Improved HOMA-IR Insulin Sensitivity and Glycemic Control Utilizing Physiologic Insulin Resensitization

Author(s): Brian Loveridge, Michael Alexander, Zach Villaverde, Natalie Parkin, Shelley Messerly, Jonathan RT Lakey

Type 2 diabetes (T2DM) is a chronic metabolic disorder resulting in the inability to regulate glucose metabolism due to either insulin resistance, the lack of insulin secretion or both. Unfortunately, new cases of diabetes continue to rise globally mainly due to the increase in obesity. Left untreated, chronic hyperglycemia can result in devastating micro and macrovascular complications such as heart disease, stroke, kidney failure, blindness, and diabetic neuropathy. A hallmark of T2DM is progressive insulin resistance and metabolic dysfunction that plays a central role in the myriad complications found in this condition. A simple measure of insulin resistance is calculated with the Homeostatic Model Assessment for Insulin Resistance (HOMA-IR). It is calculated according to the formula: fasting glucose (nmol/L) X fasting insulin (microU/L)/22.5. Greater than 1.9 indicates early insulin resistance, while greater than 2.9 indicates significant insulin resistance. Reversing insulin resistance, in the setting of T2DM, may play a critical role in improving the complications of this chronic disease. As such, physiologic insulin resensitization (PIR) has been used as a novel approach to treat patients suffering from progressive insulin resistance and later stage complications of T2DM. In this case study, we present a case series of T2DM patients that who improved HOMA-IR and A1C glycemic control utilizing PIR.