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 Presentation

"Insulin resistance and hyperglycemia"

Groups 1&2 (biography)
English - 2003-03-29 - 22 minutes
(14 slides)

Summary :
Group 1: The purpose of this workshop was to speculate on whether current agents accelerate B cell loss, and how this may affect current practice. We know that when diabetes occurs, beta cell failure is well advanced, but it’s not clear whether early disease with limited failure is more responsive to IR reduction or beta cell failure reduction. The current clinical opinion and behaviour in this area is mixed and diverse, but there is a consensus that aggressive and early therapy may improve beta cell preservation. According to the available data, TZDs perhaps could have a greater preventative role early in disease rather than only late in disease. While these preliminary studies have been helpful, outcome studies are still required, as well as mechanism of action studies regarding beta cell death.

Group 2: This workshop focused on whether IR should be a primary therapeutic target for the prevention of IGT and/or preserving B cell function, and to suggest how this could be achieved. The current clinical behaviour and opinion shows doubt based on diabetes treatment. If we want to re-evaluate current therapy, we need to have Metabolic Syndrome clinics, work with pediatric groups, talk to the government and get patients to advocate for themselves. We also need a practical and accepted definition for IR, and help in promoting lifestyle to achieve a better result.


Learning objectives :
The participant will learn what are the current consensuses among physicians regarding the treatment of IR:
- Preliminary studies indicate that TZDs may have a greater preventative role in early disease rather than only in late disease
- IR for the purpose of this discussion is a clinical syndrome of impaired insulin action which could be different in different tissues
- We can implement better treatment of IR in several ways, including having Metabolic Syndrome clinics, working with pediatric groups, and getting help in promoting lifestyle.


Bibliographic references :
Effects of insulin resistance and insulin secretion on the efficacy of interventions to retard development of type 2 diabetes mellitus: the DA Qing IGT and Diabetes Study.

Li G, Hu Y, Yang W, Jiang Y, Wang J, Xiao J, Hu Z, Pan X, Howard BV, Bennett PH.

Department of Endocrinology, China-Japan Friendship Hospital, Yinghua Yeast Street, Caoyang District, 100029, Beijing, People's Republic of China

OBJECTIVE: To investigate the effects of insulin resistance (IR) and insulin secretion (IS) on the development of diabetes mellitus in individuals with impaired glucose tolerance (IGT) who underwent lifestyle interventions. METHODS: 284 out of 577 individuals with IGT identified by population-based screening in Da Qing, China, who were randomized to undergo diet change and/or increased physical activity had baseline fasting and 2 h post-load insulin determinations. They were followed for 6 years for the development of diabetes. IR and IS were assessed using calculated indices based on fasting plasma insulin and glucose. The interactions of IR, IS, obesity and plasma glucose and the effects of the lifestyle interventions were evaluated using Cox Proportional Hazards analysis. RESULTS: Both IR and IS were significantly associated with the development of diabetes. Lifestyle interventions were more effective in those with lower IT and higher IS at baselin. Diet plus exercise interventions resulted in significantly lower incidence of diabetes, even after controlling for IR, IS, BMI and 2hrPG. CONCLUSION: Both IR and beta-cell function were predictors of diabetes in Chinese with IGT. Lifestyle intervention reduced the incidence of DM and these interventions were more effective in those with less IR.

Diabetes Res Clin Pract 2002 Dec;58(3):193-200


   


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