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Basic Concepts in Insulin Resistance and Diabetes Treatment

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Dermatology and Diabetes

Abstract

Type 2 diabetes mellitus (T2DM) should be understood as the final common pathway that results from an imbalance between increased insulin resistance (i.e., decreased insulin action) and relative insulinopenia (i.e., impaired insulin secretion). There is consensus that for most patients with T2DM the earliest defect observed is insulin resistance. At early stages, the pancreas is able to compensate for insulin resistance by increasing insulin secretion so that glucose tolerance is preserved. Thus, a state of normal glucose tolerance is maintained at the expense of hyperinsulinemia. Over time, and by mechanisms that are still incompletely understood, pancreatic β-cells fail to maintain this high rate of insulin secretion and impaired glucose tolerance and overt T2DM develop. In the current chapter, the mechanisms leading to insulin resistance and the spectrum of therapeutic approaches for patients with T2DM will be described.

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References

  1. DeFronzo RA, Ferrannini E, Groop L, Henry RR, Herman WH, Holst JJ, et al. Type 2 diabetes mellitus. Nat Rev Dis Primers. 2015;1:15019.

    Article  PubMed  Google Scholar 

  2. Cusi K. The epidemic of type 2 diabetes mellitus: its links to obesity, insulin resistance, and lipotoxicity. In: Regensteiner JG, Reusch JEB, Stewart KJ, Veves A, editors. Diabetes and exercise. 1st ed. New York: Humana Press; 2009. p. 3–54.

    Chapter  Google Scholar 

  3. Cusi K. The role of adipose tissue and lipotoxicity in the pathogenesis of type 2 diabetes. Curr Diab Rep. 2010;10:306–15.

    Article  CAS  PubMed  Google Scholar 

  4. Caprio S, Perry R, Kursawe R. Adolescent obesity and insulin resistance: roles of ectopic fat accumulation and adipose inflammation. Gastroenterology. 2017;152:1638–46.

    Article  CAS  PubMed  Google Scholar 

  5. Cusi K. Role of obesity and lipotoxicity in the development of nonalcoholic steatohepatitis: pathophysiology and clinical implications. Gastroenterology. 2012;142:711–25. e716

    Article  CAS  PubMed  Google Scholar 

  6. Parker VE, Semple RK. Genetics in endocrinology: genetic forms of severe insulin resistance: what endocrinologists should know. Eur J Endocrinol. 2013;169:R71–80.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  7. Semple RK, Savage DB, Cochran EK, Gorden P, O’Rahilly S. Genetic syndromes of severe insulin resistance. Endocr Rev. 2011;32:498–514.

    Article  CAS  PubMed  Google Scholar 

  8. Semple RK. EJE PRIZE 2015: how does insulin resistance arise, and how does it cause disease? Human genetic lessons. Eur J Endocrinol. 2016;174:R209–23.

    Article  CAS  PubMed  Google Scholar 

  9. Cusi K. Lessons learned from studying families genetically predisposed to type 2 diabetes mellitus. Curr Diab Rep. 2009;9:200–7.

    Article  CAS  PubMed  Google Scholar 

  10. Repaske DR. Medication-induced diabetes mellitus. Pediatr Diabetes. 2016;17:392–7.

    Article  PubMed  Google Scholar 

  11. Asghar A, Sheikh N. Role of immune cells in obesity induced low grade inflammation and insulin resistance. Cell Immunol. 2017;315:18–26.

    Article  CAS  PubMed  Google Scholar 

  12. Sell H, Habich C, Eckel J. Adaptive immunity in obesity and insulin resistance. Nat Rev Endocrinol. 2012;8:709–16.

    Article  CAS  PubMed  Google Scholar 

  13. Unger RH. Lipotoxicity in the pathogenesis of obesity-dependent NIDDM. Genetic and clinical implications. Diabetes. 1995;44:863–70.

