Management Of Insulin Resistance Research Articles

Adult Female Acne: Recent Advances in Pathophysiology and Therapeutic Approaches

Adult Female Acne: Recent Advances in Pathophysiology and Therapeutic Approaches

Vitamin D, anti-Mullerian hormone and glycemic status in infertile polycystic ovarian syndrome (PCOS), infertile non PCOS and fertile non PCOS at Mediheal Fertility Center - Western Kenya

Background: Diabetes of the bearded women was first described by Achard and Theirs in 1921 and since then insulin resistance and hyperinsulinemia in women with polycystic ovary syndrome (PCOS) remains one of the commonest metabolic problems. Insulin resistance and type II diabetes mellitus occurs in 70% of women with PCOS. The mechanism of insulin resistance has not been well established and inconsistent study results have complicated treatment modalities and management of insulin resistance and PCOS in general. There is evidence that 80% of women with PCOS are deficient in Vitamin D and this could be the missing link between Vitamin D and insulin resistance.
 Objective: To determine the correlation of Vitamin D, AMH and glycemic status in infertile PCOS, infertile non PCOS patients and fertile non PCOS attending Mediheal Fertility Center in Western Kenya as there is dearth of such studies within Kenyan population.
 Methods: A case control design with 20 patients per group for infertile PCOS, infertile non PCOS and fertile non PCOS which served as normal controls. Quantification of HbA1c was done at AMPATH reference laboratories using fluorescence immunoassay while Vitamin D and AMH was done at MTRH laboratories using ECLIA Roche. Data was analyzed using Statistical Package for Social Sciences (SPSS) version 25.
 Results: The mean HbA1c and median serum AMH in infertile PCOS, infertile non PCOS and infertile non PCOS were 6.1±0.4 and 7.5(6.2, 11.1), 5.5±0.3, and (1.2, 4.4), 5.6±0.3 and 2.0(1.7, 2.3) respectively. The study revealed statistically significant increase in HbA1c and serum AMH in infertile PCOS as compared to infertile non PCOS and fertile non PCOS (F=15.7, p<0.001 and F=46.7, p<0.001) respectively. In addition, Vitamin D was significantly deficient among infertile PCOS versus infertile non PCOS and fertile non PCOS (F=41.8, p<0.001).
 Conclusion: Infertile patients with PCOS have deficiency in Vitamin D and increase in HbA1c and AMH hence there might be a link of Vit D and AMH in pathophysiology of insulin resistance among PCOS patient

Temporal relationship between triglyceride-glucose index and blood pressure and their joint cumulative effect on cardiovascular disease risk: a longitudinal cohort study

BackgroundConcurrent insulin resistance and elevated blood pressure are commonly observed in cardiovascular disease (CVD) and have long been proposed to contribute to CVD. However, the temporal relationship between them and the effect of their cumulative co-exposure on future incident CVD remains unclear.MethodsLongitudinal analysis of data on 57,192 participants from a real-world, prospective cohort study (Kailuan Study) was performed to address the temporal relationship between Triglyceride-Glucose Index (TyG, calculated as ln [TG (mg/dL) × FBG (mg/dL)/2]) and blood pressure (BP) assessed by cross-lagged analyses in an approximately 4-year exposure period (2006/2007 to 2010/2011). After excluding 879 participants with known diabetes, 56,313 nonCVD participants were included for further analysis of the CVD outcome. Cox regression models were used to examine the hazard ratios (HRs) upon the cumulative TyG (CumTyG) and BP(CumBP) in the exposure period.ResultsThe standard regression coefficient from baseline TyG to follow-up systolic BP was 0.0142 (95% CI 0.0059–0.0226), which was greater than the standard regression coefficient from baseline systolic BP to follow-up TyG (− 0.0390; 95% CI − 0.0469 to − 0.0311). The same results were observed in the cross-lag between TyG and diastolic blood pressure [0.0271 (0.0185 to 0.0356) vs. − 0.0372 (− 0.0451 to − 0.0293)]. During a median follow-up of 9.98 years, 3981 CVD cases occurred. Significant interactions were observed between the median CumTyG (8.61) and CumSBP thresholds (130, 140 mmHg) (P = 0.0149), the median CumTyG (8.61) and CumDBP thresholds (80, 90 mmHg) (P = 0.0441). Compared to CumTyG < 8.61 and CumSBP < 130 mmHg, after adjusting for potential confounding factors, the HR gradually increased in the high co-exposure groups. The hazard ratios (HRs) and 95% confidence intervals (CIs) for Q2–Q6 were 1.39 (1.24, 1.57), 1.94 (1.69, 2.22), 2.40 (2.12, 2.71), 2.74 (2.43, 3.10), and 3.07 (2.74, 3.45). Additionally, the CVD risks in the co-exposure were more prominent in younger participants.ConclusionsThese findings suggest that elevated TyG has a greater impact on future blood pressure changes than vice versa. Dual assessment and management of insulin resistance and blood pressure contribute to the prevention of CVD, especially in younger individuals.

