Insulin resistance idf

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This is an overview of 2011 Dubai IDF conferencel abstracts about Insulin Resistance the


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2. Best of IDF Insulin ResistanceFrom Theory to Therapy Presented by: Dr. Emad HamedPracticing Physician, Naga- Hammady 3. Why Insulin Resistance ? Although it is a well known and documented condition foryears; I think it is still a vague issue in the minds of manyPracticing Physicians. We want to point out the role of IR in T1DM, hypertension,PCOS and other conditions. It is important to clarify that IR is a measurable parameter andits measurement is easy, practical and very useful inunderstanding the underlying pathogenesis of differentconditions and consequently their management. 4. Presentation Topics Background Assessment of Insulin Resistance Epidemiology Type 1 Diabetes Insulin Resistance & Metabolic Syndrome Metabolic Syndrome (MS) MS in Persons with IFG & IGT 5. Presentation Topics IR & the Liver OBESITY IR & Hypertension IR & Vit. D IR & PCOS IR & Other Issues ( Spleen Psoriasis ) Management of IR Prevention of Diabetes 6. Background The syndromes of insulin resistance actually make up abroad clinical spectrum, which includes obesity, glucoseintolerance, diabetes, and the metabolic syndrome, aswell as an extreme insulin-resistant state. Many of these disorders are associated with variousendocrine, metabolic, and genetic conditions. 7. Assessment of Insulin ResistanceIn theory, insulin sensitivity can be assessed through thefollowing methods:Fasting insulin level Measurement of response to directintravenous infusion of insulin.Euglycemic insulin clamp technique.These 2 tests are accurate, but they are research toolsand are not routinely used in clinical practice. 8. Assessment of Insulin Resistance Homeostatic model assessment for insulin resistance(HOMA-IR) = fasting glucose (mg/dL) X fasting insulin (uU/mL) / 405 = fasting glucose (mmol/L) X fasting insulin (uU/L) / 22.5. A value greater than 2 indicates insulin resistance. Quantitative Insulin Sensitivity Check Index (QUICKI).They both correlate reasonably well with the euglycemicclamp technique. 9. Epidemiology The mean HOMA-IR score of the subjects from urbancommunity were statistically greater than that of thesubjects from rural community. The prevalence of insulin resistance in urban communityand rural community were 64% and 2% respectively.( P-1393, Nigeria ) 10. Epidemiology A study was done to examine Insulin Resistance among5-15 years old children from an urban area of Sri Lanka. Although many children were able to control glucosewithin normal limits, they had very high levels of insulinsecretion denoting that insulin resistance is developingform a very young age. Those who were of low birthweight but obese as children had the highest risk ofdeveloping insulin resistance.( O-0434, Sri-Lanka ) 11. Epidemiology A study was done to assess IR in diabetic people as well inhealthy controls and to find out its association with thecomponents of MS in Nepal. C-peptide levels and insulin resistance are closely associatedwith the components of MS in healthy individuals as well as indiabetic people. ( P-1392, Nepal ) 12. Type 1 DM MS is a frequent finding in Type1 DM and its presenceis associated with poor metabolic control and moremicro and macro vascular complications. MS was associated with increased IR estimated byeGDR. ( D-1108, Spain) Obese Type1 patients may as well show insulinresistance. The amount of insulin can be significantlyreduced through additional treatment with Metforminand DPP4 inhibitors.( P- 1402, Germany ) 13. IR & Metabolic SyndromeInsulin resistance plays a major pathogenic role in thedevelopment of the metabolic syndrome, which may include anyor all of the following:HyperinsulinemiaType 2 diabetes or glucose intoleranceCentral obesityHypertensionDyslipidemia that includes high triglyceride levelsLow HDL-C level and small, dense low-density lipoprotein(LDL) particlesHypercoagulability characterized by an increased plasminogenactivator inhibitor1 (PAI-1) level. 14. Metabolic Syndrome Metabolic syndrome (MS) is defined by cluster ofcardiovascular risk factors which to a greater extent isinfluenced by ethnicity. Many definitions have beensuggested since the inception of this syndrome which hascreated uncertainty among physicians. To determine the frequency of metabolic syndrome in type2 D.M according to three commonly used operationaldefinitions (WHO, NCEP ATP III and IDF) and to evaluatethe agreement between these classifications in Pakistanicohort. 15. Metabolic Syndrome A study was done to examine the relationship betweenreduction in insulin resistance and various metabolicparameters in patients with metabolic syndrome. Data obtained show that insulin sensitizing therapysignificantly changes SUA levels and other metabolicparameters; all this strongly depends on the degree ofthe reduction in insulin resistance.