    Article  CAS  PubMed  Google Scholar 

  14. Bril F, Lomonaco R, Cusi K. The challenge of managing dyslipidemia in patients with nonalcoholic fatty liver disease. Clin Lipidol. 2012;7:471–81.

    Article  CAS  Google Scholar 

  15. Lomonaco R, Ortiz-Lopez C, Orsak B, Webb A, Hardies J, Darland C, et al. Effect of adipose tissue insulin resistance on metabolic parameters and liver histology in obese patients with nonalcoholic fatty liver disease. Hepatology. 2012;55:1389–97.

    Article  CAS  PubMed  Google Scholar 

  16. Unger RH, Scherer PE, Holland WL. Dichotomous roles of leptin and adiponectin as enforcers against lipotoxicity during feast and famine. Mol Biol Cell. 2013;24:3011–5.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  17. Bril F, Cusi K. Nonalcoholic fatty liver disease: the new complication of type 2 diabetes mellitus. Endocrinol Metab Clin N Am. 2016;45:765–81.

    Article  Google Scholar 

  18. Sunny NE, Bril F, Cusi K. Mitochondrial adaptation in nonalcoholic fatty liver disease: novel mechanisms and treatment strategies. Trends Endocrinol Metab. 2017;28:250–60.

    Article  CAS  PubMed  Google Scholar 

  19. Bril F, Barb D, Portillo-Sanchez P, Biernacki D, Lomonaco R, Suman A, et al. Metabolic and histological implications of intrahepatic triglyceride content in nonalcoholic fatty liver disease. Hepatology. 2017;65:1132–44.

    Article  CAS  PubMed  Google Scholar 

  20. Bril F, Sninsky JJ, Baca AM, Superko HR, Portillo Sanchez P, Biernacki D, et al. Hepatic steatosis and insulin resistance, but not steatohepatitis, promote atherogenic dyslipidemia in NAFLD. J Clin Endocrinol Metab. 2016;101:644–52.

    Article  CAS  PubMed  Google Scholar 

  21. Chalasani N, Younossi Z, Lavine JE, Charlton M, Cusi K, Rinella M, et al. The diagnosis and management of nonalcoholic fatty liver disease: practice guidance from the American Association for the Study of Liver Diseases. Hepatology. 2017. https://doi.org/10.1002/hep.29367.

  22. European Association for the Study of the Liver (EASL), European Association for the Study of Diabetes (EASD), European Association for the Study of Obesity (EASO). EASL-EASD-EASO clinical practice guidelines for the management of non-alcoholic fatty liver disease. Diabetologia. 2016;59:1121–40.

    Article  Google Scholar 

  23. Bril F, Cusi K. Management of nonalcoholic fatty liver disease in patients with type 2 diabetes: a call to action. Diabetes Care. 2017;40:419–30.

    Article  PubMed  Google Scholar 

  24. Belfort R, Mandarino L, Kashyap S, Wirfel K, Pratipanawatr T, Berria R, et al. Dose-response effect of elevated plasma free fatty acid on insulin signaling. Diabetes. 2005;54:1640–8.

    Article  CAS  PubMed  Google Scholar 

  25. Kashyap SR, Belfort R, Berria R, Suraamornkul S, Pratipranawatr T, Finlayson J, et al. Discordant effects of a chronic physiological increase in plasma FFA on insulin signaling in healthy subjects with or without a family history of type 2 diabetes. Am J Physiol Endocrinol Metab. 2004;287:E537–46.

    Article  CAS  PubMed  Google Scholar 

  26. Kashyap S, Belfort R, Cersosimo E, Lee S, Cusi K. Chronic low-dose lipid infusion in healthy subjects induces markers of endothelial activation independent of its metabolic effects. J Cardiometab Syndr. 2008;3:141–6.