The role of folate in the management of insulin resistance in adults : a systematic review

Insulin resistance (IR) is one of the main risk factors for type 2 diabetes. IR employs a heavy economic burden, and the prevalence rate of IR in Indonesia is high. Homeostasis model of assessment-insulin resistance (HOMA-IR) is proven to be a great clinical tool to assess IR. Nutrition intervention should be the primary focus in treating IR. Folate is proven to be effective in lowering homocysteine concentrations, which is one of the risk factors for IR. This study aimed to summarize the role of folate in the management of IR in adults.

Flavonoids improve type 2 diabetes mellitus and its complications: a review.

The prevalence of type 2 diabetes mellitus (T2DM) is increasing every year. Medications are currently the most common therapy for T2DM. However, these medications have certain adverse effects. In order to find safe and effective ways to improve this disease, researchers have discovered that some natural products can decrease blood sugar. Flavonoids are one of the most essential low molecular weight phenolic chemicals in the plant world, which widely exist in plant roots, stems, leaves, flowers, and fruits. They possess a variety of biological activities, including organ protection, hypoglycemic, lipid-lowering, anti-oxidative and anti-inflammatory effects. Some natural flavonoids ameliorate T2DM and its complications through anti-oxidation, anti-inflammatory action, glucose and lipid metabolism regulation, insulin resistance management, etc. Hence, this review aims at demonstrating the potential benefits of flavonoids in T2DM and its complications. This laid the foundation for the development of novel hypoglycemic medications from flavonoids.

Insulin resistance, does it exist? The current state of knowledge

Insulin resistance is a growing concern worldwide, affecting millions of people and increasing the risk of various metabolic disorders, including type 2 diabetes, cardiovascular diseases, and fatty liver disease. This paper aims to display the symptoms of insulin resistance and the importance of early detection through various diagnostic tests such as fasting insulin levels, oral glucose tolerance tests, and HOMA-IR scores. Despite the high prevalence of insulin resistance, there is currently no known cure for this condition as it is not a disease in itself. However, lifestyle modifications, including exercise and dietary changes, can effectively manage and prevent the progression of insulin resistance and its associated complications. This study emphasizes the importance of raising awareness about insulin resistance and its adverse effects on individuals' health and the healthcare system's burden. Early detection and management of insulin resistance can significantly reduce the risk of developing metabolic disorders and prevent serious health complications.

Physical Activity, Rather Than Diet, Is Linked to Lower Insulin Resistance in PCOS Women-A Case-Control Study.

Insulin resistance (IR) is a prominent feature of polycystic ovary syndrome (PCOS). The importance of lifestyle interventions in the management of PCOS is strongly highlighted and it is suggested that diet and physical activity may significantly influence insulin sensitivity. Therefore, we evaluated the link between diet and physical activity and various indices of insulin resistance, including adipokines secreted by the adipose tissue in 56 PCOS and 33 healthy control women. The original food frequency questionnaire and Actigraph GT3X-BT were used to assess the adherence to the diet recommended in IR and the level of physical activity, respectively. We observed that higher levels of physical activity were associated with lower HOMA-IR and a greater chance of its normal value in PCOS group. No such relationship was observed for other IR indices and adipokines or for the diet. However, we noted a strong correlation between HOMA-IR (Homeostatic Model Assessment of Insulin Resistance) and HOMA-AD (Homeostatic Model Assessment-Adiponectin) in PCOS women. Additionally, when we used HOMA-AD we observed a higher prevalence of IR among PCOS women. Our study supports the beneficial role of physical activity in the management of insulin resistance in PCOS women. Moreover, our findings indicate that HOMA-AD may be a promising surrogate marker for insulin resistance assessment in women with PCOS.

