Search

One of the major public health challenges facing clinicians in primary care is the effective management of the overweight, sedentary person with dyslipidaemia, hypertension, hyperglycaemia and type 2 diabetes. The culprit for this cluster of metabolic and haemodynamic abnormalities has been known since 1988 when Reaven explained the link between insulin resistance and treated or untreated hypertension, as a consequence of the high insulin concentrations found in insulin resistant people — i.e. insulin resistance is a significant risk factor for heart disease. Over a decade has passed but there are still many clinicians with little understanding of insulin resistance and the catastrophic consequences that result from underrecognition and under-treatment. This feature will seek to put a new face on old knowledge, unpack the characteristics of insulin resistance and offer a practical way forward. The size of the challenge It is estimated that two million people in the UK suffer from type 2 diabetes, although only 50% may be diagnosed. The lifetime expectation of developing the disease is thought to be greater than 10% (King’s Fund Policy Institute, 1996). The annual cost of caring for people with type 2 diabetes is £2 billion, or 4.7% of total Health Service expenditure. This is much higher than for cancer or asthma, which account for 2.1% and 1.6% of the NHS spend respectively. Life expectancy of a person with type 2 diabetes is reduced by eight to ten years (Campbell, 1997). Therefore, the cost to the individual, being premature death, is far higher.