Evaluation and Treatment of Insulin Resistance and Hyperglycemic States

Abstract

Hyperglycemic disorders are very common in patients with overweight or obesity. With increasing fat mass and the development of adiposopathy comes increasing risk of developing hyperglycemia. However, the prevalence of overweight or obesity is estimated at over 60% of the American population. Yet, type 2 diabetes mellitus affects only 16.4% of people with an extreme body mass index. The progression from lean and healthy to overweight or obesity with type 2 diabetes offers opportunities for diagnosing individuals at risk, and for treatment. Adiposopathy, which includes accrual of intra-abdominal adipose tissue and the development of an inflammatory milieu, promotes insulin resistance. Insulin resistance in turn leads to ineffective insulin activity and hyperglycemia. Prediabetes, defined as hyperglycemia, which does not meet thresholds for diabetes mellitus, already carries an increased risk of cardiovascular disease and death. The standard of care for patients with insulin resistance and hyperglycemic states is to aggressively modify all cardiovascular risk factors. At the same time, it is now also the standard of care to equally aggressively treat overweight, obesity, and adiposopathy.