Insulin Resistance and the Metabolic Syndrome
Integrative Medicine Insulin Resistance and the Metabolic Syndrome: Key Points
Insulin Resistance and the Metabolic Syndrome: Key Points
DEFINING METABOLIC SYNDROME
The terms “syndrome of insulin resistance (IR)” and “the metabolic syndrome” were coined in the 1980s by Ger¬ald Reaven, MD, an endocrinologist at Stanford Medical School in California. Other names used to describe the condition include syndrome X, prediabetes, dysmetabolic syndrome, and cardiometabolic syndrome.
Metabolic syndrome is associated with a constellation of risk factors for atherosclerosis and type 2 diabetes mel¬litus (DM) including:
- Elevated fasting glucose
- Elevated triglycerides
- Reduced high-density lipoprotein (HDL) cholesterol
- Hypertension
- Central obesity
The presence of three or more of these risk factors defines the metabolic syndrome. Following a joint sci¬entific statement by several major organizations, a set of defined cut off values were determined for all compo¬nents, with the exception of waist circumference. According to the National Cholesterol Education Program Adult Treatment Panel III, a waist circumfer¬ence of more than 40 inches (101 cm) in men and more than 35 inches (89 cm) in women is a defining criteria for metabolic syndrome. These values apply to West¬ern cultures only. For information regarding other ethnic groups, readers should refer to the 2010 article by Lear et al. that outlines existing and proposed waist circum¬ference and waist-to-hip ratios.
Additional abnormalities posited to define the meta¬bolic syndrome include endothelial dysfunction, and pro¬coagulant and proinflammatory states.
IR is the most common clinical finding associated with metabolic syndrome and is thought by many investigators to represent the predominant mechanism underlying the pathogenesis of this condition. IR is defined as decreased cellular sensitivity to insulin and varies according to cell type, organ, and particular metabolic pathway. Research suggests that IR is associated with an inflammatory state and the activation of inflammatory pathways sustains IR and ulti¬mately leads to the development of metabolic syndrome.