Abstract

Objective: Hyperinsulinemic euglycemia, or the Insulin Resistance Syndrome (IRS), is associated with increased morbidity and mortality. Although thought to be associated with proinflammatory states, little work has been done in this area. Here, we determined the impact of IRS on functional, biochemical, metabolic, and inflammatory status in a high risk population: elderly women in nursing homes.

Research Design and Methods: Functional, biochemical, metabolic, and inflammatory parameters were measured in 100 consecutive ambulatory, elderly, nursing home females. Diabetics and residents with FBS ≥110 mg/dl were excluded. Remaining residents were classified as insulin resistant (IR: insulin>100 pM) or non-insulin resistant (NIR).

Results: 16 residents had IR and 53 NIR. No differences in functional status, BMI, renal function, C-reactive protein, or immune cell levels were found. FBS was higher in IR (94.1 ± 8.1 (SD) vs 87.9 ± 8.2, P<0.05), indicating a very mild glucose intolerance. Serum C-peptide (P<0.05), amylin (P<0.01), and leptin (P<0.01), but not adiponectin nor resistin, were higher in IR. Higher leptin/BMI and insulin/C-peptide ratios suggested an increased percent body fat mass and altered clearance of insulin, respectively. 11 of 13 cytokines had arithmetic elevations, but only tumor necrosis factor-alpha (TNF) reached statistical significance (P<0.01). TNF and insulin levels were highly correlated.

Conclusions: IRS in the healthiest of long-term care residents is relatively rare, but associated with mild glucose intolerance, increased percent body fat, altered insulin clearance, and a proinflammatory status as evidenced by an elevated TNF.