Discovering New Challenges in the Pharmacological and Non-Pharmacological Management of Insulin Resistance

Insulin resistance has become a serious health problem over time. As people age, the incidence of insulin resistance increases. Genetic factors in families with a history of type 2 diabetes are also key risk factors. In Indonesia, an increase in the prevalence of type 2 diabetes to 8.5% was reported in 2018. This indicates that insulin resistance necessitates comprehensive management, encompassing both pharmacological and non-pharmacological approaches. This systematic review aims to discuss insulin resistance and its management, which can be achieved both pharmacologically through various available drugs and non-pharmacologically by modifying lifestyle habits that can be applied to patients with type 2 diabetes.

Studies examining the comprehensive management of insulin resistance with antidiabetic pharmacological drugs and non-pharmaceutical interventions published between 2018 and 2023 were comprehensively searched using advanced searches on PubMed and Google Scholar, according to the specified inclusion and exclusion criteria.

Twenty studies were selected that met the inclusion criteria and have low risks of bias in most domains.

Non-pharmacological therapy, such as lifestyle changes that include a ketogenic diet, a vegetarian diet, a structured exercise intervention program, aerobic exercise, Continuous Positive Airway Pressure (CPAP), and electroacupuncture therapy, can significantly reduce insulin resistance and increase insulin sensitivity. Drugs currently prescribed for type 2 DM stimulate insulin secretion or increase insulin sensitivity.

There are benefits of a plant-based diet, a ketogenic diet, and physical exercise in reducing insulin resistance non-pharmacologically. Meanwhile, pharmacologically, the first drug often given is metformin monotherapy. Combination therapy may be considered if monotherapy does not achieve the therapeutic target.