Diagnosis and treatment of insulin resistance

The article is professionally consulted by Professional Advisor, Associate Professor, Dr. Hoang Dang Mich and Master, Doctor Do Xuan Chien - Department of Medical Examination and Internal Medicine - Vinmec Ha Long International General Hospital.

Insulin resistance is becoming a leading common health problem today in the world. According to statistics from the Centers for Disease Control and Prevention (CDC), about 15-30% of patients with insulin resistance will develop type 2 diabetes within 2-5 years. Not only that, this condition also increases the risk of many other dangerous diseases.

No test can directly detect insulin resistance. Clinicians need to consider the entire clinical setting of the patient, and then consider insulin resistance if the patient has elevated triglycerides and LDL, along with a decrease in HDL.
Tests to be ordered include:
Glucose Fasting blood glucose is usually tested, but in some cases a glucose tolerance test (GTT) may be needed: doing multiple tests blood glucose before and after giving oral glucose at certain times. The purpose of the glucose tolerance test is to determine whether the patient has an abnormal response to glucose.

Blood lipid profile (lipid profile) Measures HDL, LDL, triglycerides, and total cholesterol. If triglycerides are significantly elevated, a direct measurement of LDL should be performed (DLDL=direct measurement of the LDL). One of the most commonly used methods to detect insulin resistance is to use a homeostatic model. assessment = HOMA). This method measures blood glucose and insulin and then uses calculations to estimate beta cell function and insulin sensitivity. Other tests can be used to assess insulin resistance and provide additional information. including:
Insulin Fasting insulin testing results are variable, but insulin levels are often elevated in people with significant insulin resistance.
hs-CRP This test is commonly used to assess inflammation that leads to cardiovascular risk. Hs-CRP may be elevated in insulin resistance.
sdLDL This test measures the number of small dense low-density lipoprotein molecules.
Insulin tolerance test (ITT) This test is used to determine sensitivity (or resistance) to insulin, especially in obese patients or patients with polycystic ovary syndrome (PCOS). This test is done by IV infusion of insulin, followed by multiple glucose and insulin tests. Specific insulin suppression tests are used to study insulin resistance, but are less widely indicated in clinical practice.

Reducing insulin resistance will significantly reduce the risk of diabetes, cardiovascular disease, fatty liver and a number of other diseases. For patients who already have diseases related to insulin resistance, improving this condition also helps to reduce and delay the progression of the disease.
Studies have shown that reducing insulin resistance in people with type 2 diabetes will help reduce and control blood sugar more easily, and also help limit the risk of cardiovascular complications.
Currently, metformin and thiazolidinedione drugs (pioglitazone, rosiglitazone) are drugs that reduce insulin resistance. But due to the potential risk of side effects, it is mainly used for cases of insulin resistance that have progressed to type 2 diabetes.
Therefore, the first solution is preferred for patients to Reducing insulin resistance is a lifestyle change and exercise:
Regular physical activity from 30 minutes to 1 hour a day, a week for at least 5 days. Limit starchy foods (rice, porridge, rice, bread,...), should be replaced with nuts, whole grains, sweet potatoes,... Increase the use of rich foods fiber Make time for relaxing activities If you are overweight, try to lose weight by eating a diet that limits energy-rich foods and active physical activity. Stop smoking if you are using US Diabetes Prevention Program (DPP) studies show that lifestyle changes and exercise are nearly twice as effective in reducing insulin resistance as taking them. treatment drugs.
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