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[Insulin resistance: therapeutic approaches]
1Service de Nutrition Diabétologie et Maladies Métaboliques Hôpital Haut-Lévêque, USN, Pessac.
Annales D'Endocrinologie
|October 16, 1999
Summary
Non-insulin-dependent diabetes mellitus (NIDDM) involves reduced insulin sensitivity. Lifestyle changes are key, and several drugs can improve insulin sensitivity in liver, muscle, and fat cells.
Area of Science:
- Endocrinology
- Metabolic Diseases
- Pharmacology
Context:
- Non-insulin-dependent diabetes mellitus (NIDDM) is marked by diminished insulin sensitivity in key metabolic tissues.
- Lifestyle interventions like diet, exercise, and weight management are primary NIDDM treatments and preventative measures.
Purpose:
- To review pharmacological agents that enhance insulin sensitivity in NIDDM.
- To detail the specific mechanisms of action of these drugs on hepatic, muscular, and adipose tissues.
Summary:
- Thiazolidinediones enhance adipose tissue insulin sensitivity by activating PPAR gamma 2, though they can cause hepatotoxicity and weight gain.
- Acipimox, a nicotinic acid analogue, initially lowers free fatty acids by suppressing lipolysis, but this effect is transient.
- Metformin's hepatic insulin-sensitizing effects are discussed, including potential combination therapy with Troglitazone.
- Vanadyl sulfate shows potential for improving insulin sensitivity, but requires further long-term human studies.
Impact:
- Provides a comprehensive overview of current and investigational drugs for improving insulin sensitivity in NIDDM.
- Highlights the tissue-specific actions and potential side effects of various therapeutic agents.
- Informs clinical practice and future research directions for NIDDM pharmacotherapy.