Disease states diabetes with insulin resistance

Diabetes mellitus is characterized by hypergly-caemia and disturbances of carbohydrate, fat and protein metabolism that are associated with absolute or relative deticiencies in insulin action and/or insulin secretion. Although diabetes is an endocrine deficiency or resistance state its major manifestations are those of metabolic disease with wide ranging tissue effects. Insulin resistance does exist in type 2 diabetes, however it is also exists in many individuals without diabetes. It is difficult to accept insulin resistance is the sole determining pathogenic factor in type 2 diabetes. Therefore, it is more appropriate to describe type 2 diabetes as a condition of /3-cell dysfunction in an insulin resistance background. 

Finally, insulin resistance is present in disease states other than type 2 diabetes mellitus. Patients with conditions such as hypertension, obesity, and certain hyperlipidemias are also found to have decreased tissue sensitivity to circulating insulin.19,72 As discussed in Chapter 21, a combination of these abnormalities is often described as metabolic syndrome, or syndrome X.127,128 Metabolic syndrome occurs when insulin resistance, high blood pressure, abdominal... 

In conclusion, it can be stated, that biguanides, preferably metformin, have been shown in innumerable clinical trials to be highly effective as antihyper-glycaemic drugs. Together with acarbose, they may be the first-choice drug for the treatment of obese hyperinsulinaemic, insulin resistant Type-II diabetics with dietary failure. They help to correct most of the unwanted aspects of the metabolic syndrome, which is felt to contribute most to the high mortality rate of NIDDM patients with heart disease. 

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