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İnsülin Direnci ve Klinik Önemi

Year 2017, Volume: 24 Issue: 3, 116 - 125, 01.09.2017

Hasan Basri Savaş Fatih Gültekin

https://doi.org/10.17343/sdutfd.264358
Cited By: 2

Abstract

İnsülin metabolizmanın düzenleyici temel hormonlarından biridir.
İnsülinin keşfi için uzun asırlara dayanan araştırmalar mevcuttur. Bilim
adamlarını insülini araştırmaya iten sebep insülin direncinin ortaya çıkardığı
klinik hastalıklardır. İnsülin direnci, karmaşık bir patogeneze sahiptir.
İnsülin direncinin patogenezi halen tam olarak aydınlatılamamış ve
araştırılmaktadır. Obezite ile insülin direnci arasında çok güçlü bir ilişki
bulunmaktadır. İnsülin direncinin en sık sebebi obezitedir. İnsülin direnci
ortaya çıktığında hemen klinik belirti vermeyebilir. Subklinik dönemde diyet
düzenlenmesi ve egzersizi içeren yaşam tarzı değişiklikleri ve kilo verilmesi
ile insülin direnci gerileyebilir. İnsülin direncine müdahale edilmediğinde,
uzun dönemde birçok hastalığa sebep olabilir. Kardiyovasküler hastalık riski artar.
Endotel fonksiyonu bozulur. Hiperkoagulasyon problemi ortaya çıkar. Tip 2
diyabetes mellitus gelişir. Polikistik over sendromu gibi sık görülen
hastalıklar da insülin direnci ile ilişkilidir. Metabolik sendrom sıklığı
gittikçe artmaktadır. Metabolik sendromun en önemli bileşeni insülin
direncidir. İnsülin direncinin ölçümü için altın standart olan metot, öglisemik
hiperinsülinemik klemp metotudur. Bu metodun zahmetli ve pahalı olması
sebebiyle HOMA (Homeostazis Model Assesment) metodu kullanılmaktadır. HOMA formülü
açlık serum glikozu ve açlık serum insülini değerleri ile hesaplamaya dayanır.
Yaşam tarzı değişiklikleri ile insülin direncini geriletme hedeflenir. Şayet
geriletilemeyecek duruma gelmiş ve klinik problemler ortaya çıkmışsa hastalığa
uygun ilaç tedavisi verilebilir. İnsülin direnci temelinde ortaya çıkan
hastalıkların medikal tedavisine ek olarak yaşam tarzı değişiklikleri ilaçların
etkinliğini arttırmaktadır. İnsülin direncine karşı yapılacak yaşam tarzı
değişiklikleri, kilo verilmesi, diyet düzenlenmesi ve düzenli egzersiz olarak
sayılabilir.