The Effect of Healthy Lifestyle Strategies on the Management of Insulin Resistance in Children and Adolescents with Obesity: A Narrative Review.

Childhood obesity is characterized by an increased risk of several metabolic derangements including insulin resistance (IR). The strongest recommendations to prevent obesity and related complications are a balanced and adequate diet and practicing physical activity from early childhood. In this review, we propose to present the effects of healthy lifestyle strategies, including physical exercise and dietary approaches, on the management of IR and related metabolic derangements. All types of exercise (aerobic, resistance and combined training) effectively reduce IR in pediatric patients with obesity; it seems that aerobic and combined training stimulate greater improvements in IR compared to resistance training. Balanced normocaloric or hypocaloric dietary approaches are also valid strategies to address IR; it is not possible to assess the long-term impact of varying macronutrients on cardiometabolic risk. The glycemic index/load evaluation is a useful dietary approach to glucose metabolism control. Similarly, they should adopt the principle of the Mediterranean diet. Randomized studies with longer monitoring are needed to define the benefits of nutritional supplementation on IR. Considering that healthy style acquisition could track to later ages, programs of healthy lifestyle starting with children offer a better preventive strategy to preserve metabolic control and children's health.

Prevalence and risk factors associated with acanthosis nigricans in primary school children

Background Acanthosis nigricans (AN) is characterized by pigmented velvety thickening of the intertriginous body areas and neck. Many studies linked it to metabolic syndrome. Aim To detect the prevalence of AN among primary school children and to identify the associated risk factors. Patients and methods We included 2060 primary school students who were selected from two rural and four urban schools. The data were collected by questionnaire sheets that were fulfilled from each student in which present and past history for any disease were taken. Results The prevalence of AN was 17.7% of all examined students, higher in females (18.6%) than males (16.3%), but it was not statistically significant. More than half of the students 55.0% were of normal weight, 23.3% were overweight, and 21.7% were obese. In the current study, 69.1% of obese children were having AN. Conclusions Regular dermatologic examination for early identification of AN is required. AN in the knuckles should be considered as a classic site and highly prevalent. It should be borne in mind that coordinated efforts of medical professional teams may be required aiming to correct the underlying disease to improve the skin symptoms. Strict follow-up of patients with AN for early detection and management of insulin resistance and metabolic syndrome.

Aqueous and alcoholic extracts of Artemisia annua L. improved insulin resistance via decreasing TNF-alpha, IL-6 and free fatty acids in high-fat diet/streptozotocin-induced diabetic mice.

Objective:Type 2 diabetes mellitus (T2DM) is a metabolic disease that influences many people worldwide. Management of insulin resistance in T2DM without side effects of chemical drugs, is the ultimate goal of the medical community. Artemisia annua L. is used for the treatment of diabetes in folkloric medicine. The present study investigated the effects of aqueous and alcoholic extracts of A. annua (AA) on insulin resistance in high-fat diet/STZ-induced diabetic mice. Material and Methods: Mice were divided into groups including control with a normal diet, un-treated high-fat diet/streptozotocin-induced diabetic mice, and diabetic mice treated by oral administration of 100, 200, and 400 mg/kg body weight of water (hot and cold) and alcoholic extracts of AA. After four weeks of treatment with AA, blood sampling was carried out to measure factors involved in insulin resistance such as low-density lipoprotein/ High-density lipoprotein (LDL/HDL) ratio, free fatty acids, Tumor necrosis factor alpha (TNF-alpha), interleukin-6 (IL-6), and homeostasis model assessment of insulin resistance (HOMA-IR) as an index of insulin resistance. Results:The results showed that all AA extracts (100, 200, and 400 mg/kg) and metformin (250 mg/kg) significantly reduced the serum levels of free fatty acids, TNF-alpha, IL-6, LDL/HDL ratio, and HOMA-IR in diabetic mice compared to untreated diabetic mice (p<0.0001). Notably, the 400 mg/kg dose of cold-water extract was more effective than metformin in reduction of TNF-alpha and IL-6 (p<0.01 and p<0.05, respectively). Conclusion:These data illustrated that AA extracts attenuated insulin resistance by reducing the lipid profile and adipocytokines.

