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Pharmacological treatment of insulin resistance |
Sang Thrombose Vaisseaux. Volume 10, Number 10, 631-41, Décembre 1998, Mini-revues
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 Résumé
Article gratuit
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Author(s) : Blandine Janand-Delenne, Philippe Vague |
Summary : Insulin resistance (IR) is defined by a decrease in the biological response to insulin. It is a major component of type 2 non-insulin dependent diabetes mellitus (NIDDM) together with impaired secretion of insulin. An “insulin resistance” syndrome (or “plurimetabolic” syndrome) has been individualized in which cluster many risk factors of NIDDM and cardiovascular disease such as hyperinsulinemia, dyslipoproteinaemia, hypertension and hypofibrinolysis. However the relationship between resistance to insulin action and the various parameters of the plurimetabolic syndrome has not been entirely clarified. In the same way the molecular mechanisms leading to IR are not well known. They include genetic as well as acquired and environmental factors. Enhancing insulin action is appropriate to treat NIDDM but also to diminish the cardiovascular risk associated with insulin resistance syndrome. Metformin, a biguanide known for 40 years is traditionally considered to be the first choice. The efficiency of metformin on the different IR parameters (increased thepatic glucose production, decreased peripheral glucose uptake) is well demonstrated, but its mechanism of action is not fully known. The thiazolidinediones, a new therapeutic class, are under evaluation. Troglitazone, the first to become available, significantly reduces insulin resistance but its potential toxicity, especially on the liver, limits its utilization. In a NIDDM prevention study, metformin and troglitazone are currently tested in patients with impaired glucose tolerance. In diabetic patients, treatments which aim to improve blood glucose control, have a beneficial effect on insulin sensitivity, chronic hyperglycemia being associated with the “glucotoxicity”, phenomenon genereting some degree of insulin resistance. Finally, many new drugs (vanadium, acipimox, etomoxir…) are being developed. |
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