Keywords

İnsülin direnci HOMA formulü

References

  • 1. Zimmet PZ, Alberti KGMM. Epidemiology of Diabetes—Status of a Pandemic and Issues Around Metabolic Surgery. Diabetes Care 2016; 39(6): 878-883. http://dx.doi.org/10.2337/dc16-0273
  • 2. Satman I, R Rea R, Eriksson M, Mosenzon O, Pratley R, M Baeres F, D Ørsted D, F Mann J; LEADER Trial Investigators. LEADER-6: Baseline renal function and associated factors in a high cardiovascular risk type 2 diabetes population. J Diabetes Complications. 2016;30(8):1631-1639. doi: 10.1016/j.jdiacomp.2016.06.001.
  • 3. Gundogan NU. The Story of A Nobel Prize, The 80th Anniversary of the Discovery of Insulin. Baskent University Publication, 2001, Ankara, p: 5-55
  • 4. Sanjeevi C.B. One hundred years of Nobel Prize and Diabete. Diabetologia, 2001, 44:9;37-38
  • 5. Gürdöl F, Ademoğlu E, Biyokimya, 2. Baskı, sayfa: 238, Nobel Tıp Kitabevleri, İstanbul, 2012
  • 6. Kumar V, Cotran RS, Robbins SL, Robbins Temel Patoloji, 7. Baskı, Nobel Tıp Kitabevleri, sayfa: 642, 2003, İstanbul
  • 7. David GG, Shoback D. Greenspan’s Lange Temel ve Klinik Endokrinoloji, 8. Baskı, sayfa: 660-667, Güneş Tıp Kitabevleri, İstanbul, 2009
  • 8. Flier JS. Lilly Lecture: syndromes of insulin resistance. From patient to gene and back again. Diabetes 1992;41:1207-19.
  • 9. American Diabetes Assocation. Concensus Development Conferance on Insulin Resistance. Diabetes Care 1998;21:310-4.
  • 10. Reaven GM. Banting lecture 1988. Role of insülin resistance in human disease (Rewiev). Diabetes 1988:37:1595-607.
  • 11. Almind K, Doria A, Kahn CR. Putting the genes for type 2 diabetes on the map. Nat Med 2001;7:277-9.
  • 12. Gürlek A. İnsülin Direncinde Genetik Faktörler. Klinik Endokrinoloji. İzmir, Meta Basım 2001;5(1):49-53.
  • 13. Hollenbeck C, Reaven GM. Variations in insulin stimulated glucoseuptake in healthy individuals with normal glucose tolerance. J ClinEndocrinol Metab 1987;64:1169-73.
  • 14. Champe PC, Harvey RA, Ferrier DR. Biyokimya. Lipincott. 3. Baskı. Nobel Tıp Kitapevleri. İstanbul. 2007. Sayfa 340-345.
  • 15. Mauvais-Jarvis F, Kulkarni RN, Kahn CR, Knockout models are useful tools to dissect the patophysiology and genetics of insülin resistance. Clin Endocrinol 2002;57:1-7
  • 16. Accili D, Drago J, Lee EJ et al. Early neonatal death in mice homozygous for a null allele of the insülin reseptor gene. Nat Gen1996;12:106-9
  • 17. Joshi RL, Lamothe B, Cordonnier N, et al. Targeted disruption of the insülin reseptor gene in the mouse results in neonatal lethality. EMBO J 1996;15:1542-7.
  • 18. Bruning JC, Winnay J, Bonner-Weir S et al. Development of a novel polygenic model of NIDDM in mice heterozygous for IR and IRS-1 null alleles. Cell 1997:88:561-72.
  • 19. Das UN. Minireview: Is metabolic syndrome X an inflammatory condition? Exp Biol Med 227:989-997, 2002.
  • 20. Montagne CT, O’Rahilly S. The perils of portliness – causes and consequences of visceral adiposity. Diabetes. 2000;49:883-8.
  • 21. McGary JD. Dysregulation of fatty acid metabolism in the etiology of the type 2 diabetes. Diabetes. 2002:51:7-18.
