Abstract
Prevalence of type 2 diabetes increased from 2.5% of the US population in 1990 to 10.5% in 2018. This creates a major public health problem, due to increases in long-term complications of diabetes, including neuropathy, retinopathy, nephropathy, skin ulcers, amputations, and atherosclerotic cardiovascular disease. In this review, we evaluated the scientific basis that supports the use of physiologic insulin resensitization. Insulin resistance is the primary cause of type 2 diabetes. Insulin resistance leads to increasing insulin secretion, leading to beta-cell exhaustion or burnout. This triggers a cascade leading to islet cell destruction and the long-term complications of type 2 diabetes. Concurrent with insulin resistance, the regular bursts of insulin from the pancreas become irregular. This has been treated by the precise administration of insulin more physiologically. There is consistent evidence that this treatment modality can reverse the diabetes-associated complications of neuropathy, diabetic ulcers, nephropathy, and retinopathy, and that it lowers HbA1c. In conclusion, physiologic insulin resensitization has a persuasive scientific basis, significant treatment potential, and likely cost benefits.
Highlights
The prevalence of type 2 diabetes has increased from 2.5% of the US population in 1990 and constituted 10.5% of the total US population or 13.0% of US adults in 2018 [1].This is an astounding 320% increase in 28 years
We offer the hypothesis that it is an insulin secretion defect that drives the insulin resistance (IR) responsible for the pathophysiology of type 2 diabetes
Obesity is associated with an increase in beta cell mass, by the time type 2 diabetes develops, there has been a 65% reduction in beta cell mass due to apoptosis associated with increased levels of amylin that is secreted in equimolar amounts to insulin [17]
Summary
The prevalence of type 2 diabetes has increased from 2.5% of the US population in 1990 and constituted 10.5% of the total US population or 13.0% of US adults in 2018 [1]. Given that the annual direct medical cost for treating diabetes increased from $245 Billion to $327 Billion per year between 2012 and 2017 [4], it is not unreasonable to assume that the cost of treating diabetes in 2021 will approach $400 Billion This expenditure is high and increasing because it is directed toward a progressive disease for which therapy is designed to slow the progression of diabetes-associated conditions until death occurs. This article has two purposes: (1) To explore insulin resistance pathophysiology and (2) to review literature for clinical outcomes and molecular mechanisms that support the use of physiologic insulin resensitization as an effective treatment modality to address insulin resistance, of which diabetes and its complications are the most common results
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