Insulin resistance and subsequent hyperinsulinemia have long been recognized as risk factors for cardiovascular disease (CVD), type 2 diabetes (T2D), and select types of cancer and neurodegenerative conditions. A recent publication went a step further and sought to determine whether there is a direct relationship between insulin resistance and hyperinsulinemia (IR/hyperins) and increased risk of mortality.
The review assessed studies published in high-impact medical journals from 1980 to 2024. Insulin resistance or hyperinsulinemia were determined by elevated HOMA-IR, elevated fasting insulin, or a diagnosis of metabolic syndrome, and the studies reviewed included subjects with T2D and IR, as well as non-diabetic subjects with insulin resistance who were at a normal weight, slightly overweight, or obese.
Results indicate that IR/hyperins is “an independent and important risk factor for different multiple pathologies,” and that it is directly related to increased all-cause mortality as well increased CVD and cancer-specific mortality. The authors call for “scientific societies and health authorities of different nations [to] face this serious problem,” stressing that the global burden of conditions caused or exacerbated by IR/hyperins is already staggering and only continues to grow.
It is noteworthy that the relationship between chronically elevated insulin and increased mortality was identified even in non-diabetic subjects and those who were not overweight. This shows that even when blood glucose and body weight are normal, elevated insulin may be driving a host of cardiometabolic diseases – something that physicians and researchers had identified as far back as the 1970s.
This highlights the importance of routinely screening for insulin resistance and perhaps using measurements that go beyond fasting glucose and HbA1c – such as HOMA-IR and fasting insulin. This approach could identify individuals at risk much earlier and possibly put them on a better trajectory via diet and lifestyle change and insulin sensitizing medications or supplements.