What is the role of medications 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

The goals of pharmacotherapy are to reduce morbidity and to prevent complications. Medications that reduce insulin resistance include biguanides and thiazolidinediones, which have insulin-sensitizing and antihyperglycemic effects. Large quantities of insulin are also used in overcoming insulin resistance. Response to usual dosage of insulin is observed in instances in which the resistance is due to enhanced destruction at the subcutaneous injection site.

The treatment of type 2 diabetes and impaired glucose tolerance (IGT)—conditions that are strongly associated with insulin resistance and significant cardiovascular morbidity and mortality—should aim at restoring the normal relationship between insulin sensitivity and secretion.

For diabetes, this involves pharmacotherapy, which includes stimulation of insulin secretion (sulfonylureas, meglitinides, incretin mimetics) and insulin sensitivity (metformin, thiazolidinediones), as well as treatment intended to support the signals that mediate the islet adaptation (incretin mimetics). [9, 66]

Pramlintide (an amylin analogue) acts as an amylinomimetic agent by modulating gastric emptying, preventing postprandial increases in plasma glucagon, and promoting satiety, leading to decreased caloric intake and potential weight loss. Antiobesity drugs, such as orlistat, may reduce insulin resistance and related cardiovascular risk factors through weight reduction and other mechanisms. [77, 78, 79, 80, 81] In most patients, the administration of insulin is also crucial in the treatment of diabetes.

Most experts recommend early preventive strategies in children, especially lifestyle changes such as diet and increased level of physical activity, whereas pharmacotherapy is reserved for selected cases. [40]


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