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2017 ; 7
(1
): 37-51
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Skin Manifestations of Insulin Resistance: From a Biochemical Stance to a
Clinical Diagnosis and Management
#MMPMID27921251
González-Saldivar G
; Rodríguez-Gutiérrez R
; Ocampo-Candiani J
; González-González JG
; Gómez-Flores M
Dermatol Ther (Heidelb)
2017[Mar]; 7
(1
): 37-51
PMID27921251
show ga
Worldwide, more than 1.9 billion adults are overweight, and around 600 million
people suffer from obesity. Similarly, ~382 million individuals live with
diabetes, and 40-50% of the global population is labeled at "high risk" (i.e.,
prediabetes). The impact of these two chronic conditions relies not only on the
burden of illnesses per se (i.e., associated increased morbidity and mortality),
but also on their increased cost, burden of treatment, and decreased
health-related quality of life. For this review a comprehensive search in several
databases including PubMed (MEDLINE), Ovid EMBASE, Web of Science, and Scopus was
conducted. In both diabetes and obesity, genetic, epigenetic, and environmental
factors overlap and are inclusive rather than exclusive. De facto, 70-80% of the
patients with obesity and virtually every patient with type 2 diabetes have
insulin resistance. Insulin resistance is a well-known pathophysiologic factor in
the development of type 2 diabetes, characteristically appearing years before its
diagnosis. The gold standard for insulin resistance diagnosis (the euglycemic
insulin clamp) is a complex, invasive, costly, and hence unfeasible test to
implement in clinical practice. Likewise, laboratory measures and derived indexes
[e.g., homeostasis model assessment of insulin resistance (HOMA-IR-)] are
indirect, imprecise, and not highly accurate and reproducible tests. However,
skin manifestations of insulin resistance (e.g., acrochordons, acanthosis
nigricans, androgenetic alopecia, acne, hirsutism) offer a reliable,
straightforward, and real-time way to detect insulin resistance. The objective of
this review is to aid clinicians in recognizing skin manifestations of insulin
resistance. Diagnosing these skin manifestations accurately may cascade
positively in the patient's health by triggering an adequate metabolic
evaluation, a timely treatment or referral with the ultimate objective of
decreasing diabetes and obesity burden, and improving the health and the quality
of care for these patients.
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