What are the treatment options for insulin resistance?

From the Guidelines

Lifestyle modifications, including a balanced diet and regular physical activity, are the primary approach to treating insulin resistance, with weight loss of 5-10% of body weight significantly improving insulin sensitivity. Treatment options for insulin resistance include lifestyle modifications and medications. The primary approach involves lifestyle changes such as adopting a balanced diet rich in vegetables, lean proteins, and complex carbohydrates while limiting processed foods and added sugars, as recommended by the American Diabetes Association 1. Regular physical activity is crucial, with at least 150 minutes of moderate exercise weekly recommended, as stated in the 2016 American Diabetes Association standards of medical care in diabetes 1.

Key Lifestyle Modifications

• Adopting a balanced diet with reduced energy and fat intake, as recommended by the American Diabetes Association 1
• Engaging in regular physical activity, such as at least 150 minutes of moderate-intensity aerobic activity per week, as recommended by the 2016 American Diabetes Association standards of medical care in diabetes 1
• Achieving weight loss of 5-10% of body weight, which can significantly improve insulin sensitivity

Medications

For medications, metformin is the first-line pharmaceutical treatment, improving insulin sensitivity by reducing liver glucose production, as recommended by the 2016 American Diabetes Association standards of medical care in diabetes 1. Thiazolidinediones like pioglitazone may be prescribed to enhance insulin sensitivity in muscle and fat tissue. GLP-1 receptor agonists such as semaglutide or liraglutide can help with weight loss and improve insulin sensitivity. SGLT-2 inhibitors like empagliflozin or dapagliflozin may be beneficial, especially for those with cardiovascular risk factors. Regular monitoring of blood glucose levels, blood pressure, and lipid profiles is essential to track progress and adjust treatment as needed. These interventions work by reducing the body's resistance to insulin, allowing it to more effectively transport glucose from the bloodstream into cells for energy use.

From the FDA Drug Label

Metformin is an antihyperglycemic agent which improves glucose tolerance in patients with type 2 diabetes mellitus, lowering both basal and postprandial plasma glucose. Metformin decreases hepatic glucose production, decreases intestinal absorption of glucose, and improves insulin sensitivity by increasing peripheral glucose uptake and utilization

The treatment options for insulin resistance include metformin, which improves insulin sensitivity by increasing peripheral glucose uptake and utilization.

• Key benefits of metformin include:
  • Decreasing hepatic glucose production
  • Decreasing intestinal absorption of glucose
  • Improving insulin sensitivity 2 Note that metformin is used to treat type 2 diabetes mellitus, and its use in treating insulin resistance may be off-label.
• Clinical studies have shown that metformin can be effective in reducing fasting plasma glucose and HbA1c levels in patients with type 2 diabetes mellitus 2.

From the Research

Treatment Options for Insulin Resistance

The treatment of insulin resistance involves a combination of lifestyle modifications and pharmacological interventions. Some of the key treatment options include:

• Lifestyle modifications such as diet and exercise 3
• Nutritional and botanical substances like minerals (magnesium, calcium, potassium, zinc, chromium, and vanadium) and amino acids (L-carnitine, taurine, and L-arginine) 3
• Pharmacological interventions like metformin and thiazolidinediones (pioglitazone and rosiglitazone) 4, 5, 6

Pharmacological Interventions

Pharmacological interventions play a crucial role in the management of insulin resistance. Some of the key pharmacological interventions include:

• Metformin: improves glycemic control by suppressing hepatic glucose output 4, 5, 6
• Thiazolidinediones (TZDs): improve insulin sensitivity by increasing peripheral glucose uptake 4, 5, 6
• Combination therapy: metformin and TZDs can be used in combination to achieve better glycemic control and improve cardiovascular risk factors 4, 5, 6

Lifestyle Modifications

Lifestyle modifications are essential for the management of insulin resistance. Some of the key lifestyle modifications include:

• Diet: a healthy diet that is low in sugar and saturated fats can help improve insulin sensitivity 3, 7
• Exercise: regular physical activity can help improve insulin sensitivity and reduce the risk of cardiovascular disease 3, 7
• Stress management: stress can exacerbate insulin resistance, and stress management techniques like yoga and meditation can help improve insulin sensitivity 3, 7

Nutritional and Botanical Substances

Nutritional and botanical substances can also play a role in the management of insulin resistance. Some of the key substances include:

• Minerals: magnesium, calcium, potassium, zinc, chromium, and vanadium have been shown to have a positive effect on insulin sensitivity 3
• Amino acids: L-carnitine, taurine, and L-arginine have been shown to have a positive effect on insulin sensitivity 3
• Herbal medicines: some herbal medicines like silymarin and Inula racemosa have been shown to have a positive effect on insulin sensitivity 3