Insulin Resistance in Chronic Disease

Patients with chronic diseases may develop, in addition to their underlying disease, insulin resistance, and the metabolic syndrome (MetS). The MetS is a cluster of conditions—hypertension, central obesity, dyslipidemia, and insulin resistance—that increases the risk for coronary heart disease, type 2 diabetes, and stroke. In this chapter, we aim to review the prevalence of the MetS in several chronic diseases and its impact on long-term morbidity. Bidirectional relationships between obesity and chronic diseases may exist, such as obesity predating the development of the disease, while medications and disability further increase the risk of developing the MetS. Patients with chronic disease may develop components of the MetS, even with normal body mass index (BMI). Patients with chronic disease carry an increased risk of morbidity due to coronary heart disease. A beneficial effect of metformin on glycemic control has been demonstrated, and this may be a promising drug for preventing metabolic side effects in some chronic diseases.