Freeman 2023: Insulin Resistance - Clinical Overview

Background

This StatPearls clinical reference (PMID: 29939616, continuously updated through 2023) provides a comprehensive overview of insulin resistance for clinical practice. StatPearls is a peer-reviewed medical education resource from the National Institutes of Health.

Study Design

Comprehensive clinical review covering pathophysiology, diagnosis, and management of insulin resistance.

Key Findings

Diagnostic approaches:

Method	Clinical Utility
Fasting insulin	Accessible but variable
HOMA-IR	Most practical clinical tool
Fasting glucose/insulin ratio	Simple screening
OGTT with insulin	Gold standard but rarely done
Euglycemic clamp	Research standard

HOMA-IR interpretation:

• •<1.0: Optimal insulin sensitivity
• •1.0-2.0: Normal
• •2.0-2.9: Early insulin resistance
• •≥3.0: Significant insulin resistance

Associated conditions:

• •Type 2 diabetes
• •PCOS
• •NAFLD
• •Metabolic syndrome
• •Cardiovascular disease

Mechanistic Insights

Insulin resistance develops through:

1. •Ectopic lipid accumulation (liver, muscle)
2. •Inflammatory cytokines from adipose tissue
3. •Oxidative stress
4. •Mitochondrial dysfunction
5. •Genetic predisposition

Clinical Implications

First-line treatment is lifestyle modification:

• •Weight loss (5-10% of body weight)
• •Exercise (both aerobic and resistance)
• •Dietary modification (reduced refined carbohydrates)

Metformin considered for prevention in high-risk individuals.

Metabolic Health Perspective

HOMA-IR provides accessible insight into metabolic health that standard glucose testing misses. Identifying and addressing insulin resistance early prevents progression to diabetes and cardiovascular disease.