Which medications are used in the treatment of insulin resistance?

Updated: Aug 07, 2019
  • Author: Samuel T Olatunbosun, MD, FACP, FACE; Chief Editor: George T Griffing, MD  more...
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Answer

Medications that reduce insulin resistance (insulin-sensitizing and antihyperglycemic effects) include metformin and the thiazolidinediones. [9]

Metformin is a biguanide; it reduces hepatic glucose output and increases the uptake in the peripheral tissues (muscle and adipocytes). Metformin is a major drug in the treatment of patients who are obese and have type 2 diabetes. The drug enhances weight reduction and improves lipid profile and vascular integrity. [66]

Long-term follow-up data from the Diabetes Prevention Program (DPP)/DPP Outcomes Study (DPPOS) found metformin is associated with vitamin B12 deficiency, and routine measurement of vitamin B12 should be considered in patients receiving metaformin. [67]

Thiazolidinediones lower plasma insulin levels and treat type 2 diabetes associated with insulin resistance. [68, 69, 70]  In a multicenter, double-blind trial of 3876 insulin-resistant patients who had had a recent ischemic stroke or transient ischemic attack (TIA), those receiveing pioglitazone  (45 mg daily) had a reduced the risk of stroke, myocardial infarction, and diabetes compared to those receiving placebo. However, pioglitazone increased the risk for weight gain, edema, and fracture. [71]

Successful treatment of severe type B insulin resistance has been reported with rituximab, cyclophosphamide, and prednisone following failure of immunosuppressive therapy and plasmapheresis to control glucose levels or reduce insulin dosage. [72]


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