Insulin Resistance Concepts

Perspectives on the News commentaries are now part of a new, free monthly CME activity. The Mount Sinai School of Medicine, New York, New York, is designating this activity for 2.0 AMA PRA Category 1 credits. If you wish to participate, review this article and visit www.diabetes.procampus.net to complete a posttest and receive a certificate. The Mount Sinai School of Medicine is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians. This is the first in a series of four articles on presentations given at the World Congress on the insulin resistance syndrome (IRS), reviewing concepts pertaining to insulin resistance.Yehuda Handelsman (Tarzana, CA) discussed the clinical implications of insulin resistance. He reminded listeners that Gerald Reaven introduced the concept of Syndrome X with his 1988 Banting Lecture, leading to increasing recognition of the importance of the IRS by the World Health Organization (WHO), the American College of Endocrinology, the International Diabetes Federation (IDF), and the American Heart Association. With new definitions, there have been new approaches to treatment, and areas of controversy as well, with the IDF and American Heart Association suggesting that the syndrome exists and is clinically important, while the American Diabetes Association and European Association for the Study of Diabetes have suggested this not to be the case.Handelsman offered a synthesis of the apparently opposing positions. “The syndrome,” he said, “is not a disease. It is distinguished from type 2 diabetes and CVD [cardiovascular disease]. The concept [of an IRS] is designed to predict and prevent [the development of illness].” In this context, it may be particularly important to redefine the “metabolic syndrome” as the “insulin resistance syndrome,” allowing one to group together the multitude of seemingly diverse conditions, affecting skin, the reproductive system, liver, cancer, the …