Calculating insulin resistance in the primary care setting: why should we worry about insulin levels in euglycemic patients?
OBJECTIVE
To describe measures that would determine which patients are insulin resistant and at risk for the metabolic syndrome and its sequelae cardiovascular diseases (CVD) and to analyze methods to determine the presence of insulin resistance and the advantages or disadvantages of each.


METHODS
Review of the multidisciplinary clinical and research literature.


CONCLUSIONS
Insulin resistance occurs early in the trajectory of the metabolic syndrome, making it a prime candidate for timely interventions to reduce risk for both type 2 diabetes and CVD. Therefore, prompt recognition of insulin resistance prior to the development of the full metabolic syndrome, type 2 diabetes, and/or CVD may assist in the prevention of morbidity and premature mortality. Likewise, because many insulin-resistant patients belong to minority racial groups (i.e., African American, Hispanic, Native American, or Pacific Islanders), early identification may have a positive impact on the reduction of cardiovascular health disparities.


CONCLUSIONS
Documenting the presence of insulin resistance will assist the practitioner to determine if a low-risk patient is in jeopardy for development of type 2 diabetes and/or CVD. Early cardiovascular risk identification is important to clinical practice as it allows more time for the practitioner to counsel patients for the essential planning needed to make lifestyle changes.
Appel
Susan J
SJ
Division of Graduate Studies, School of Nursing, University of Alabama, Birmingham, AL, USA. sappel@uab.edu
D002318:Cardiovascular Diseases / Q000209:etiology; D003924:Diabetes Mellitus, Type 2 / Q000150:complications / Q000503:physiopathology*; D006801:Humans; D007328:Insulin / Q000097:blood; D007333:Insulin Resistance; D024821:Metabolic Syndrome / Q000150:complications / Q000175:diagnosis*; D009765:Obesity / Q000150:complications; D011320:Primary Health Care
D007328:Insulin