Diabetes Precursor Rife Among Americans

You might live in blissful ignorance of insulin resistance syndrome, but there is a decent chance you have it.

The condition, which physicians are also calling "dysmetabolic syndrome," involves not only impaired sensitivity to insulin but blood fat anomalies, high blood pressure, and obesity. The syndrome is linked to a constellation of severe health problems, including diabetes, heart ailments, and strokes. Experts suspect that between one in five and one in three Americans have it.

There Is Good News

But the good news, they said, is that staying fit and shedding excess pounds can greatly reduce the chances that insulin resistance will lead to illness.

"We have the capacity to make an enormous, enormous impact," said Dr. Gerald Reaven, a Stanford University diabetes expert acknowledged as the father of insulin resistance syndrome, which he initially dubbed Syndrome X. Even modest reductions in body weight, say 5 to 10 percent, and regular physical activity can sharply improve the outlook for people with abnormal insulin sensitivity.

New Guidelines Are Published

New guidelines for the condition have been put forth by a panel that included members of the American Medical Association, The Endocrine Society, the American Association of Diabetes Educators, and the American College of Physicians-American Society of Internal Medicine. The prevalence of the syndrome in this country has soared by 61 percent over the last decade, thanks to an equally stunning rise in obesity.

However, roughly 20 percent of people with insulin resistance syndrome are not overweight at all, Reaven said. So physicians who only look for the problem in their heavier patients may be missing a large chunk of cases. That is especially important for the detection of risk factors for heart disease, which is a major complication of insulin trouble and its most severe form, diabetes.

Dr. Daniel Einhorn, medical director of the Scripps/Whittier Diabetes Institute in La Jolla, Calif., and co-chairman of the panel, said the guidelines should help physicians identify patients with the syndrome.

Potential Signs of the Condition

A family history of diabetes and heart disease, a high body mass index—a measure of obesity—and elevated blood pressure are potential signs of the syndrome. So, too, are high levels of blood fats called triglycerides, and low concentrations of high-density lipoprotein (HDL), the so-called "good" cholesterol. Many people with insulin resistance syndrome may have normal levels of LDL, the "bad" form of cholesterol.

"If you are a person at risk, you should know your values. If you have one or more of these abnormalities, you most likely have the insulin resistance syndrome," Einhorn said.

Physicians should also be alert to the condition in their patients over age 40, as well as those whose body fat is distributed chiefly around their abdomen. And women with a history of diabetes during pregnancy or a disorder called polycystic ovary syndrome have a high risk of insulin insensitivity, too.

Insulin resistance syndrome cannot currently be identified directly. But physicians see its shadow in the blood by testing people for how well they process a large dose of blood sugar.

Dr. Omega Silva, past president of the American Medical Women's Association, called insulin resistance a "public health epidemic" that "needs to be prevented rather than treated."

Einhorn noted that while diet and exercise can keep insulin problems from flowering into disease, physicians do not yet have medications approved specifically to enhance sensitivity to the hormone in non-diabetic patients.

Reaven said weight and physical activity each contribute about 25 percent to the variability in insulin sensitivity between people. The rest appears to be genetic, though researchers have not made much progress identifying the genes involved.

Always consult your physician for more information.