Insulin resistance syndrome. Description, pathogenesis, and management.
The insulin resistance syndrome is composed of risk factors for cardiovascular disease, including insulin resistance with hyperinsulinemia, atherogenic dyslipidemia, hypertension, abdominal obesity, and impaired hemostasis. Patients with type 2 diabetes frequently manifest multiple risk factors for cardiovascular morbidity and mortality. Management of the insulin resistance syndrome often includes antihypertensive, lipid-lowering, and antihyperglycemic agents. Because thiazolidinediones (TZDs) directly improve insulin resistance, early use may provide substantial benefits to patients with type 2 diabetes. TZDs reduce plasma glucose and insulin concentrations, promote relocation of body fat, and have anti-inflammatory effects on the vascular endothelium. Combination oral hypoglycemic therapy may be ideal for maintaining adequate glycemic control in patients with type 2 diabetes. The combination of a TZD and a biguanide, which improves insulin sensitivity and lowers blood glucose through different pathways, offers significant benefits and may help prevent or delay prevent complications associated with type 2 diabetes.
Miller
Jeffrey L
JL
Thomas Jefferson University Hospital, Philadelphia, PA 19107, USA. jeffrey.l.miller@mail.tju.edu
D003924:Diabetes Mellitus, Type 2 / Q000503:physiopathology / Q000628:therapy; D006801:Humans; D007004:Hypoglycemic Agents / Q000494:pharmacology / Q000627:therapeutic use; D024821:Metabolic Syndrome / Q000503:physiopathology / Q000628:therapy; D012307:Risk Factors; D013844:Thiazoles / Q000494:pharmacology / Q000627:therapeutic use; D045162:Thiazolidinediones
D007004:Hypoglycemic Agents; D013844:Thiazoles; D045162:Thiazolidinediones; C089946:2,4-thiazolidinedione