin and rosiglitazone treatment on glucose transporter 4 mRNA expression in women with polycystic ovary syndrome. Eur J Endocrinol. 2008 Jun. 158(6):793-801. [Medline].

  55. Salpeter SR, Buckley NS, Kahn JA, Salpeter EE. Meta-analysis: metformin treatment in persons at risk for diabetes mellitus. Am J Med. 2008 Feb. 121(2):149-157.e2. [Medline].

  56. Quinn CE, Hamilton PK, Lockhart CJ, McVeigh GE. Thiazolidinediones: effects on insulin resistance and the cardiovascular system. Br J Pharmacol. 2008 Feb. 153(4):636-45. [Medline]. [Full Text].

  57. Nissen SE, Wolski K. Effect of rosiglitazone on the risk of myocardial infarction and death from cardiovascular causes. N Engl J Med. 2007 Jun 14. 356(24):2457-71. [Medline].

  58. Rasouli N, Raue U, Miles LM, Lu T, Di Gregorio GB, Elbein SC, et al. Pioglitazone improves insulin sensitivity through reduction in muscle lipid and redistribution of lipid into adipose tissue. Am J Physiol Endocrinol Metab. 2005 May. 288(5):E930-4. [Medline].

  59. Lee WJ, Lee YC, Ser KH, Chen JC, Chen SC. Improvement of insulin resistance after obesity surgery: a comparison of gastric banding and bypass procedures. Obes Surg. 2008 Sep. 18(9):1119-25. [Medline].

  60. Herman WH, Hoerger TJ, Brandle M, Hicks K, Sorensen S, Zhang P, et al. The cost-effectiveness of lifestyle modification or metformin in preventing type 2 diabetes in adults with impaired glucose tolerance. Ann Intern Med. 2005 Mar 1. 142(5):323-32. [Medline]. [Full Text].

  61. Pritchett AM, Foreyt JP, Mann DL. Treatment of the metabolic syndrome: the impact of lifestyle modification. Curr Atheroscler Rep. 2005 Mar. 7(2):95-102. [Medline].

  62. Hawley JA. Exercise as a therapeutic intervention for the prevention and treatment of insulin resistance. Diabetes Metab Res Rev. 2004 Sep-Oct. 20(5):383-93. [Medline].

  63. Hawley JA, Lessard SJ. Exercise training-induced improvements in insulin action. Acta Physiol (Oxf). 2008 Jan. 192(1):127-35. [Medline].

  64. Shih KC, Janckila AJ, Kwok CF, Ho LT, Chou YC, Chao TY. Effects of exercise on insulin sensitivity, inflammatory cytokines, and serum tartrate-resistant acid phosphatase 5a in obese Chinese male adolescents. Metabolism. 2010 Jan. 59(1):144-51. [Medline].

  65. Ioannides-Demos LL, Proietto J, McNeil JJ. Pharmacotherapy for obesity. Drugs. 2005. 65(10):1391-418. [Medline].

  66. Jayagopal V, Kilpatrick ES, Holding S, Jennings PE, Atkin SL. Orlistat is as beneficial as metformin in the treatment of polycystic ovarian syndrome. J Clin Endocrinol Metab. 2005 Feb. 90(2):729-33. [Medline].

  67. Kiortsis DN, Filippatos TD, Elisaf MS. The effects of orlistat on metabolic parameters and other cardiovascular risk factors. Diabetes Metab. 2005 Feb. 31(1):15-22. [Medline].

  68. Sjöström L. Analysis of the XENDOS study (Xenical in the Prevention of Diabetes in Obese Subjects). Endocr Pract. 2006 Jan-Feb. 12 Suppl 1:31-3. [Medline].

  69. Swinburn BA, Carey D, Hills AP, Hooper M, Marks S, Proietto J, et al. Effect of orlistat on cardiovascular disease risk in obese adults. Diabetes Obes Metab. 2005 May. 7(3):254-62. [Medline].

  70. Fauci AS, Braunwald E, Kasper DL, et al. Harrison’s Principles of Internal Medicine. 17th ed. New York, NY: New York, NY; 2008.

  71. Kolterman OG, Buse JB, Fineman MS, Gaines E, Heintz S, Bicsak TA, et al. Synthetic exendin-4 (exenatide) significantly reduces postprandial and fasting plasma glucose in subjects with type 2 diabetes. J Clin Endocrinol Metab. 2003 Jul. 88(7):3082-9. [Medline].

  72. Sarkar G, Alattar M, Brown RJ, Quon MJ, Harlan DM, Rother KI. Exenatide treatment for 6 months improves insulin sensitivity in adults with type 1 diabetes. Diabetes Care. 2014 Mar. 37(3):666-70. [Medline]. [Full Text].

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