Meeting the challenge of insulin resistance in general practice
As evidence around the role of insulin resistance in many long term conditions continues to grow, George Winter looks at what we know so far
‘Insulin resistance is the major determinant of cardiovascular disease in overweight/obese individuals’ (Reaven, 2005); ‘if more physicians understood that insulin resistance is a huge risk factor for ischemic heart disease, we could potentially do more to motivate our patients’ (Bertsch and Merchant, 2015); and Noakes and Sboros (2017) cite Reaven (2012) that ‘the six conditions most likely caused by high-carbohydrate diets in those with insulin resistance are obesity; arterial disease, both local (heart attack or stroke) and disseminated (type-2 diabetes); hypertension; non-alcoholic fatty liver disease (NAFLD); cancer; and dementia (Alzheimer's disease, also known as type-3 diabetes).’
Yet ‘insulin resistance is the epidemic you may have never heard of’ (Bikman, 2020: 3).
Insulin resistance is a reduced response to the hormone insulin (Bikman, 2020: 6), with insulin resistance a key component of metabolic syndrome (Gallagher and LeRoith, 2020). In metabolic syndrome the patient must have two of either hypertension, dyslipidaemia, central obesity, or low concentrations of urinary protein; and second, the patients must have insulin resistance (Bikman, 2020: p81).
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