Gene ontology enrichment analysis of PPAR-γ modulators from Cassia glauca in diabetes mellitus.

PPAR-γ has an integrative role in the management of insulin resistance; ligands of this receptor have emerged as potent insulin sensitizers and may modulate proteins involved in the pathogenesis of diabetes mellitus. Hence the present study is aimed to identify PPAR-γ modulators from the plant Cassia glauca and predict the ontology enrichment analysis utilizing various in-silico tools. ChEBI database was used to mine the phytoconstituents present in the plant C. glauca, SwissTargetPrediction database was used to identify the targets, and scrutinizing of phytoconstituents modulating PPAR-γ was performed. Autodock4.0 was used to dock phytoconstituent ligands with the target PPAR-γ. Multiple open-source databases and in-silico tools were utilized to predict the drug-likeness characters and predict side effects of the phytoconstituents modulating PPAR-γ and STRING database was used to construct a network between the modulated genes. Twenty-four phytoconstituents were identified from the plant Cassia glauca from which four were found to modulate PPAR-γ, sennoside was predicted to have the greatest drug-likeness score and a significantly less side effect whereas diphenyl sulfone was predicted to show hepatotoxicity with the greatest pharmacological activity of 0.815. [epicatechin-(4beta- > 8)]5-epicatechin showed the lowest binding affinity with target PPAR-γ i.e. -8.6kcal/mol and possessing a positive drug-likeness score with no side effect data. Bioctives were found free from probable side effects leaving out diphenyl sulfone having a prediction of hepatotoxicity, the anti-diabetic property of the plant may be due to the presence of [epicatechin-(4beta- > 8)]5-epicatechin which needs further validation by in-vitro and in-vivo protocols.

Importance of Antidiabetic Medicinal Plants in the Prevention and Management of Insulin Resistance: Case of Gestational Diabetes in Cameroon

Importance of Antidiabetic Medicinal Plants in the Prevention and Management of Insulin Resistance: Case of Gestational Diabetes in Cameroon

The Role of Probiotics and Synbiotics on Hirsutism

Probiotics and synbiotics are known to have beneficial effects on human health and disease. Hirsutism, a disorder that is characterised by the presence of coarse terminal hairs in a male-like pattern, is usually caused by elevated androgen levels in blood plasma. This disorder is usually observed in PCOS women and it is linked to insulin resistance (IR). Although idiopathic hirsutism (IH) is not shown to have excess androgen production from the ovarian and adrenal glands, increased 5α-reductase in peripheral tissues and insulin resistance are common observations. The effect of probiotics and synbiotics have been recently studied on PCOS women; androgens were also included in the hormonal groups that were investigated. Only a few studies focus on hirsutism and the potential effect of the beneficial microbes mentioned, whereas the increasing interest on insulin resistance and synbiotics indicate a potential beneficial effect on hirsutism through the management of insulin resistance.

Angiotensin receptor neprilysin inhibitor as a novel antihypertensive drug: Evidence from Asia and around the globe.

Hypertension is a worldwide epidemic that continues to grow, with a subset of patients responding poorly to current treatment available. This is especially relevant in Asia, which constitutes 61% of the global population. Hypertension in Asia is a unique entity that is often salt‐sensitive, nocturnal, and systolic predominant. Sacubitril/valsartan is a first‐in‐class angiotensin receptor neprilysin inhibitor that was first used in heart failure with reduced ejection fraction. Sacubitril inhibits neprilysin, a metallopeptidase that degrades natriuretic peptides (NPs). NPs exert sympatholytic, diuretic, natriuretic, vasodilatory, and insulin‐sensitizing effects mostly via cyclic guanosine monophosphate (cGMP)‐mediated pathways. As an antihypertensive agent, sacubitril/valsartan has outperformed angiotensin II receptor type 1 blockers (ARBs), with additional reductions of office systolic blood pressures ranging between 5 and 7 mmHg, in multiple studies in Asia and around the globe. The drug was well tolerated even in the elderly or those with chronic kidney disease. Its mechanisms of actions are particularly attractive for treatment of hypertension in Asia. Sacubitril/valsartan offers a novel, dual class, single‐molecule property that may be considered as first‐line antihypertensive therapy. Further investigations are needed to validate its safety for long‐term use and to explore other potentials such as in the management of insulin resistance and obesity, which often coexist with hypertension in Asia.