    Article  PubMed  Google Scholar 

  27. Amati F, Dube JJ, Alvarez-Carnero E, Edreira MM, Chomentowski P, Coen PM, et al. Skeletal muscle triglycerides, diacylglycerols, and ceramides in insulin resistance: another paradox in endurance-trained athletes? Diabetes. 2011;60:2588–97.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  28. Iozzo P, Pratipanawatr T, Pijl H, Vogt C, Kumar V, Pipek R, et al. Physiological hyperinsulinemia impairs insulin-stimulated glycogen synthase activity and glycogen synthesis. Am J Physiol Endocrinol Metab. 2001;280:E712–9.

    Article  CAS  PubMed  Google Scholar 

  29. Abdul-Ghani MA, Tripathy D, DeFronzo RA. Contributions of beta-cell dysfunction and insulin resistance to the pathogenesis of impaired glucose tolerance and impaired fasting glucose. Diabetes Care. 2006;29:1130–9.

    Article  CAS  PubMed  Google Scholar 

  30. Del Prato S, Leonetti F, Simonson DC, Sheehan P, Matsuda M, DeFronzo RA. Effect of sustained physiologic hyperinsulinaemia and hyperglycaemia on insulin secretion and insulin sensitivity in man. Diabetologia. 1994;37:1025–35.

    Article  CAS  PubMed  Google Scholar 

  31. Kashyap S, Belfort R, Gastaldelli A, Pratipanawatr T, Berria R, Pratipanawatr W, et al. A sustained increase in plasma free fatty acids impairs insulin secretion in nondiabetic subjects genetically predisposed to develop type 2 diabetes. Diabetes. 2003;52:2461–74.

    Article  CAS  PubMed  Google Scholar 

  32. Solomon TP, Knudsen SH, Karstoft K, Winding K, Holst JJ, Pedersen BK. Examining the effects of hyperglycemia on pancreatic endocrine function in humans: evidence for in vivo glucotoxicity. J Clin Endocrinol Metab. 2012;97:4682–91.

    Article  CAS  PubMed  Google Scholar 

  33. American Diabetes Association. Standards of medical care in diabetes-2017: summary of revisions. Diabetes Care. 2017;40:S4–5.

    Article  Google Scholar 

  34. Look AHEAD Research Group, Wing RR, Bolin P, Brancati FL, Bray GA, Clark JM, et al. Cardiovascular effects of intensive lifestyle intervention in type 2 diabetes. N Engl J Med. 2013;369:145–54.

    Article  Google Scholar 

  35. Vilar-Gomez E, Martinez-Perez Y, Calzadilla-Bertot L, Torres-Gonzalez A, Gra-Oramas B, Gonzalez-Fabian L, et al. Weight loss through lifestyle modification significantly reduces features of nonalcoholic steatohepatitis. Gastroenterology. 2015;149:367–78.

    Google Scholar 

  36. Keidar A. Bariatric surgery for type 2 diabetes reversal: the risks. Diabetes Care. 2011;34(Suppl 2):S361–266.

    Article  PubMed  PubMed Central  Google Scholar 

  37. Adams TD, Davidson LE, Litwin SE, Kim J, Kolotkin RL, Nanjee MN, Gutierrez JM, Frogley SJ, Ibele AR, Brinton EA, Hopkins PN, McKinlay R, Simper SC, Hunt SC. Weight and metabolic outcomes 12 years after gastric bypass. N Engl J Med. 2017;377:1143–55.

    Article  PubMed  Google Scholar 

  38. Rena G, hardie DG, Pearson ER. The mechanisms of action of metformin. Diabetologia. 2017;60:1577–85.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  39. Madiraju AK, Erion DM, Rahimi Y, Zhang XM, Braddock DT, Albright RA, et al. Metformin suppresses gluconeogenesis by inhibiting mitochondrial glycerophosphate dehydrogenase. Nature. 2014;510:542–6.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  40. Goldberg RB, Kendall DM, Deeg MA, Buse JB, Zagar AJ, Pinaire JA, et al. A comparison of lipid and glycemic effects of pioglitazone and rosiglitazone in patients with type 2 diabetes and dyslipidemia. Diabetes Care. 2005;28:1547–54.

