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Hyperinsulinemia--how innocent a bystander?

P Z Zimmet1

  • 1International Diabetes Institute, Caulfield, Victoria, Australia.

Diabetes Care
|December 1, 1993
PubMed
Summary

Hyperinsulinemia and insulin resistance are linked to type 2 diabetes and cardiovascular disease, often appearing years before diagnosis. Early intervention, including exercise, can prevent these conditions, despite unclear biochemical mechanisms.

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Area of Science:

  • Endocrinology and Metabolism
  • Cardiovascular Disease Research
  • Preventive Medicine

Background:

  • Hyperinsulinemia is implicated in the etiology of non-insulin-dependent diabetes mellitus (NIDDM) and associated cardiovascular disease (CVD) risk factors.
  • Insulin resistance and hyperinsulinemia can precede impaired glucose tolerance and NIDDM by many years.
  • The 'thrifty genotype' hypothesis offers a framework, but detailed biochemical mechanisms linking insulin resistance to NIDDM and CVD remain elusive.

Purpose of the Study:

  • To review the significance of hyperinsulinemia in the development of NIDDM and related metabolic and morphological risk factors for atherosclerotic CVD.
  • To examine the role of hyperinsulinemia in conditions such as upper-body obesity, dyslipidemia, hypertension, and hyperuricemia.
  • To explore the implications for prevention and treatment strategies for NIDDM and atherosclerotic CVD.

Main Methods:

  • Review of epidemiological data and clinical research findings on hyperinsulinemia, insulin resistance, and CVD risk factors.
  • Examination of the potential influence of the sympathetic nervous system on hyperinsulinemia.
  • Analysis of the impact of therapeutic interventions, including ACE inhibitors and exercise, on insulin sensitivity and risk factors.

Main Results:

  • Epidemiological data suggest a significant role for hyperinsulinemia in NIDDM and associated CVD risk factors, though conclusive evidence is pending.
  • Hyperinsulinemia and insulin resistance are detectable early in life, even in childhood and adolescence.
  • Exercise demonstrates a clear association with improved insulin sensitivity, modification of CVD risk factors, and reduced NIDDM prevalence.

Conclusions:

  • NIDDM and atherosclerotic CVD are potentially preventable, necessitating early intervention strategies commencing in childhood.
  • Intensive risk factor management in individuals with NIDDM can significantly reduce atherosclerotic CVD risk.
  • Despite incomplete understanding of underlying biochemical mechanisms, prevention of NIDDM and atherosclerotic CVD is achievable through lifestyle modifications and risk factor control.

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