  • 22. Kim JK, Gavrilova O, Chen Y. Mechanisms of insulin resistancein a ZIP/17-1 fatless mice. Biol Chem 2000:276:8456-60.
  • 23. Boden G ve Shulman GI. Free fatty acids in obesity and type 2 diabetes: definig their role in the development of insulin resistance and beta cell dysfunction. Eur J Clin Invest 2002;32:S13:14-23
  • 24. Özata M, Yönem A. Endokrinoloji Metabolizma ve Diyabet. İstanbul Medikal Yayıncılık. İstanbul. 2006. Sayfa: 553-55.
  • 25. Salway J.G. Metabolizma Atlası Bir Bakışta Metabolizma,3. Baskı, İstanbul Tıp Kitabevi, İstanbul, 2012, sayfa: 112.
  • 26. Yenigün M. Her Yönüyle Diabetes Mellitus. 2. Baskı. İstanbul, Nobel Tıp Kitabevi 2001;51.
  • 27. Shils ME. Modern Nutrition in Health and Disease. 9. Baskı. Lippincott Williams and Wilkins, 1999.
  • 28. Li G, Zhang P, Wang J. The long-term effects of lifestyle interventions to prevent diabetes in the China Da Qing Diabetes Prevention Study: a 20 year follow-up study. Lancet 2008;371:1783-1789
  • 29. Lowe MR, Miller-Kovach K, Frye N. An initial evaluation of a commercial weight loss program: short-term effects on weight, eating behavior, and mood. Obes Res. 1999;7:51-59
  • 30. American Diabetes Association. Standarts of medical care in diabetes-2011. Diabetes Care. 2011; 34:11-61.
  • 31. Jameson JL. Harrison Endokrinoloji. 16. Baskı, 2009, Nobel Tıp Kitabevi, İstanbul, sayfa:268-271
  • 32. Schulz MB. Sugar –sweetened beverages, weight gain and incidence of type 2 diabetes in young and middle-aged women. JAMA 2004; 292:927-34.
  • 33. Sencer E, Orhan Y. Beslenme, İstanbul Medikal Yayıncılık, 1. Baskı, 2005, İstanbul, sayfa: 560-562.
  • 34. Haffner S, Taegtmeyer H. Epidemic obesity and the metabolic syndrome. Circulation 108: 1541, 2003
  • 35. Buchwald H, Avidor Y, Braunwald E, Jensen MD, Pories W, Fahrbach K, Schoelles K. Bariatric surgery: A systematic review and meta-analysis. JAMA 292:1724, 2004
  • 36. Özenoğlu A. Hatemi H.H. Diabette Beslenme. 2004. İstanbul Medikal Yayıncılık, sayfa: 11-18.
  • 37. Lavin N. Lippincott Williams & Wilkins, Endokrinoloji ve Metabolizma El Kitabı, 3. Baskı, Güneş Kitabevi, İstanbul, 2006
  • 38. McFarlane SI, Banerji M, Sowers JR. Insulin resistance and cardiyovascular disease. J Clin Endocrinol Metab 2001;86:713-18
  • 39. Metabolik Sendrom Kılavuzu, Türkiye Endokrinoloji ve Metabolizma Derneği, Tuna Matbaacılık, 2009, Ankara
  • 40. Expert panel. Executive summary of the third report of the National Cholesterol Education Program (NCEP) expert panel on detection, eveulation and treatment of high blood cholesterol in adults. JAMA 2001;285:2486-97.
  • 41. Burtis CA. Ashwood ER. Bruns ED. Tietz Textbook of Clinical Chemistry and Molecular Diagnostics. Fourth Edition. 2006. Elsevier Saunders
  • 42. Satman I, Yilmaz T, Sengül A, Salman S, Salman F, Uygur S, Bastar I, Tütüncü Y, Sargin M, Dinççag N, Karsidag K, Kalaça S, Ozcan C, King H. Population-based study of diabetes and risk characteristics in Turkey: results of the turkish diabetes epidemiology study (TURDEP). Diabetes Care. 2002;25(9):1551-6.
