Lifestyle Therapy Targeting Hyperinsulinemia Normalizes Hyperglycemia and Surrogate Markers of Insulin Resistance in a Large, Free-Living Population

AJPM Focus. 2022 Sep 16;1(2):100034. doi: 10.1016/j.focus.2022.100034. eCollection 2022 Dec.

Abstract

Introduction: This article reports the evaluation of a personalized, team-based comprehensive lifestyle modification program targeting known triggers of hyperinsulinemia and insulin resistance.

Methods: A retrospective chart review was undertaken for 536 participants in a novel high-intensity lifestyle behavioral modification program. Surrogate markers of insulin resistance and metabolic syndrome‒related pathologies were measured before and after participation in the the program.

Results: Reversal of metabolic syndrome was present in 42% of participants who met the criteria for this syndrome. Additional changes seen in this cohort include: 36% decrease in triglyceride to high-density lipoprotein cholesterol ratio; 5% (-7.2 mm Hg) decrease in systolic blood pressure and 4% (-3.8 mm Hg) decrease in diastolic blood pressure; decreased abdominal adiposity and waist circumference (-7.6 cm); increased high-density lipoprotein cholesterol (1.3 mg/dL); and 23% (-57.1 mg/dL) decrease in serum triglycerides. Hyperglycemia was normalized in 35% of participants with prediabetes. Only 2% of those with prediabetes progressed to type 2 diabetes mellitus. Among those with type 2 diabetes mellitus, 46% experienced a reduction in HbA1c to below diabetic cut offs. Compared to baseline, the Metabolic Syndrome Severity Score decreased by 30% among those with metabolic syndrome, 11% among those with prediabetes, 26% among those with type 2 diabetes mellitus, and 38% among those with uncontrolled type 2 diabetes mellitus. Cardiorespiratory fitness, measured by the calculated Metabolic Equivalent of Task maximum, increased by 30% in the metabolic syndrome cohort, 28% in the prediabetic cohort, 29% in the type 2 diabetes mellitus cohort, 29% in the uncontrolled type 2 diabetes mellitus cohort, and 32% in the cohort with obesity.

Conclusion: Modifying lifestyle factors that trigger hyperinsulinemia provided pleiotropic improvements to all measured surrogate markers of insulin resistance, mitigated the progressive nature of the insulin resistance and metabolic syndrome‒related chronic pathologies, reduced Metabolic Syndrome Severity Score, and improved cardiorespiratory fitness. These results suggest that earlier identification of the diagnostic criteria of metabolic syndrome and/or Metabolic Syndrome Severity Score and the prompt initiation of a comprehensive therapeutic lifestyle approach would significantly mitigate disease burden.

Keywords: Lifestyle intervention; Metabolic Syndrome Severity Score; hyperinsulinemia; insulin resistance; metabolic syndrome; therapeutic carbohydrate reduction.