Insulin Resistance, Type 2 Diabetes and Atherosclerosis

Insulin resistance is a hallmark of type 2 diabetes mellitus and is associated with a metabolic and cardiovascular cluster of disorders (dyslipidaemia, hypertension, obesity, glucose intolerance, metabolic syndrome and endothelial dysfunction), each of which is an independent risk factor for Cardiovascular Disease (CVD). Many prospective studies have documented an association between insulin resistance and accelerated CVD in patients with type 2 diabetes. Insulin resistance and lipotoxicity represent the missing links that help to explain the accelerated rate of CVD in type 2 diabetic patients. Accumulation of toxic lipid metabolites in muscle, liver, adipocytes, beta cells and arterial tissues contributes to insulin resistance, beta cell dysfunction and accelerated atherosclerosis, respectively, in type 2 diabetes. Treatment with diet, exercise and drugs mobilizes fat out of tissues, leading to enhanced insulin sensitivity, improved beta cell function and decreased atherogenesis.