  • 43. Onat A, Ceyhan K, Basar O, Erer B, Toprak S, Sansoy V. Metabolic syndrome: majör impact on coronary risk in population with low cholesterol levels, a prospective and cross-sectional evaluation. Atherosclerosis. 2002;165:285-92.
  • 44. Abe H, Yamada N, Kamata K, Kuwaki T, Shimada M, Osupa J, Shionoiri, F, Yahagi N, Kadowaki T, Tamemoto H, Ishibashi S, Yazaki Y, MakuuchiM. Hypertension, hypertriglyceridemia and impaired endotheliumdependentvascular relaxation in mice lacking insulin receptor substrate-1. J Clin Invest 1998 Apr;101:1784-8.
  • 45. McMurray F, Patten DA, Harper ME. Reactive Oxygen Species and Oxidative Stress in Obesity-Recent Findings and Empirical Approaches. Obesity (Silver Spring). 2016;24(11):2301-2310. doi: 10.1002/oby.21654.
  • 46. Kaidonvich-Beilin O. Crosstalk between metabolic and neuropsychiatric disorders. Biology Reports. Doi 10.3410/B4-14.
  • 47. Jeon CY, Haan MN, Cheng C, Clayton ER, Mayed ER, Miller JW. Helicobacter Pylori infection is associated with an increased rate of diabetes. Diabetes care. 2012;35:520-25.
  • 48. Brunning PF, Bonfrer JM, Von Noord PA, Hart A, de Jong Bakker M, Insulin resistance and breast cancer risk,Int J Cancer, 1992:21:52(4):511-16.
  • 49. Byers T, Sedjo RL. Does international weight loss reduce cancer risk? Diabetes Obesity Metabolism. 2011;13:1063-72.
  • 50. Spyridopoulos TN, Dessypris N, Antoniadis AG, Gialamas S, Antolopoulos CN, Katsifoti K, Adami HO. Insulin resistance and risk of renal cancer. A case control study. Hormones. 2012;11:308-15.
  • 51. Ma J, Li H, Giovanucci E, Mucci L, Qiu W, Nguyen PL, Gaziano JM, Pollak M. Prediagnostic body-mass index, plasma C peptide concentration and prostate cancer. Spesific mortality in men with prostate cancer; a long term survival analysis. Lancet oncology. 2008;9:1039-47.
  • 52. Wang Y, Hua S, Tian W, Zhang L, Zhao J, Zhang H, Zhang W, Xue F. Mitogenic and anti-apoptotic effects of insulin in endometrial cancer are phosphatidylinositol 3-kinase. Gynecologic Oncology. 2012;125:734-741.
  • 53. De Fronzo RA, Tobin JD, Andres R. Glucose clamp technique: a methodfor quantifying insulin secretion and resistance. Am J Physiol 1979;237(3):214-23.
  • 54. Hermans MP, Levy JC, Morris JC, Turner RC. Comparison of tests ofbeta-cell function across a range of glucose tolerance from normal todiabetes. Diabetes 1999;48(9):1779-86.
  • 55. Kidson W. Policystic ovary syndrome: a new direction in treatment. MJA1998;169:537-40.
  • 56. Mathews DR, Hesken YP, Rudenski AS, Naylor BA, Treocher DF, Turner RC. Homeostasis Model Assesment-Insulin resistance and beta cell function from fasting plasma glucose and insulin concentration in man. Diabetologic. 1985;28(7);412-419.
  • 57. Pick A, Clark J, Kupstrup C, Levisett M, Pugh W, Bonner-Weir S, Polonsky KS. Role of apoptosis in failure of beta cell mass compensation for insulin resistance and beta cell defects in the male zucker diabetic fatty rat. Diabetes. 1998;47:358-364.
  • 58. Powell K. The two faces of fat. Nature. 2007;447:525-527.

