Insulin Resistance (cont.)
Melissa Conrad Stöppler, MD
Melissa Conrad Stöppler, MD, is a U.S. board-certified Anatomic Pathologist with subspecialty training in the fields of Experimental and Molecular Pathology. Dr. Stöppler's educational background includes a BA with Highest Distinction from the University of Virginia and an MD from the University of North Carolina. She completed residency training in Anatomic Pathology at Georgetown University followed by subspecialty fellowship training in molecular diagnostics and experimental pathology.
Robert Ferry Jr., MD
Robert Ferry Jr., MD, is a U.S. board-certified Pediatric Endocrinologist. After taking his baccalaureate degree from Yale College, receiving his doctoral degree and residency training in pediatrics at University of Texas Health Science Center at San Antonio (UTHSCSA), he completed fellowship training in pediatric endocrinology at The Children's Hospital of Philadelphia.
In this Article
- Insulin resistance facts
- What is insulin resistance?
- What causes insulin resistance?
- What is the relationship between insulin resistance and diabetes?
- What medical conditions are associated with insulin resistance?
- Who is at risk for insulin resistance?
- How is insulin resistance diagnosed?
- How is insulin resistance managed?
- Lifestyle changes (diet, weight loss, exercise)
- What's new in insulin resistance?
- Find a local Endocrinologist in your town
Metformin (Glucophage) is a medication that is used for treating type 2 diabetes. It exerts two actions that help to control blood glucose levels. Metformin prevents the liver from releasing glucose into the blood, and it increases the sensitivity of muscle and fat cells to insulin. So, the muscle and fat remove more glucose from the blood. By these actions, metformin lowers blood insulin levels.
The DPP studied the effects of metformin, in addition to diet and exercise, for prevention of type 2 diabetes in insulin resistant people. Metformin reduced the development of type 2 diabetes by 31%. Note, however, that the benefit was not as great as with diet and intense exercise. Metformin is a reasonably safe medication when used in the proper population. Although occasionally associated with gastrointestinal side effects, metformin is usually well-tolerated. While there are no FDA-approved drugs to prevent type 2 diabetes or to treat pre-type 2 diabetes (insulin resistance), the American Diabetes Association has recommended that metformin be the only drug considered for the prevention of type 2 diabetes.
The STOP NIDDM (Study to Prevent Non-insulin Dependent Diabetes Mellitus) trial assessed individuals with insulin resistance by treating with acarbose (Precose). Acarbose slows the gut's absorption of sugars, which reduces the demand for insulin after a meal. This study suggested that acarbose could reduce the development of type 2 diabetes by 25%.
Thiazolidinediones comprise another class of drugs which increase sensitivity to insulin, including pioglitazone (Actos) and rosiglitazone (Avandia). These medications are no longer used routinely, in part because of liver toxicity that requires monitoring of liver blood tests. Avandia has been associated with an increased risk of heart attack and stroke, but experts have debated the severity of these concerns since this risk was first reported. In September 2010, the U.S. Food and Drug Administration (FDA) significantly restricted the use of Avandia to patients who cannot control their type 2 diabetes on other medications (including pioglitazone). These restrictions responded to data suggesting an elevated risk of cardiovascular events (such as heart attack and stroke) in patients treated with Avandia.
The TRIPOD (Troglitazone in Prevention of Diabetes) study assessed troglitazone (Rezulin) for treating women with gestational diabetes, a precursor of insulin resistance and type 2 diabetes. However, due to severe toxicity to the liver, troglitazone has been taken off the market and is no longer available. Type 2 diabetes was prevented in 25% of those women treated with troglitazone.
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