Insulin Resistance: Insulin Action and Its Disturbances in Disease
http://www.100md.com
《新英格兰医药杂志》
Although insulin resistance was originally viewed as a total inability of insulin to stimulate the metabolism of carbohydrates, the work of Harold Himsworth in the 1930s made it clear that insulin's stimulatory effect varies widely among people, including those without diabetes. Since the 1960s, insulin resistance, along with beta-cell defects, has been implicated in the pathogenesis of type 2 diabetes mellitus. More recently, Gerald Reaven and others have popularized the concept that insulin resistance in itself is a risk factor for many chronic ailments, including hypertension, cardiovascular disease, and some cancers. Insulin resistance is a hallmark of the so-called metabolic syndrome; formal definitions of this syndrome have been adopted in Europe and the United States. Even though immense intellectual and financial resources have been invested in attempting to understand it, the underlying cause of insulin resistance in most cases of type 2 diabetes remains unknown.
A PubMed database search for the term reveals almost 25,000 original articles; thus, the editors of Insulin Resistance have taken on a daunting task. They have gathered chapters from a group of investigators, most of whom are from the United Kingdom, Canada, and Europe. This may be an advantage; because many of the contributions to understanding insulin resistance have come from the United States, the European and Canadian perspectives are valuable. Yet many of the principal scientific players in this field are not represented.
This book is useful for all levels, from medical students to senior investigators. Breadth is its chief strength. Not surprisingly, the insulin action pathway, which has been the model for research about the action of molecular insulin, is discussed repeatedly in the book. But there is also coverage of insulin resistance in the metabolism of carbohydrates, fats, and proteins, as well as in relation to inheritance, neural control, and various insulin-resistance syndromes in humans, such as obesity, endothelial dysfunction, and the polycystic ovary syndrome. The discussions of the role of inheritance — including rare insulin-resistance syndromes, transport biology, insulin and the brain, peroxisome-proliferator–activated receptor , and thiazolidinediones — are all outstanding. Overall, the clinical physiology of insulin resistance is not well covered, but the book includes a particularly insightful review of resistance in vivo by Beck-Nielsen and colleagues.
Other coverage is less commendable, such as the chapters about physical activity and endothelial dysfunction. A few important features are missing; for example, there is little about the critical relationship between insulin resistance and insulin secretory function, and key work on hemodynamic effects of insulin — such as that of Michael Clark and Eugene Barrett and colleagues — is not addressed. The book also could have included more discussion of insulin resistance and ethnic background. The debate regarding the role of adipokines as compared with free fatty acids is little represented here, but it is a central focus of debate today. Moreover, the book would have benefited from an overall perspective on the field of insulin resistance: where it has come from and where it will be heading in the near future. Finally, the book is poorly edited in some instances; in one chapter the same text is repeated twice.
Sniping aside, this book is a major contribution to the increasing body of work by investigators at the bench and the bedside who are attempting to understand the origins of insulin resistance. Treatment of this ubiquitous syndrome will yield important improvements in public health, could prevent diabetes mellitus, and could reduce the incidence of cardiovascular disease and colon and breast cancer. Thus, this book appears at an appropriate moment to educate and excite young investigators who are looking to make their mark in an important but very difficult area of research.
Richard N. Bergman, Ph.D.
Keck School of Medicine at the University of Southern California
Los Angeles, CA 90033
rbergman@usc.edu(Edited by Sudhesh Kumar a)
A PubMed database search for the term reveals almost 25,000 original articles; thus, the editors of Insulin Resistance have taken on a daunting task. They have gathered chapters from a group of investigators, most of whom are from the United Kingdom, Canada, and Europe. This may be an advantage; because many of the contributions to understanding insulin resistance have come from the United States, the European and Canadian perspectives are valuable. Yet many of the principal scientific players in this field are not represented.
This book is useful for all levels, from medical students to senior investigators. Breadth is its chief strength. Not surprisingly, the insulin action pathway, which has been the model for research about the action of molecular insulin, is discussed repeatedly in the book. But there is also coverage of insulin resistance in the metabolism of carbohydrates, fats, and proteins, as well as in relation to inheritance, neural control, and various insulin-resistance syndromes in humans, such as obesity, endothelial dysfunction, and the polycystic ovary syndrome. The discussions of the role of inheritance — including rare insulin-resistance syndromes, transport biology, insulin and the brain, peroxisome-proliferator–activated receptor , and thiazolidinediones — are all outstanding. Overall, the clinical physiology of insulin resistance is not well covered, but the book includes a particularly insightful review of resistance in vivo by Beck-Nielsen and colleagues.
Other coverage is less commendable, such as the chapters about physical activity and endothelial dysfunction. A few important features are missing; for example, there is little about the critical relationship between insulin resistance and insulin secretory function, and key work on hemodynamic effects of insulin — such as that of Michael Clark and Eugene Barrett and colleagues — is not addressed. The book also could have included more discussion of insulin resistance and ethnic background. The debate regarding the role of adipokines as compared with free fatty acids is little represented here, but it is a central focus of debate today. Moreover, the book would have benefited from an overall perspective on the field of insulin resistance: where it has come from and where it will be heading in the near future. Finally, the book is poorly edited in some instances; in one chapter the same text is repeated twice.
Sniping aside, this book is a major contribution to the increasing body of work by investigators at the bench and the bedside who are attempting to understand the origins of insulin resistance. Treatment of this ubiquitous syndrome will yield important improvements in public health, could prevent diabetes mellitus, and could reduce the incidence of cardiovascular disease and colon and breast cancer. Thus, this book appears at an appropriate moment to educate and excite young investigators who are looking to make their mark in an important but very difficult area of research.
Richard N. Bergman, Ph.D.
Keck School of Medicine at the University of Southern California
Los Angeles, CA 90033
rbergman@usc.edu(Edited by Sudhesh Kumar a)