Year 2017, Volume: 24 Issue: 3, 116 - 125, 01.09.2017

Hasan Basri Savaş Fatih Gültekin

https://doi.org/10.17343/sdutfd.264358
Cited By: 2

Abstract

References

  • 1. Zimmet PZ, Alberti KGMM. Epidemiology of Diabetes—Status of a Pandemic and Issues Around Metabolic Surgery. Diabetes Care 2016; 39(6): 878-883. http://dx.doi.org/10.2337/dc16-0273
  • 2. Satman I, R Rea R, Eriksson M, Mosenzon O, Pratley R, M Baeres F, D Ørsted D, F Mann J; LEADER Trial Investigators. LEADER-6: Baseline renal function and associated factors in a high cardiovascular risk type 2 diabetes population. J Diabetes Complications. 2016;30(8):1631-1639. doi: 10.1016/j.jdiacomp.2016.06.001.
  • 3. Gundogan NU. The Story of A Nobel Prize, The 80th Anniversary of the Discovery of Insulin. Baskent University Publication, 2001, Ankara, p: 5-55
  • 4. Sanjeevi C.B. One hundred years of Nobel Prize and Diabete. Diabetologia, 2001, 44:9;37-38
  • 5. Gürdöl F, Ademoğlu E, Biyokimya, 2. Baskı, sayfa: 238, Nobel Tıp Kitabevleri, İstanbul, 2012
  • 6. Kumar V, Cotran RS, Robbins SL, Robbins Temel Patoloji, 7. Baskı, Nobel Tıp Kitabevleri, sayfa: 642, 2003, İstanbul
  • 7. David GG, Shoback D. Greenspan’s Lange Temel ve Klinik Endokrinoloji, 8. Baskı, sayfa: 660-667, Güneş Tıp Kitabevleri, İstanbul, 2009
  • 8. Flier JS. Lilly Lecture: syndromes of insulin resistance. From patient to gene and back again. Diabetes 1992;41:1207-19.
  • 9. American Diabetes Assocation. Concensus Development Conferance on Insulin Resistance. Diabetes Care 1998;21:310-4.
  • 10. Reaven GM. Banting lecture 1988. Role of insülin resistance in human disease (Rewiev). Diabetes 1988:37:1595-607.
  • 11. Almind K, Doria A, Kahn CR. Putting the genes for type 2 diabetes on the map. Nat Med 2001;7:277-9.
  • 12. Gürlek A. İnsülin Direncinde Genetik Faktörler. Klinik Endokrinoloji. İzmir, Meta Basım 2001;5(1):49-53.
  • 13. Hollenbeck C, Reaven GM. Variations in insulin stimulated glucoseuptake in healthy individuals with normal glucose tolerance. J ClinEndocrinol Metab 1987;64:1169-73.
  • 14. Champe PC, Harvey RA, Ferrier DR. Biyokimya. Lipincott. 3. Baskı. Nobel Tıp Kitapevleri. İstanbul. 2007. Sayfa 340-345.
  • 15. Mauvais-Jarvis F, Kulkarni RN, Kahn CR, Knockout models are useful tools to dissect the patophysiology and genetics of insülin resistance. Clin Endocrinol 2002;57:1-7
  • 16. Accili D, Drago J, Lee EJ et al. Early neonatal death in mice homozygous for a null allele of the insülin reseptor gene. Nat Gen1996;12:106-9
  • 17. Joshi RL, Lamothe B, Cordonnier N, et al. Targeted disruption of the insülin reseptor gene in the mouse results in neonatal lethality. EMBO J 1996;15:1542-7.
  • 18. Bruning JC, Winnay J, Bonner-Weir S et al. Development of a novel polygenic model of NIDDM in mice heterozygous for IR and IRS-1 null alleles. Cell 1997:88:561-72.
  • 19. Das UN. Minireview: Is metabolic syndrome X an inflammatory condition? Exp Biol Med 227:989-997, 2002.
  • 20. Montagne CT, O’Rahilly S. The perils of portliness – causes and consequences of visceral adiposity. Diabetes. 2000;49:883-8.
  • 21. McGary JD. Dysregulation of fatty acid metabolism in the etiology of the type 2 diabetes. Diabetes. 2002:51:7-18.
