The 6th Annual World Congress on the Insulin Resistance Syndrome

This is the first of a series of articles based on presentations at the 6th Annual World Congress on the Insulin Resistance Syndrome held 25–27 September 2008 in Los Angeles, California.

Yehuda Handelsman (Tarzana, CA), the organizer and prime mover of the International Committee for Insulin Resistance, discussed clinical implications of insulin resistance, touching on its relationship to sleep disorders, and the cytokines produced by adipocytes. Reducing adiposity appears to be an optimal approach to treatment of insulin resistance, with excess adipose tissue playing roles in genesis of nonalcoholic steatohepatitis (NASH), hyperuricemia, the polycystic ovary syndrome, atherosclerosis, and diabetes. There are ∼57 million people in the U.S. and 314 million overall in the world with pre-diabetes, with conversion to diabetes directly related to insulin resistance, particularly in the setting of decreased insulin secretion. “Treating diabetes works,” he commented, noting the recent UKPDS (United Kingdom Prospective Diabetes Study) follow-up study, and asked whether one should therefore treat pre-diabetes, given the strong similarities in risk for diabetes and cardiovascular disease (CVD), further suggesting that metabolic syndrome should be considered a pre-diabetes equivalent. Treatment of pre-diabetes may benefit from lifestyle intervention, with consideration of pharmacological treatment in high-risk patients, including thiazolidinediones, metformin, and α-glucosidase inhibitors; such patients should have aggressive efforts directed to CVD prevention with blood pressure and LDL cholesterol goals of <130/80 mmHg and <100 mg/dl, respectively.