Suppression of non-esterified fatty acids to treat type A insulin resistance syndrome.

Abstract

A patient with type A insulin-resistance syndrome resistance presented with severe hypertriglyceridaemia and diabetes. Fasting insulin and non-esterified fatty acids (NEFA) were very high (41 mU/L and 3.3 mmol/L). A low-fat diet failed to correct hyperlipidaemia and diabetes. Sustained suppression of NEFA with slow-release acipimox for 8 weeks resulted in substantial reduction of serum fasting NEFA (0.31 mmol/L). Glucose tolerance became normal and insulin sensitivity increased from 7% to 32%. The glucose fatty-acid cycle may operate in patients with severe insulin resistance and hyperlipidaemia: high serum NEFA aggravates insulin resistance and hyperglycaemia by inhibiting glucose uptake and utilisation.