  • 22. Kim JK, Gavrilova O, Chen Y. Mechanisms of insulin resistancein a ZIP/17-1 fatless mice. Biol Chem 2000:276:8456-60.
  • 23. Boden G ve Shulman GI. Free fatty acids in obesity and type 2 diabetes: definig their role in the development of insulin resistance and beta cell dysfunction. Eur J Clin Invest 2002;32:S13:14-23
  • 24. Özata M, Yönem A. Endokrinoloji Metabolizma ve Diyabet. İstanbul Medikal Yayıncılık. İstanbul. 2006. Sayfa: 553-55.
  • 25. Salway J.G. Metabolizma Atlası Bir Bakışta Metabolizma,3. Baskı, İstanbul Tıp Kitabevi, İstanbul, 2012, sayfa: 112.
  • 26. Yenigün M. Her Yönüyle Diabetes Mellitus. 2. Baskı. İstanbul, Nobel Tıp Kitabevi 2001;51.
  • 27. Shils ME. Modern Nutrition in Health and Disease. 9. Baskı. Lippincott Williams and Wilkins, 1999.
  • 28. Li G, Zhang P, Wang J. The long-term effects of lifestyle interventions to prevent diabetes in the China Da Qing Diabetes Prevention Study: a 20 year follow-up study. Lancet 2008;371:1783-1789
  • 29. Lowe MR, Miller-Kovach K, Frye N. An initial evaluation of a commercial weight loss program: short-term effects on weight, eating behavior, and mood. Obes Res. 1999;7:51-59
  • 30. American Diabetes Association. Standarts of medical care in diabetes-2011. Diabetes Care. 2011; 34:11-61.
  • 31. Jameson JL. Harrison Endokrinoloji. 16. Baskı, 2009, Nobel Tıp Kitabevi, İstanbul, sayfa:268-271
  • 32. Schulz MB. Sugar –sweetened beverages, weight gain and incidence of type 2 diabetes in young and middle-aged women. JAMA 2004; 292:927-34.
  • 33. Sencer E, Orhan Y. Beslenme, İstanbul Medikal Yayıncılık, 1. Baskı, 2005, İstanbul, sayfa: 560-562.
  • 34. Haffner S, Taegtmeyer H. Epidemic obesity and the metabolic syndrome. Circulation 108: 1541, 2003
  • 35. Buchwald H, Avidor Y, Braunwald E, Jensen MD, Pories W, Fahrbach K, Schoelles K. Bariatric surgery: A systematic review and meta-analysis. JAMA 292:1724, 2004
  • 36. Özenoğlu A. Hatemi H.H. Diabette Beslenme. 2004. İstanbul Medikal Yayıncılık, sayfa: 11-18.
  • 37. Lavin N. Lippincott Williams & Wilkins, Endokrinoloji ve Metabolizma El Kitabı, 3. Baskı, Güneş Kitabevi, İstanbul, 2006
  • 38. McFarlane SI, Banerji M, Sowers JR. Insulin resistance and cardiyovascular disease. J Clin Endocrinol Metab 2001;86:713-18
  • 39. Metabolik Sendrom Kılavuzu, Türkiye Endokrinoloji ve Metabolizma Derneği, Tuna Matbaacılık, 2009, Ankara
  • 40. Expert panel. Executive summary of the third report of the National Cholesterol Education Program (NCEP) expert panel on detection, eveulation and treatment of high blood cholesterol in adults. JAMA 2001;285:2486-97.
  • 41. Burtis CA. Ashwood ER. Bruns ED. Tietz Textbook of Clinical Chemistry and Molecular Diagnostics. Fourth Edition. 2006. Elsevier Saunders
  • 42. Satman I, Yilmaz T, Sengül A, Salman S, Salman F, Uygur S, Bastar I, Tütüncü Y, Sargin M, Dinççag N, Karsidag K, Kalaça S, Ozcan C, King H. Population-based study of diabetes and risk characteristics in Turkey: results of the turkish diabetes epidemiology study (TURDEP). Diabetes Care. 2002;25(9):1551-6.
  • 43. Onat A, Ceyhan K, Basar O, Erer B, Toprak S, Sansoy V. Metabolic syndrome: majör impact on coronary risk in population with low cholesterol levels, a prospective and cross-sectional evaluation. Atherosclerosis. 2002;165:285-92.
