Insulin Resistance as a Predictor of Age-Related Diseases

Insulin Resistance as a Predictor of Age-Related Diseases

Francesco S. Facchini, Nancy Hua, Fahim Abbasi and Gerald M. Reaven
– Author Affiliations

Departments of Medicine (F.S.F., N.H., F.A., G.M.R.), Stanford University, School of Medicine Stanford, California 94305; and San Francisco General Hospital (F.S.F.), University of California–San Francisco, San Francisco, California 94110
Address all correspondence and requests for reprints to: G. M. Reaven, M.D., 213 East Grand Avenue, South San Francisco, California 94080. E-mail: greaven@shaman.com.

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Abstract

The current study was initiated to evaluate the ability of insulin resistance to predict a variety of age-related diseases. Baseline measurements of insulin resistance and related variables were made between 1988–1995 in 208 apparently healthy, nonobese (body mass index < 30 kg/m2) individuals, who were then evaluated 4–11 yr later (mean ± SEM = 6.3 ± 0.2 yr) for the appearance of the following age-related diseases: hypertension, coronary heart disease, stroke, cancer, and type 2 diabetes. The effect of insulin resistance on the development of clinical events was evaluated by dividing the study group into tertiles of insulin resistance at baseline and comparing the events in these 3 groups. Clinical endpoints (n = 40) were identified in 37 individuals (18%) of those evaluated, including 12 with hypertension, 3 with hypertension + type 2 diabetes, 9 with cancer, 7 with coronary heart disease, 4 with stroke, and 2 with type 2 diabetes. Twenty-eight out of the total 40 clinical events were seen in 25 individuals (36%) in the most insulin-resistant tertile, with the other 12 occurring in the group with an intermediate degree of insulin resistance. Furthermore, insulin resistance was an independent predictor of all clinical events, using both multiple logistic regression and Cox’s proportional hazards analysis. The fact that an age-related clinical event developed in approximately 1 out of 3 healthy individuals in the upper tertile of insulin resistance at baseline, followed for an average of 6 yr, whereas no clinical events were observed in the most insulin-sensitive tertile, should serve as a strong stimulus to further efforts to define the role of insulin resistance in the genesis of age-related diseases.

A picture is worth a thousand words: check out the graph: all the instances of disease, including heart disease and cancer, occurred in the upper two tertiles of insulin resistance. Those in the lower tertile had no age-related diseases in the time period in which they were tracked.

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5 comments
Steve Parker MD says September 21, 2013

For those who don’t know, there are 3 common ways to reduce insulin resistance:
1) caloric restriction
2) lose excess fat weight
3) regular physical activity

-Steve

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Toddy Cat says September 23, 2013

This is pretty much in line with what Gary Taubes was saying six years ago.

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eah says September 23, 2013

Dennis,

Thanks for another interesting post. Quick question (sorry if it’s a dumb question): How is insulin resistance measured? Is it a simple test one can ask a doctor to perform? — ie as part of a routine physical.

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    Mangan says September 23, 2013

    eah: the way IR is measured in studies like this involves a so-called clamp, and this is a rather complicated exercise. However, I believe that a simple fasting blood glucose level, a simple test, will give a good indication of IR. Slightly more complicated, but easily doable, is a glucose tolerance test, which involves drinking a bolus of glucose and taking blood glucose levels at various intervals afterward.

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Mangan says September 23, 2013

Oh, and thanks to Steve Parker for pointing out what I neglected, and Toddy Cat, you are correct.

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