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Is Insulin Resistance a Treatment Target?

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Insulin Resistance

Part of the book series: Contemporary Endocrinology ((COE))

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Abstract

In recent years, pediatricians have been increasingly treating insulin resistance with drugs such as metformin to improve cardiovascular risk. However, some randomized controlled trials in adolescents reported that metformin has no effect on insulin resistance and its associated cardiovascular risk factors. This raises questions about the concept of insulin resistance as a treatment target. Furthermore, some shortcomings of the definition and measurement of insulin resistance in children and adolescents have to be kept in mind. There is currently no accurate, reliable, reproducible, and easily applicable method of measurement of insulin resistance. Fasting insulin as an index of insulin resistance or insulin resistance indices such as homeostasis model assessment (HOMA) may be applicable in epidemiological studies using large populations of children and/or well-defined cohorts, but not at the individual level. Even if a uniformly reliable insulin assay became available, separate normative values specific to sex, ethnic group, and pubertal stage would be needed. Additionally, there are very limited longitudinal data in childhood regarding whether insulin resistance itself predicts the development of cardiovascular diseases and type 2 diabetes mellitus better than body mass index (BMI) or classic cardiovascular risk factors alone. In conclusion, the presence of obesity or associated cardiovascular risk factors should be treated with lifestyle intervention and/or drugs that secondarily improve insulin resistance without a focus on insulin resistance as a primary treatment target.

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  1. Department of Pediatric Endocrinology, Diabetes and Nutrition Medicine, Vestische Children’s Hospital, University of Witten/Herdecke, Datteln, NRW, Germany

    Thomas Reinehr

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  1. Section of Pediatric Endocrinology, Children’s Hospital Colorado, Aurora, CO, USA

    Philip S. Zeitler

  2. Department of Pediatrics, Children’s Hospital Colorado, Aurora, CO, USA

    Kristen J. Nadeau

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Reinehr, T. (2020). Is Insulin Resistance a Treatment Target?. In: Zeitler, P., Nadeau, K. (eds) Insulin Resistance. Contemporary Endocrinology. Humana, Cham. https://doi.org/10.1007/978-3-030-25057-7_17

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