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 Presentation

"The Epidemic of Insulin Resistance and its Metabolic Consequences"

Prof. Bernard Zinman (biography)
English - 2002-04-27 - 27 minutes
(29 slides)

Summary :
Insulin resistance is a risk a factor for diabetes, and is changing all the time on a population level. We need to examine insulin resistance in context to obesity, the metabolic syndrome, type 2 diabetes, and IGT. The therapeutic challenge in treating type 2 diabetes now involves long-term glycemic control, increased insulin sensitivity, improved beta cell function, and medications which also lower the risk of CVD.

Learning objectives :
The participant will learn how obesity has reached epidemic proportions and how it is contributing to insulin resistance and the metabolic syndrome.New guidelines for the treatment of type 2 diabetes are presented.

Bibliographic references :
Analysis of obesity and hyperinsulinemia in the development of metabolic syndrome: san antonio heart study.

Han TS, Williams K, Sattar N, Hunt KJ, Lean ME, Haffner SM.

Cambridge Clinical School, Cambridge, United Kingdom. Department of Medicine, University of Texas Health Science Center at San Antonio, San Antonio, Texas. University Department of Human Nutrition, Glasgow Royal Infirmary, Glasgow, United Kingdom.

OBJECTIVE: To use standardized cut-offs of body mass index (BMI), waist circumference, waist-to-hip ratio, and fasting insulin levels to predict the development of metabolic disorders and metabolic syndrome. RESEARCH
METHODS AND PROCEDURES: We performed an 8-year follow-up study of 628 non-Hispanic whites and 1340 Mexican Americans, ages 25 to 64 years, from the second cohort of the San Antonio Heart Study. We defined metabolic disorders as dyslipidemia (triglycerides >/=2.26 mM or high-density lipoprotein <0.91 mM in men and <1.17 mM in women), hypertension (blood pressure >/=140/>/=90 mm Hg, or receiving antihypertensive medications), and type 2 diabetes (fasting glucose >/=7.0 mM, 2-hour test glucose >/=11.1 mM, or receiving anti-diabetic medications). People with at least two metabolic disorders were defined as having metabolic syndrome.
RESULTS: High waist-to-hip ratio and fasting insulin levels were significant predictors of developing metabolic syndrome. High anthropometric indices remained significant predictors of metabolic syndrome after adjusting for fasting insulin. Waist circumference, BMI, and insulin had similar areas under the receiver operating characteristic curves (0.74 to 0.76). Further multivariate analyses combining these indices showed minimal increase in prediction. Of subjects who had a combination of high BMI (>/=30 kg/m(2)) and high waist circumference (above "Action Level 2"), 32% developed metabolic syndrome, compared with 10% of subjects with both low BMI and low waist circumference.
DISCUSSION: These findings support the National Institutes of Health recommendations for reducing the risk of metabolic syndrome. Adjustment for baseline fasting insulin levels had only a small effect on the ability of anthropometric indices to predict the metabolic syndrome.

Obes Res 2002 Sep;10(9):923-31

   


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