It is interesting to note that although the incidence of people with diabetes in the UK is thought to be around 5%, the number of people with insulin resistance is nearer 25% (7). There are strong genetic determinants for the development of insulin resistance. The offspring of people with Type 2 diabetes have been shown to be more insulin resistant than those with no family history and this relationship is independent of obesity (8). Non-diabetic first-degree relatives of people with Type 2 diabetes also have similar thrombotic risk clustering to their diabetic relatives (9).
In 1990 Haffner et al. (10) theorised that macrovascular complications start to develop very early on, initiated by insulin resistance and/or hyperinsulinae-mia in the prediabetic state, whereas microvascular complications develop after sustained hyperglycaemia. In the Quebec heart disease study high fasting insulin concentrations were reported to be an independent predictor of ischaemic heart disease in men (11). However, a meta-analysis of a prospective population-based cohort and case-controlled studies, reported by Ruige et al. in 1998 (12), found a weak relationship between plasma insulin levels and CVD, suggesting that other risk factors, such as lipids, must also be involved.
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