Fonseca Vivian A
Section of Endocrinology, Tulane University Health Sciences Center, New Orleans, Louisiana 70112, USA.
Clin Cornerstone. 2007;8 Suppl 7:S7-18. doi: 10.1016/s1098-3597(07)80017-2.
Insulin resistance (IR) is characterized by decreasing sensitivity of target tissues to the action of insulin, elevated blood glucose concentration, and increased hepatic production of atherogenic lipids. IR is associated with declining insulin production by the pancreas, the emergence of type 2 diabetes, and increasing risk of cardiovascular disease (CVD). Clinical markers of IR include elevated plasma glucose concentration under fasting conditions or following ingestion of an oral glucose challenge. IR and hyperinsulinemia produce a number of effects that promote CVD, including adverse effects on blood pressure, endothelial cell function, lipid profile, platelet function, and blood coagulation. Glucose dysregulation often occurs in combination with other cardiovascular risk factors, including hypertension, obesity, and dyslipidemia. Clinical trials have shown that lifestyle changes to promote weight loss and medical therapy with insulin-sensitizing agents can reduce the likelihood of progression from early stages of IR to type 2 diabetes. However, it is important to recognize that obesity is a chronic condition that needs strategies beyond a diet plan to maintain sufficient weight loss over time. Pharmacologic therapies that are currently in development may help not only to promote weight loss but also to improve the symptoms of cardiometabolic risk in patients with and without diabetes.
胰岛素抵抗（IR）的特征是靶组织对胰岛素作用的敏感性降低、血糖浓度升高以及肝脏产生致动脉粥样硬化脂质增加。IR与胰腺胰岛素分泌减少、2型糖尿病的出现以及心血管疾病（CVD）风险增加有关。IR的临床标志物包括空腹条件下或口服葡萄糖耐量试验后血浆葡萄糖浓度升高。IR和高胰岛素血症会产生多种促进CVD的效应，包括对血压、内皮细胞功能、血脂谱、血小板功能和血液凝固的不良影响。血糖调节异常常与其他心血管危险因素同时出现，包括高血压、肥胖和血脂异常。临床试验表明，促进体重减轻的生活方式改变以及使用胰岛素增敏剂进行药物治疗可以降低从IR早期进展为2型糖尿病的可能性。然而，必须认识到肥胖是一种慢性病，需要超越饮食计划的策略来长期维持足够的体重减轻。目前正在研发的药物疗法不仅可能有助于促进体重减轻，还可能改善糖尿病患者和非糖尿病患者的心脏代谢风险症状。
