Glucocorticoids and the insulin resistance syndrome.

BACKGROUND

Insulin regulates the uptake, utilization and storage of cellular nutrients. An attenuated responsiveness of tissues to insulin (insulin resistance), results in the metabolic or insulin resistance syndrome, polycystic ovary disease, lipodystrophic states and leprechaunism. Type 2 diabetes mellitus, a consequence of insulin resistance and a major component of the insulin resistance syndrome, currently affects 177 million people worldwide and is predicted to rise to over 300 million by 2025 (the majority of cases in Africa).

METHODS

We reviewed currently available literature on the role of glucocorticoids in the pathogenesis and clinical management of the insulin resistance syndrome.

RESULTS

The epidemiology of insulin resistance, the components of insulin resistance syndrome, factors responsible for insulin resistance, the role of glucocorticoids, and the treatment of gluocorticoid induced insulin resistance have been discussed.

CONCLUSION

Chronically elevated serum glucocorticoid levels contribute to diabetes and removal of glucocorticoid excess improves insulin sensitivity. Because insulin regulates 11beta-hydroxysteroid dehydrogenase enzyme type-1 (11betaHSD-1) activity, it has been suggested that dysregulation of (11betaHSD-1) may underlie the pathogenesis of glucocorticoid-dependent insulin-resistance. Indeed, 11beta-HSD1 has been proposed as a new target for type 2 diabetes drugs.