  • 44. Abe H, Yamada N, Kamata K, Kuwaki T, Shimada M, Osupa J, Shionoiri, F, Yahagi N, Kadowaki T, Tamemoto H, Ishibashi S, Yazaki Y, MakuuchiM. Hypertension, hypertriglyceridemia and impaired endotheliumdependentvascular relaxation in mice lacking insulin receptor substrate-1. J Clin Invest 1998 Apr;101:1784-8.
  • 45. McMurray F, Patten DA, Harper ME. Reactive Oxygen Species and Oxidative Stress in Obesity-Recent Findings and Empirical Approaches. Obesity (Silver Spring). 2016;24(11):2301-2310. doi: 10.1002/oby.21654.
  • 46. Kaidonvich-Beilin O. Crosstalk between metabolic and neuropsychiatric disorders. Biology Reports. Doi 10.3410/B4-14.
  • 47. Jeon CY, Haan MN, Cheng C, Clayton ER, Mayed ER, Miller JW. Helicobacter Pylori infection is associated with an increased rate of diabetes. Diabetes care. 2012;35:520-25.
  • 48. Brunning PF, Bonfrer JM, Von Noord PA, Hart A, de Jong Bakker M, Insulin resistance and breast cancer risk,Int J Cancer, 1992:21:52(4):511-16.
  • 49. Byers T, Sedjo RL. Does international weight loss reduce cancer risk? Diabetes Obesity Metabolism. 2011;13:1063-72.
  • 50. Spyridopoulos TN, Dessypris N, Antoniadis AG, Gialamas S, Antolopoulos CN, Katsifoti K, Adami HO. Insulin resistance and risk of renal cancer. A case control study. Hormones. 2012;11:308-15.
  • 51. Ma J, Li H, Giovanucci E, Mucci L, Qiu W, Nguyen PL, Gaziano JM, Pollak M. Prediagnostic body-mass index, plasma C peptide concentration and prostate cancer. Spesific mortality in men with prostate cancer; a long term survival analysis. Lancet oncology. 2008;9:1039-47.
  • 52. Wang Y, Hua S, Tian W, Zhang L, Zhao J, Zhang H, Zhang W, Xue F. Mitogenic and anti-apoptotic effects of insulin in endometrial cancer are phosphatidylinositol 3-kinase. Gynecologic Oncology. 2012;125:734-741.
  • 53. De Fronzo RA, Tobin JD, Andres R. Glucose clamp technique: a methodfor quantifying insulin secretion and resistance. Am J Physiol 1979;237(3):214-23.
  • 54. Hermans MP, Levy JC, Morris JC, Turner RC. Comparison of tests ofbeta-cell function across a range of glucose tolerance from normal todiabetes. Diabetes 1999;48(9):1779-86.
  • 55. Kidson W. Policystic ovary syndrome: a new direction in treatment. MJA1998;169:537-40.
  • 56. Mathews DR, Hesken YP, Rudenski AS, Naylor BA, Treocher DF, Turner RC. Homeostasis Model Assesment-Insulin resistance and beta cell function from fasting plasma glucose and insulin concentration in man. Diabetologic. 1985;28(7);412-419.
  • 57. Pick A, Clark J, Kupstrup C, Levisett M, Pugh W, Bonner-Weir S, Polonsky KS. Role of apoptosis in failure of beta cell mass compensation for insulin resistance and beta cell defects in the male zucker diabetic fatty rat. Diabetes. 1998;47:358-364.
  • 58. Powell K. The two faces of fat. Nature. 2007;447:525-527.
There are 58 citations in total.

Details

Primary Language Turkish
Subjects Clinical Sciences
Journal Section Derlemeler
Authors

Hasan Basri Savaş

Fatih Gültekin

Publication Date September 1, 2017
Submission Date November 8, 2016
Published in Issue Year 2017 Volume: 24 Issue: 3

Cite

Vancouver Savaş HB, Gültekin F. İnsülin Direnci ve Klinik Önemi. Med J SDU. 2017;24(3):116-25.

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