This Article  • Full text  • PDF  • Send to a friend  • Save in My Folder  • Save to citation manager  • Permissions  Citing Articles  • Contact me when this article is cited  Related Content  • Related letters  • Related article  • Similar articles in JAMA  Topic Collections  • Nutritional and Metabolic Disorders  • Lipids and Lipid Disorders  • Nutritional and Metabolic Disorders, Other  • Cardiovascular System  • Cardiovascular Disease/ Myocardial Infarction  • Endocrine Diseases  • Diabetes Mellitus  • Congestive Heart Failure/ Cardiomyopathy  • Alert me on articles by topic  Social Bookmarking   What's this?

	Since this article does not have an abstract, we have provided the first 150 words of the full text and any section headings.

To the Editor: In his Commentary, Dr Unger¹ hypothesized that insulin therapy should be the treatment of last resort in patients with type 2 diabetes because exogenous hyperinsulinemia may increase ectopic lipid deposition in the skeletal muscle and other tissues in insulin-resistant states. The major mechanism proposed for this effect is the demonstration in leptin-deficient animals that insulin receptor substrate 2 is suppressed and the expression of sterol response element binding protein 1c (SREBP-1c) is increased in the liver by hyperinsulinemia. Unger concludes that these effects of insulin may contribute to insulin resistance and increased atherogenesis and potentially explain the higher mortality observed in the intensive arm of the ACCORD study.¹

In proposing this hypothesis, Unger did not consider that increased free fatty acids and not triglycerides are responsible for insulin resistance.² Insulin reduces concentrations of free fatty acids, and we are aware of no evidence that insulin leads to . . . [Full Text of this Article]

Paresh Dandona, MD, PhD
pdandona@kaleidahealth.org

Ajay Chaudhuri, MD; Husam Ghanim, PhD
Kaleida Health
Buffalo, New York

CiteULike    Connotea    Del.icio.us    Digg    Reddit    Technorati    Twitter     What's this?

RELATED LETTERS

Reinventing Type 2 Diabetes: Pathogenesis, Treatment, and Prevention
Roger H. Unger
JAMA. 2008;299(10):1185-1187.
EXTRACT | FULL TEXT  

Insulin Therapy and Lipid Overload in Type 2 Diabetes
Raffaele Marfella, Michelangela Barbieri, and Giuseppe Paolisso
JAMA. 2008;300(7):789.
EXTRACT | FULL TEXT  

Insulin Therapy and Lipid Overload in Type 2 Diabetes—Reply
Roger H. Unger
JAMA. 2008;300(7):790.
EXTRACT | FULL TEXT  

RELATED ARTICLE

Reinventing Type 2 Diabetes: Pathogenesis, Treatment, and Prevention
Roger H. Unger
JAMA. 2008;299(10):1185-1187.
EXTRACT | FULL TEXT