Glycemic Control: Key to Metabolic Health

January 09, 2024

What is Metabolic Health?

Metabolic health is often defined by what it is not: the absence of conditions or factors that increase the risk of cardiometabolic disorders.^1,2 Experts typically describe being metabolically healthy as the absence of metabolic syndrome, insulin resistance, diabetes, and/or high blood pressure (ie, hypertension).¹

How Is Insulin Resistance Related to Metabolic Health?

The body’s ability to metabolize glucose is one of the fundamental components of metabolic health.¹ Insulin sensitivity plays a key role in metabolic health, with studies showing that insulin resistance is a shared characteristic of type 2 diabetes mellitus (T2DM), metabolic syndrome, obesity, and cardiovascular disease (CVD).^3–5

The pathogenesis of cardiometabolic disorders and their risk factors is closely associated with insulin resistance.^3,6–9 For instance, insulin resistance is known to develop hand-in-hand with obesity, with abdominal obesity leading to hyperlipidemia (ie, high blood lipid levels), hyperglycemia (ie, high blood glucose levels), and hyperinsulinemia (ie, elevated insulin levels), and subsequently resulting in pancreatic b-cell damage and insulin resistance through complex mechanisms.^6–9 In addition to characterizing metabolic syndrome and obesity, insulin resistance also plays a key role in the development of CVD.³ It is known to increase inflammation and lipid accumulation in the blood vessels, which can promote the build-up and hardening of cholesterol plaques in arteries.

Is Glycemic Control Important in Improving Metabolic Health?

Various guidelines emphasize the importance of improving insulin sensitivity and obtaining glycemic control for metabolic health.^2,10 For instance, the American Heart Association (AHA) recommends weight loss and increased physical activity to normalize blood glucose and hemoglobin A1c levels in those with metabolic syndrome.² The 2019 American College of Cardiology (ACC) and AHA guideline on the prevention of CVD reiterates similar recommendation.¹⁰ Hyperglycemia and T2DM are recognized as key risk factors for CVD, and the ACC/AHA strongly suggests improving glycemic control through increased physical activity and healthy dietary changes that promote weight loss.

References:
1. Khalid K, Apparow S, Mushaddik IL, Anuar A, Rizvi SAA, Habib A. Effects of Ketogenic Diet on Reproductive Hormones in Women With Polycystic Ovary Syndrome. J Endocr Soc. 2023;7(10):bvad112. doi:10.1210/jendso/bvad112
2. Paoli A, Mancin L, Giacona MC, Bianco A, Caprio M. Effects of a Ketogenic Diet in Overweight Women with Polycystic Ovary Syndrome. J Transl Med. 2020;18:104. doi:10.1186/s12967-020-02277-0
3. Barrea L, Verde L, Camajani E, et al. Ketogenic Diet as Medical Prescription in Women with Polycystic Ovary Syndrome (PCOS). Curr Nutr Rep. 2023;12(1):56-64. doi:10.1007/s13668-023-00456-1
4. Masood W, Annamaraju P, Uppaluri KR. Ketogenic Diet. In: StatPearls. StatPearls Publishing; 2022. Accessed August 9, 2022. http://www.ncbi.nlm.nih.gov/books/NBK499830/
5. Alarim RA, Alasmre FA, Alotaibi HA, Alshehri MA, Hussain SA. Effects of the Ketogenic Diet on Glycemic Control in Diabetic Patients: Meta-Analysis of Clinical Trials. Cureus. 12(10):e10796. doi:10.7759/cureus.10796
6. Italian Standards for Treatment of Obesity, released by the Italian Society for the Study of Obesity (SIO) and the Italian Association of Dietetics and Clinical Nutrition (ADI) (2016–2017). https://www.sio-obesita.org/wp-content/uploads/2017/09/STANDARD-OBESITA-SIO-ADI.pdf. Accessed 12 Dec 2023.
7. Caprio M, Infante M, Moriconi E, et al. Very-Low-Calorie Ketogenic Diet (vlckd) in the Management of Metabolic Diseases: Systematic Review and Consensus Statement from the Italian Society of Endocrinology (sie). J Endocrinol Invest. 2019;42(11):1365-1386. doi:10.1007/s40618-019-01061-2

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