American Association of Clinical Endocrinologists (AACE) Consensus Conference on the Insulin Resistance Syndrome

25–26 August 2002, Washington, DC

  1. Zachary T. Bloomgarden, MD
  1. Diabetes Center, Mount Sinai School of Medicine, New York, New York

    This is the second of two articles on the American Association of Clinical Endocrinologists (AACE) consensus conference on the insulin resistance syndrome (IRS), which was held in Washington, DC, 25–26 August 2002. (See for summary.)

    Ele Ferrannini (Pisa, Italy) noted that the San Antonio Heart Study, which involved 3,000 individuals, shows a linear relationship between fasting plasma insulin and fat mass. Eight-year follow-up of 1,000 subjects showed that weight increase or decrease is associated with increase or decrease in fasting insulin, to a greater extent in men than in women. He presented data from the European Group for the study of Insulin Resistance (EGIR), a pooling project with insulin clamp data from 21 centers involving a “normal” population of 1,466 persons without diabetes, impaired glucose tolerance (IGT), or hypertension. The prevalence of hyperinsulinemia and of insulin resistance (based on top 10% for each for subjects with BMI <25 kg/m2) were, respectively, 30 and 12% of those with BMI ≤28 kg/m2, 48 and 35% of those with BMI ≤35 kg/m2, and 80 and 60% of those with BMI >35 kg/m2. Obesity, then, triples the risk of insulin resistance, although Ferrannini pointed out that in the EGIR analysis, many obese individuals were not insulin resistant. Visceral fat area shows an inverse relationship with insulin sensitivity, particularly in persons without diabetes (as those with diabetes may have additional causes of insulin resistance). Waist circumference is not, however, more strongly correlated than BMI, suggesting that the overall degree of obesity remains important. Either in the fasting state or during a hyperinsulinemic clamp, there is a negative relationship between circulating free fatty acid (FFA) levels and insulin sensitivity, suggesting that there is also “insulin resistance in lipolysis.” The EGIR data show that both women and men have …

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