Prevention and Management of Type 2 Diabetes and Metabolic Syndrome in the Time of COVID-19: Should We Add a Cup of Coffee?

Recent evidence shows that COVID-19 patients with existing metabolic disorders, such as diabetes and metabolic syndrome, are exposed to a high risk of morbidity and mortality. At the same time, in order to manage the pandemic, the health authorities around the world are advising people to stay at home. This results in decreased physical activity and an increased consumption of an unhealthy diet, which often leads to an increase in body weight, risk for diabetes, insulin resistance, and metabolic syndrome, and thus, paradoxically, to a high risk of morbidity and mortality due to COVID-19 complications. Here we summarize the evidence demonstrating that the promotion of a healthy life style, including physical activity and a dietary intake of natural polyphenols present in coffee and tea, has the potential to improve the prevention and management of insulin resistance and diabetes in the time of COVID-19 pandemic. Particularly, it would be pertinent to evaluate further the potential positive effects of coffee beverages, rich in natural polyphenols, as an adjuvant therapy for COVID-19, which appear not to be studied sufficiently.

Efficacy Evaluation of Standardized Fenugreek seeds extract as Furostanolic Saponins &amp; Myo-Inositol (Nutricyst-M) in Management of Insulin Resistance (IR) &amp; Ovary Volume in PCOS Subjects

Polycystic ovarian syndrome (PCOS) currently affects nearly 6-10% of women of reproductive age. A frequent feature of women with PCOS is insulin resistance accompanied by compensatory hyperinsulinemia, and increasing evidence suggests that hyperinsulinemia plays an important role in the pathogenesis of PCOS, pointing the way to new and novel therapy for PCOS. The study was planned with one natural alternative remedy Standardized Fenugreek seeds extract as FurostanolicSaponins and Myo-Inositol.Standardized Fenugreek seeds extract as Furostanolic saponins which contains bioactive components Saponins extracted from Fenugreek seeds improves insulin sensitivity and, in turn, may regulate circulating androgen levels. It improves insulin-mediated glucose disposal in women with PCOS [1,2]. It also decreased theLuteinizing HormoneLH/FSH (Follicle- Stimulating Hormone) ratio as observed in my last study [2-4]. Myo-inositol not only improves fertility by lowering male sex hormones in both, women with and without PCOS but it could also improve ovulation in women with PCOS. In addition, Myo-inositol also reduces insulin resistance and increases estrogen levels. Myo-inositol reduced testosterone, LH, and insulin levels. The present observation study is to establish efficacy and safety in management of IR and ovarian volume.

Clinical Correlates of Insulin Resistance in Chronic Schizophrenia: Relationship to Negative Symptoms.

Higher prevalence of physical comorbidity and premature mortality in persons with schizophrenia (PwS) results primarily from heightened cardiovascular and metabolic risks. The literature suggests that insulin resistance precedes the development of obesity, smoking, and use of antipsychotic medications, although these likely play a compounding role later in the course of the disorder. It is thus important to discover the clinical characteristics of PwS with high insulin resistance, as these individuals may represent an etiopathologically distinct subgroup with a distinct course and treatment needs. We conducted a cross-sectional study and compared insulin resistance between 145 PwS and 140 nonpsychiatric comparison (NC) participants, similar in age, sex, and race distribution. In addition, we examined correlates of insulin resistance in PwS. As expected, PwS had higher levels of insulin resistance [Homeostatic Model Assessment of Insulin Resistance (HOMA-IR)] and body mass index (BMI) compared to the NC participants. HOMA-IR in the PwS was most associated with negative symptoms, BMI, and non-White race/ethnicity. The mechanistic relationships between insulin resistance and negative symptoms in schizophrenia patients warrant further investigation, and future studies should examine outcomes of PwS with this cluster of physical and mental symptoms and determine how management of insulin resistance might improve health of these individuals.

Role of epigenomic mechanisms in the onset and management of insulin resistance.

