title: Hyperinsulinemic syndrome: the metabolic syndrome is broader than you think.
abstract: BACKGROUND
  Type 2 diabetes mellitus (T2DM) is characterized by hyperinsulinemia. In 2011 we showed that gastric bypass (RYGB) corrects these high levels even though insulin resistance remains high, ie, the operation "dissociates" hyperinsulinemia from insulin resistance. RYGB produces reversal of T2DM along with other diseases associated with the metabolic syndrome. This observation led us to examine whether these illnesses also were characterized by hyperinsulinemia.
  
  
  METHODS
  A systematic review was performed to determine whether hyperinsulinemia was present in disorders associated with the metabolic syndrome. We reviewed 423 publications. 58 were selected because of appropriate documentation of insulin measurements. Comparisons were based on whether the studies reported patients as having increased versus normal insulin levels for each metabolic disorder.
  
  
  RESULTS
  The presence (+) or absence (-) of hyperinsulinemia was documented in these articles as follows: central obesity (4+ vs 0-), diabetes (5+ vs 0-), hypertension (9+ vs 1-), dyslipidemia (2+ vs 0-), renal failure (4+ vs 0-), nonalcoholic fatty liver disease (5+ vs 0-), polycystic ovary syndrome (7+ vs 1-), sleep apnea (7+ vs 0-), certain cancers (4+ vs 1-), atherosclerosis (4+ vs 0-), and cardiovascular disease (8+ vs 0-). Four articles examined insulin levels in the metabolic syndrome as a whole (4+ vs 0-).
  
  
  CONCLUSIONS
  These data document that disorders linked to the metabolic syndrome are associated with high levels of insulin, suggesting that these diseases share a common etiology that is expressed by high levels of insulin. This leads us to propose the concept of a "hyperinsulinemic syndrome" and question the safety of insulin as a chronic therapy for patients with T2DM.
authors: MD Program, Brody School of Medicine, East Carolina University, Greenville, NC.
authors: Christopher T
authors: CT
authors: Kelly
authors: MD Program, Brody School of Medicine, East Carolina University, Greenville, NC.
authors: Janet
authors: J
authors: Mansoor
authors: Department of Physiology, Brody School of Medicine, East Carolina University, Greenville, NC.
authors: G Lynis
authors: GL
authors: Dohm
authors: Department of Surgery, Brody School of Medicine, East Carolina University, Greenville, NC.
authors: William H H
authors: WH
authors: Chapman
authors: Department of Surgery, Brody School of Medicine, East Carolina University, Greenville, NC.
authors: John R
authors: JR
authors: Pender
authors: Department of Surgery, Brody School of Medicine, East Carolina University, Greenville, NC. Electronic address: poriesw@ecu.edu.
authors: Walter J
authors: WJ
authors: Pories
mesh_terms: D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000150:complications; D005260:Female; D015390:Gastric Bypass; D006801:Humans; D006946:Hyperinsulinism / Q000097:blood* / Q000150:complications* / Q000601:surgery; D007328:Insulin / Q000097:blood; D007333:Insulin Resistance; D008297:Male; D024821:Metabolic Syndrome / Q000097:blood* / Q000150:complications* / Q000601:surgery; D009765:Obesity / Q000097:blood / Q000150:complications / Q000601:surgery; D012307:Risk Factors
chemical_list: D007328:Insulin