<International Circulation>: Insulin resistance is an important factor attributed to the cardiometabolic syndrome and at this meeting a life course approach will be promoted for prevention and treatment. How should insulin resistance be detected and treated?

    Prof. Eckel: Insulin resistance is best assessed clinically by the metabolic syndrome. The metabolic syndrome is common and relates to obesity， particularly central obesity， to the other components - triglycerides， HDL cholesterol， fasting glucose， and blood pressure. If you have three out of those five， you have the metabolic syndrome， but more importantly， you are insulin resistant because insulin resistance explains the metabolic syndrome almost entirely. Now that would be argued by some， but I think the majority of evidence indicates that insulin resistance is the major player. So clinically， the metabolic syndrome is a good way to assess insulin resistance. Now there are other ways to do this. You can get a fasting insulin value but this value is flawed by the fact that fasting insulin has a lot of biological variability and measurement error， so it stands to reason that if you can’t be sure of the level you are measuring， how can you put much reliance on it in terms of assessing insulin resistance? I would say that the fasting insulin should only be used in population studies where you have thousands of people in whom you want to assess insulin resistance specifically and the insulin error tends to cancel out when you have thousands of people to measure it on， so there it may have more value in terms of research. For clinical care however， I do not think that measuring fasting insulin should be done. Then there are more sophisticated ways of measuring insulin resistance and consequently not capable of being performed in the office or hospital setting including intravenous glucose tolerance testing， the euglycemic clamp and other complicated technology like metabolomics which are entirely research driven only.

    Treating insulin resistance is approached by lifestyle for the most part and by some medications. Lifestyle typically entails weight loss， eating a heart healthy diet， and physical activity.  Improving diabetes control also reduces insulin resistance.  The pharmacological interventions are clearly two classes of compounds. Metformin is one but perhaps moreso， the PPAR-gamma agonists which are drugs that are approved in the United States and other countries for treatment of diabetes.