( P-1408, Georgia ) 16. Metabolic Syndrome This study results suggest that NCEP (ATPIII) and IDF arethe most reliable criteria for diagnosing metabolicsyndrome in type 2 diabetic patients, with NECP capturingmore patients in comparison to IDF definition. The alarmingly high frequency of metabolic syndrome intype 2 diabetes found in this study suggests that primaryprevention strategies should be initiated early in this ethnicgroup and our health care system should be geared up tocope with this deadly condition.( P-1400, Pakistan ) 17. Metabolic Syndrome A study was done to examine the difference in prevalenceof Metabolic Syndrome in populations of Albania inconfront of the Italians and Peruvians. They conclude that in all three population the prevalenceof metabolic syndrome among young healthy people isimportant and the risk factors are almost the same with adifference for low HDL level that is found very oftenamongst Albanian. ( P-1412, Albania ) 18. Metabolic Syndrome Metabolic Syndrome in obese women was frequentespecially after menopause, thus multiple cardiovascularrisk factors are added so a particular attention is needed toavoid serious complications. ( P-1404, Tunisia ) 19. Metabolic Syndrome The aim of this paper was to examine the relationshipbetween time spent in sedentary behavior and metabolicsyndrome using meta-analysis. Current results, emphasize the importance of reducingsedentary behaviors, such as TV viewing and time on thecomputer, for the prevention of metabolic syndrome. ( D-0817, UK ) 20. Metabolic Syndrome Waist circumference (WC) is a convenient measure ofabdominal adipose tissue and it is a risk factor forcardiovascular diseases (CVD) and diabetes. The cutoff points for WC are higher in women than thecurrently recommended 80cm for Sub-Saharanpopulations, whilst in men it is lower. Of importance isthat the cutoff points are reversed in this population forthe genders. These results emphasize the importance of establishingethnic based values to correctly identify subjects with themetabolic syndrome. ( D-1110, South Africa ) 21. MS in Persons with IFG & IGT The prevalence of MS in persons with either IFG or IGTwas twofold that encountered in the general population,while in individuals with both IFG and IGT it is similarto that found in patients with type 2 diabetes mellitus. Therefore IFG and IGT should not be approached asisolated conditions because often are associated withother features of the MS that, individually andinterdependently, are responsible for a substantialincrease in cardiovascular morbidity and mortality.( P-1399, Romania ) 22. IR & the Liver The liver has a central role in the regulation ofcirculating glucose concentrations. During fasting,glucose is produced mainly by the liver as a result ofincreased glycogenolysis and gluconeogenesis (GNG). During postprandial state the impaired suppression ofhepatic glucose production (HGP), due to the presenceof hepatic insulin resistance, determines high glucoseconcentrations. 23. IR & the Liver Insulin acts at the level of the liver through a direct and/or indirect effect (i.e. on glucose transport and/orintracellular enzymes). Insulin resistant (IR) subjectshave increased fasting GNG, but fasting glucoseconcentration remains within normal ranges, as well asHGP, becauseof a compensatory decrease inglycogenolysis. 24. IR & the Liver When T2DM develops, the hepatic autoregulation islost, increased GNG and glycogenolysis determine theincrease in HGP that explains fasting hyperglycemia. In conclusion, the liver plays a determinant role in thepathogenesis of T2DM. ( S-103, Italy ) 25. IR & the Liver Ectopic fat deposition in the liver is associated withmetabolic abnormalities, including insulin resistance,dyslipidemia and diabetes. Non-alcoholic fatty liver disease (NAFLD) is defined asincreased liver fat in individuals who do not drinkexcessive alcohol and who do not have other causes forliver disease. 26. IR & the Liver A subset of patients with NAFLD have non-alcoholicsteatohepatitis (NASH) characterized by lobularinflammation and evidence of cellular damage with orwithout fibrosis. While simple steatosis is considered relatively benign,NASH can progress over time to cirrhosis. ( S-114, USA ) 27. IR & the Liver A study was done to assess the effect of Orlistat(Gastrointestinal lipase inhibitors) + Metformin vs Metforminalone in Nondiabetic Patients with Insulin Resistance andNonalcoholic Steatohepatitis (NASH) Orlistat (Gastrointestinal lipase inhibitors) therapy and dietarycounseling were associated with significant decreases inNASH. ( O-0439, Venezuela ) 28. IR & the Liver Nonalcoholic fatty liver disease (NAFLD) does not seemto be associated with MS in Bangladeshi population asdefined through the 3 major criteria provided by IDF,ATP III and WHO. Various components of MS are associated with NAFLDamong which central obesity, dysglycemia anddyslipidemia are the most significant ones. However,they do not seem to cluster in the manner as predicted byIDF, ATP III and WHO ( P-1384, Bangladesh ) 29. IR