The Effects Of Insulin Resistance And Its Treatment | Mukaila Kareem, DPT | RxEconsult

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Insulin Resistance: Definition, Effects, And Treatment Category: Diabetes by - September 4, 2016 | Views: 38699 | Likes: 1 | Comment: 0  

Clinical effects of Insulin Resistance

Over time, when insulin-producing pancreatic beta cells can no longer compensate for insulin resistance, the tight control of plasma glucose levels begin to deteriorate and impaired glucose tolerance or prediabetes occurs with possible progression to overt diabetes. The progression of beta cell failure determines the rate of diabetic onset. Therefore, decreased insulin sensitivity in muscle and liver along with pancreatic beta cell failure are the core metabolic defects in type 2 diabetes. A study has demonstrated that individuals at the high end of impaired glucose tolerance have lost more than 80% of their beta cell function. Therefore more than 80% of beta cells are gone by the time the diagnosis of diabetes is made.

Treatment of Insulin Resistance and Diabetes with Drugs

Until recently, the traditional approach for achieving HbA1c less than 7% called for the use of metformin with sequential addition of a sulfonylurea. If metformin fails, then basal insulin administration is recommended. Metformin, according to a 2013 study is a potent insulin sensitizer that inhibits the increased rate of glucose production in the liver while sulfonylureas augment insulin secretion in pancreatic beta cells. This study called the traditional approach the “treat to fail” as it did not address the multiple organs involved in diabetes and most importantly failed to protect beta cell function given the fact that progressive beta cell failure is a core abnormality in the development of diabetes. The study suggested that other antidiabetes agents such pioglitazone, a thiazolidinedione (TZD) and glucagon-like-1 analog (GLP-1) should be added to metformin. TZD and GLP-1 analog are beta cell agonists and therefore protect and preserve beta cell function with a goal to reverse the pathological defects of diabetes.


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