Insulin Resistance
(Sprache: Englisch)
Insulin resistance, defined as a reduced biological action ofinsulin, has emerged as a major factor in the development andprogression of a number of common non-communicable diseases in man. The role of insulin resistance in the aetiology of type 2 diabetesis particularly well-established.
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Insulin resistance, defined as a reduced biological action ofinsulin, has emerged as a major factor in the development andprogression of a number of common non-communicable diseases in man. The role of insulin resistance in the aetiology of type 2 diabetesis particularly well-established.
Klappentext zu „Insulin Resistance “
Insulin resistance, defined as a reduced biological action ofinsulin, has emerged as a major factor in the development andprogression of a number of common non-communicable diseases in man.The role of insulin resistance in the aetiology of type 2 diabetesis particularly well-established. However, insulin resistance hasalso come to be regarded as a key component of a broader syndromeof common metabolic defects that conspire to increase the risk ofatherosclerotic coronary heart disease. The ramifications ofinsulin resistance now embrace many different medical specialties.The objective of this book is to summarize the current state ofknowledge about insulin resistance. Section 1 (Pathophysiology ofInsulin Resistance) considers the development of current conceptsof insulin resistance. This is followed by a critical review oftechniques for the assessment of insulin action in humans. Thesection concludes with an outline of current hypotheses concerningthe molecular defects responsible for insulin resistance. Section 2(Insulin Resistance in Clinical Medicine) broadens the discussionto include physiological and pathological conditions with whichinsulin resistance is associated; the effects of drug treatment oninsulin sensitivity are also considered. Section 3 (Management ofInsulin Resistance and Associated Conditions) focuses on theavoidance and treatment of insulin resistance in its clinicalmanifestations. A discussion of the potential benefits ofnon-pharmacological measures prefaces a review of the range ofdrugs used in the treatment of type 2 diabetes and relateddisorders. References are confined to key articles at the end ofeach section.
Improved nutrition allied to increased levels of physical exerciseare of crucial importance in the battle to stem the increasingincidence and prevalence of insulin resistance; however,translation of such advice into action has proved difficult inpractice. Thus, other approaches have been explored. Recent yearshave witnessed
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considerable progress in the pharmacologicalmanagement of insulin resistance. In particular, thethiazolidinediones (and other insulin-sensitizing drugs) appear toprovide a more specific assault on insulin-resistance. Clinicalexperience with these agents remains relatively limited and serioushepatotoxicity has clouded the first agent in this class -troglitazone. With its introduction into the USA in 1995 and drivenby the publication of the United Kingdom Prospective DiabetesStudy, metformin has enjoyed a renaissance. This well-establishedagent is finding application for new clinical indications. Inparallel, the development of anti-obesity drugs continuesapace.
The molecular and genetic mechanisms underlying some forms ofinsulin resistance are being revealed.
Original intellectual concepts such as the fetal origins hypothesisare challenging traditional views about the aetiology of insulinresistance and its clinical sequelae. These exciting scientificadvances notwithstanding, the evolving global epidemic of obesityand type 2 diabetes represents an enormous public health challenge.Now more than ever, research must focus on identifying solutionsthat are applicable on the level of entire populations. Bydefinition, these must also be practical and cost-effective.
The molecular and genetic mechanisms underlying some forms ofinsulin resistance are being revealed.
Original intellectual concepts such as the fetal origins hypothesisare challenging traditional views about the aetiology of insulinresistance and its clinical sequelae. These exciting scientificadvances notwithstanding, the evolving global epidemic of obesityand type 2 diabetes represents an enormous public health challenge.Now more than ever, research must focus on identifying solutionsthat are applicable on the level of entire populations. Bydefinition, these must also be practical and cost-effective.
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Inhaltsverzeichnis zu „Insulin Resistance “
Section 1. Pathophysiology of insulin resistance 1.1 Introduction 1.2 Normal physiology 1.2.1 Hormonal regulation of metabolism 1.2.2 The insulin receptor 1.2.3 Post-binding events 1.2.4 Glucose metabolism 1.2.5 Lipid metabolism 1.2.6. Protein metabolism 1.2.7. Ion transport 1.3 The concept of insulin resistance 1.3.1 Early studies of insulin action 1.4 Definitions of insulin resistance 1.5 Assessment of insulin action in vivo 1.5.1 Fasting insulin concentration 1.5.2 Dynamic tests - endogenous insulin 1.5.3 Dynamic tests - exogenous insulin 1.5.4 Mathematical modelling techniques 1.5.5 The insulin suppression test 1.5.6 The hyperinsulinaemic euglycaemic clamp technique 1.6. Mechanisms of insulin resistance 1.6.1 Genetic causes of insulin resistance 1.6.2 Acquired causes of insulin resistance 1.6.3.Fetal origins hypothesis Further Reading Section 2. Insulin resistance in clinical medicine 2.1 Clinical features 2.2 Factors influencing insulin sensitivity 2.2.1 Normal variation in insulin action 2.2.2 Sex 2.2.3 Age 2.2.4 Physical activity 2.2.5 Tobacco 2.2.6 Alcohol 2.3. Physiological states of insulin resistance 2.3.1 Puberty 2.3.2 Pregnancy 2.3.4 The menopause 2.4 Severe insulin resistance syndromes 2.5 Insulin resistance and cardiovascular risk 2.5.1 Syndrome X 2.5.2 Obesity 2.5.3 Regional adiposity 2.5.4 Impaired glucose tolerance 2.5.5 Type 2 diabetes 2.5.6 Essential hypertension 2.5.7 Dyslipidaemia 2.5.8 Endothelial dysfunction 2.5.9 Microalbuminuria 2.5.10. Hyperuricaemia 2.5.11 Impaired Fibrinolysis 2.5.12 Polycystic ovary syndrome 2.5.13 Non-alcoholic steatohepatitis 2.6 Other disorders associated with insulin resistance 2.6.1 Counter-regulatory hormone secretion 2.6.2 Endocrinopathies 2.6.3 Chronic renal failure 2.6.4 Cirrhosis 2.6.5 Cardiac failure 2.7 Miscellaneous inherited disorders 2.8 Drug-induced insulin resistance Further Reading Section 3. Management of insulin resistance and associated conditions 3.1 Non-pharmacological measures 3.1.1 Medical
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nutrition therapy 3.1.3 Alcohol 3.1.4 Tobacco 3.2 Drugs for type 2 diabetes 3.2.1 Biguanides 3.2.2 Thiazolidinediones 3.2.3 Sulphonyulreas 3.2.4 Repaglinide 3.2.5 a-glucosidase inhibitors 3.2.6 Insulin therapy 3.3 Anti-obesity drugs 3.4 Lipid-modifying drugs 3.5 Anti-hypertensive drugs 3.6 Experimental therapies
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Bibliographische Angaben
- Autor: Andrew J. Krentz
- 2002, 204 Seiten, Maße: 14 x 21,6 cm, Gebunden, Englisch
- Verlag: Blackwell Publishers
- ISBN-10: 0632056622
- ISBN-13: 9780632056620
- Erscheinungsdatum: 01.08.2002
Sprache:
Englisch
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