A Review on the Management of Insulin Resistance

Introduction: the successes of interventions to obtain weight loss and prevent relapse are limited. Moreover, comorbidities like type2 diabetes mellitus, hypertension, hypercholesterolemia, hypertrigly-ceridemia and gout, have so far been treated as separate diseases, although mounting evidence shows that these morbidities are consequences of the failing metabolism due to insulin resistance.

Objectives: to build evidence that weight loss, by treating obesity, improves comorbidities and improves quality of life.

Results: treatment of obesity and its comorbidities is a multidisciplinary matter. It can be done in primary care. It should be widely recognized that a low carbohydrate diet and exercise are the two main aspects of treatment that lead to the desired result: considerable weight loss and diminishment of comorbidities, visible through improvement of blood parameters and improved quality of life. Because of the complexity of the diet a large role in management is fit for dietitians, supported by psychologists, physiotherapists and exercise trainers. Family physicians and nurse practioners need to be aware of the important role diet and lifestyle play. In insulin resistance medication is not the preferred treatment, it should be avoided as much as possible.

Conclusions: by diagnosing and treating insulin resistance in primary care, health professionals can change the prevalence and consequences of obesity and its comorbidities, thus reducing health care costs considerably. IR is best diagnosed by measuring fasting insulin levels. Measuring waist circumference and calculating BMI are additional instruments. Management should focus on weight loss through a low carbohydrate diet, with sufficient fat, protein, vitamins and minerals. Exercise is an essential part of management and relapse prevention. Persons that are insulin resistant may regain their health through these measures. They will always stay insulin resistant to a certain extent, and cannot eat normal quantities of carbohydrates that are commonly used and advised in general dietary guidelines.