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Q: What other management strategies would you institute at this time?
A: Weight loss and increased level of physical activity are powerful modulators of insulin mediated glucose disposal. A weight loss of 5% to 10% of body weight in overweight/obese individuals who are insulin resistant will enhance insulin sensitivity, lower plasma insulin concentrations, and improve manifestations of Insulin Resistance Syndrome.5 Aerobic exercise (30 to 40 minutes 5 times weekly) will also directly enhance insulin sensitivity. The combination of weight loss and increased physical activity can significantly decrease development of type 2 diabetes in high-risk individuals.6,7 Therefore, weight loss and lifestyle changes should be recommended for patients who display characteristics of the Insulin Resistance Syndrome.
Weight loss also has beneficial effects on blood pressure. As little as 10 pounds of weight loss may significantly lower blood pressure; it is estimated that every 1 kg (2.2 lbs) of weight loss is associated with a lowering of systolic and diastolic blood pressure by 2.5 and 1.5 mm Hg, respectively.8
At this time, drugs that enhance insulin sensitivity (eg, thiazolidinediones, biguanides) are approved only for the treatment of hyperglycemia in patients with type 2 diabetes, but both classes are being evaluated for use in prediabetic patients.
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