Insulin resistance links all components of metabolic syndrome

American Association of Clinical Endocrinologists 17th Annual Meeting & Clinical Congress

Insulin resistance is a characteristic and critical feature of all components of metabolic syndrome, Ralph A. DeFronzo, MD, said today.

He highlighted the missing link between insulin resistance and cardiovascular disease and discussed the roles of lipotoxicity, insulin resistance, type 2 diabetes and cardiovascular disease.

“The molecular etiology of insulin resistance is associated with the activation of pathways, which are involved with the development of atherosclerosis,” he said.

“I’d like to suggest that lipotoxicity plays a pivotal role in the development of insulin resistance and it should be considered as a very important player in the development of the accelerated rate of atherosclerosis that we see in our diabetic patients. Of course, I believe it is a major component of the insulin resistance syndrome.”

DeFronzo stressed the importance of treating insulin resistance syndrome eagerly and aggressively. Among a variety of approaches, he considered how oral medication for diabetes may be helpful. Specifically, use of thiazolidinediones improves insulin sensitivity by augmenting insulin signaling, according to DeFronzo, and is associated with a decrease in cardiovascular events, such as MI, stroke and death.

“TZDs have a major effect to mobilize fat out of cells. Many of these inflammatory pathways that are involved in the development of atherosclerosis are significantly improved,” he said. – by Tara Grassia

Dr. DeFronzo pointed out that fat is a major contributor to the problems that develop with type 2 diabetes. He stressed the importance of better understanding the fat physiology and the development of complications of type 2 diabetes. Free fatty acids play a very important role in the pathogenesis of insulin resistance. We know that obesity is important, but he was able to show the role that obesity plays and how fat locations change after using a TZD. It’s the visceral fat that is the bad fat and after TZD use the visceral fat decreased.

- Richard Dolinar, MD

Endocrine Today Editorial Board member

For more information:
DeFronzo, RA. Insulin resistance and atherosclerosis: the missing link. Presented at: American Association of Clinical Endocrinologists 17th Annual Meeting & Clinical Congress; May 14-18, 2008; Orlando, Fla.