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this Insulin resistance (RI) is defined as The body’s cells become less responsive to insulin, a hormone produced by the pancreas that helps glucose enter cells for use as an energy source.
When cells, especially those in the liver, muscle, and fat tissue, do not respond adequately to insulin, the pancreas tries to compensate by producing more insulin. This hyperinsulinemia can only keep blood sugar at normal levels for a while. However, over time, as this condition persists, the pancreas’s actions begin to be insufficient, leading to elevated blood sugar levels and, ultimately, the development of diabetes.
Epidemiology in Chile
In Chile, In recent decades, the prevalence of insulin resistance and type 2 diabetes has increased alarmingly.reflecting global trends. According to recent studies, approximately 12.3% of adults in Chile suffer from DM2, with even higher proportions showing signs of insulin resistance and prediabetes.
Causes and risk factors
Insulin resistance has a Multifactorial etiology, including genetic, ethnic, and environmental (lifestyle) factors, may also be associated with the use of certain medications and secondary to other pathologies (e.g., PCOS).
- obesity: Excessive adipose tissue, especially visceral adipose tissue, is closely related to IR.
- Lack of physical activity: Lack of exercise can reduce muscle sensitivity to insulin.
- diet: A diet rich in refined carbohydrates, sugars, and saturated fats can lead to weight gain, which in turn causes IR.
- Stress and Sleep: Chronic stress and sleep deprivation can alter hormonal and metabolic regulation, leading to IR.
diagnosis
The diagnosis in the clinical setting must be based on the presence of characteristic findings, as laboratory test results are difficult to interpret alone. This test is for research use only and is not necessary for routine use in clinical practice.
- Clinicians:
- Abdominal obesity. Presence of skin tags and/or acanthosis nigricans.
- Background: Non-alcoholic fatty liver disease (NAFLD), T2DM, PCOS, dyslipidemia.
- Laboratory: For research, there are two methods:
- direct:
- Hyperinsulinemic euglycemic clamp: the gold standard but rarely used due to its price and accessibility to insulin tolerance testing.
- indirect:
- Bergman’s Minimal Model
- Homeostasis model assessment of insulin resistance
- Fasting insulinemia measurement
- Tests derived from the oral glucose tolerance test
- direct:
treat
To manage IR, lifestyle changes are crucial, and pharmacological intervention is only necessary in certain cases.
Lifestyle changes
- healthy eating: A balanced diet rich in fiber, vegetables, fruits, lean protein, and healthy fats is recommended. Reducing the intake of refined carbohydrates and sugars is essential.
- Physical exercise: Regular physical activity can improve insulin sensitivity. At least 150 minutes of moderate exercise per week is recommended.
- lose weight: For people who are overweight or obese, a significant weight loss of at least 7% can improve insulin resistance.
Pharmacological intervention
The cornerstone of insulin resistance treatment is lifestyle changes.
Initial medical treatment is a special case and is only indicated if the patient has dysglycemia (prediabetes or diabetes) or if the patient is a woman of childbearing age with a diagnosis of PCOS seeking fertility.
- Metformin: A first-line drug that reduces hepatic glucose production and improves insulin sensitivity.
In conclusion, insulin resistance is a disease with increasing prevalence in Chile and worldwide. Knowledge of its causes and risk factors is essential for effective management. Prevention and treatment of insulin resistance requires an integrated approach, the mainstay of which should be lifestyle changes. Pharmacological treatment should be resorted to only in certain specific cases. Fighting this disease is essential to reduce the burden of diseases such as DM2, dyslipidemia, hypertension, NAFLD, etc.
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