The prevalence of insulin resistance (IR) is increasing rapidly worldwide and it is a relevant health problem because it is associated with several diseases, such as type 2 diabetes, cardiovascular disorders and cancer. Understanding the mechanisms involved in IR onset and progression will open new avenues for identifying biomarkers for preventing and treating IR and its co-diseases. Epigenetic mechanisms such as DNA methylation are important factors that mediate the environmental effect in the genome by regulating gene expression and consequently its effect on the phenotype and the development of disease. Taking into account that IR results from a complex interplay between genes and the environment and that epigenetic marks are reversible, disentangling the relationship between IR and epigenetics will provide new tools to improve the management and prevention of IR. Here, we review the current scientific evidence regarding the association between IR and epigenetic markers as mechanisms involved in IR development and potential management.

Omega-3 Fatty Acids and Insulin Resistance: Focus on the Regulation of Mitochondria and Endoplasmic Reticulum Stress.

Mitochondrial dysfunction and endoplasmic reticulum (ER) stress have been suggested to play a key role in insulin resistance development. Reactive oxygen species (ROS) production and lipid accumulation due to mitochondrial dysfunction seemed to be important mechanisms leading to cellular insulin resistance. Moreover, mitochondria are functionally and structurally linked to ER, which undergoes stress in conditions of chronic overnutrition, activating the unfolded protein response, which in turn activates the principal inflammatory pathways that impair insulin action. Among the nutrients, dietary fats are believed to play key roles in insulin resistance onset. However, not all dietary fats exert the same effects on cellular energy metabolism. Dietary omega 3 polyunsaturated fatty acids (PUFA) have been suggested to counteract insulin resistance development by modulating mitochondrial bioenergetics and ER stress. In the current review, we summarized current knowledge on the role played by mitochondrial and ER stress in inflammation and insulin resistance onset, focusing on the modulation role of omega 3 PUFA on these stress pathways. Understanding the mechanisms by which omega 3 PUFA modulates cellular metabolism and insulin resistance in peripheral tissues may provide additional details on the potential impact of omega 3 PUFA on metabolic function and the management of insulin resistance in humans.

The effects of resistance exercise on insulin sensitivity in adolescents

Background: An escalating incidence of type 2 diabetes among adolescents is causing concern. This is thought to be sparked by rising population-wide prevalence of insulin resistance. Resistance exercise has been shown to reduce insulin resistance, however only immediate, post-intervention effects have been demonstrated. The use of resistance exercise by adolescents in managing insulin resistance in the long-term has not been evaluated. Purpose: To assess the effects, up to six months, of a physiotherapist-supervised, resistance exercise program on insulin sensitivity, cardiorespiratory fitness, muscle strength, physical activity levels, and anthropometric measures among adolescents with insulin resistance. Methods: Participants with insulin resistance were recruited from a database of patients from a pediatric chronic disease prevention program. They completed a supervised 10-week resistance exercise program, 60-minutes, three times per week. A body positive approach was used focusing on health behaviours. Using a repeated-measures design, participants were assessed during an observational run-in control period then at pre, post, and 6-month follow-up assessments. The primary outcome was insulin sensitivity, measured by the oral glucose tolerance test. Secondary outcomes included cardiorespiratory fitness, muscle strength, physical activity level, and anthropometric measures. Results: Thirteen participants (14.16±1.19 years old; 8 males, 5 females) completed the intervention. Improvements in insulin sensitivity were found, observed as reduced fasting insulin [F(₂,₂₂)=7.54,p=0.003,ηp²=0.41], fasting glucose [F(₂,₂₂)=3.58,p=0.045,ηp²=0.25], and HOMA-IR [F(₂,₂₂)=7.60,p=0.003,ηp²=0.41], which were maintained at follow-up. Cardiorespiratory fitness, waist circumference, and waist-to-hip ratio also significantly improved at post and follow-up. Daily physical activity levels improved but not significantly. Upper and lower body muscle strength significantly increased post-intervention but returned to pre-assessment values at follow-up. Conclusion: The findings suggest that a supervised 10-week resistance exercise program (60-minute, three times per week) improves insulin sensitivity, cardiorespiratory fitness, waist circumference, and waist-to-hip ratio in adolescents who are at high risk of developing type 2 diabetes. Importantly, these benefits are maintained up to six months. Supervised, resistance exercise adds significant long-term benefit in the management of insulin resistance in adolescents.