    Article  CAS  PubMed  Google Scholar 

  41. Soccio RE, Chen ER, Lazar MA. Thiazolidinediones and the promise of insulin sensitization in type 2 diabetes. Cell Metab. 2014;20:573–91.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  42. Yau H, Rivera K, Lomonaco R, Cusi K. The future of thiazolidinedione therapy in the management of type 2 diabetes mellitus. Curr Diab Rep. 2013;13:329–41.

    Article  CAS  PubMed  Google Scholar 

  43. Cusi K, Orsak B, Bril F, Lomonaco R, Hecht J, Ortiz-Lopez C, et al. Long-term pioglitazone treatment for patients with nonalcoholic steatohepatitis and prediabetes or type 2 diabetes mellitus: a randomized trial. Ann Intern Med. 2016;165:305–15.

    Article  PubMed  Google Scholar 

  44. Nissen SE, Wolski K. Effect of rosiglitazone on the risk of myocardial infarction and death from cardiovascular causes. N Engl J Med. 2007;356:2457–71.

    Article  CAS  PubMed  Google Scholar 

  45. Mazzone T, Meyer PM, Feinstein SB, Davidson MH, Kondos GT, D’Agostino RB Sr, et al. Effect of pioglitazone compared with glimepiride on carotid intima-media thickness in type 2 diabetes: a randomized trial. JAMA. 2006;296:2572–81.

    Article  CAS  PubMed  Google Scholar 

  46. Nissen SE, Nicholls SJ, Wolski K, Nesto R, Kupfer S, Perez A, et al. Comparison of pioglitazone vs glimepiride on progression of coronary atherosclerosis in patients with type 2 diabetes: the PERISCOPE randomized controlled trial. JAMA. 2008;299:1561–73.

    Article  CAS  PubMed  Google Scholar 

  47. Dormandy JA, Charbonnel B, Eckland DJ, Erdmann E, Massi-Benedetti M, Moules IK, et al. Secondary prevention of macrovascular events in patients with type 2 diabetes in the PROactive study (PROspective pioglitAzone clinical trial in macroVascular events): a randomised controlled trial. Lancet. 2005;366:1279–89.

    Article  CAS  PubMed  Google Scholar 

  48. Kernan WN, Viscoli CM, Furie KL, Young LH, Inzucchi SE, Gorman M, et al. Pioglitazone after ischemic stroke or transient ischemic attack. N Engl J Med. 2016;374:1321–31.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  49. Belfort R, Harrison SA, Brown K, Darland C, Finch J, Hardies J, et al. A placebo-controlled trial of pioglitazone in subjects with nonalcoholic steatohepatitis. N Engl J Med. 2006;355:2297–307.

    Article  CAS  PubMed  Google Scholar 

  50. Ratziu V, Giral P, Jacqueminet S, Charlotte F, Hartemann-Heurtier A, Serfaty L, et al. Rosiglitazone for nonalcoholic steatohepatitis: one-year results of the randomized placebo-controlled fatty liver improvement with rosiglitazone therapy (FLIRT) trial. Gastroenterology. 2008;135:100–10.

    Article  CAS  PubMed  Google Scholar 

  51. Lewis JD, Ferrara A, Peng T, Hedderson M, Bilker WB, Quesenberry CP Jr, et al. Risk of bladder cancer among diabetic patients treated with pioglitazone: interim report of a longitudinal cohort study. Diabetes Care. 2011;34:916–22.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  52. Lewis JD, Habel LA, Quesenberry CP, Strom BL, Peng T, Hedderson MM, et al. Pioglitazone use and risk of bladder cancer and other common cancers in persons with diabetes. JAMA. 2015;314:265–77.

    Article  CAS  PubMed  Google Scholar 

  53. Tuccori M, Filion KB, Yin H, Yu OH, Platt RW, Azoulay L. Pioglitazone use and risk of bladder cancer: population based cohort study. BMJ. 2016;352:i1541.

    Article  PubMed  PubMed Central  Google Scholar 

  54. Korhonen P, Heintjes EM, Williams R, Hoti F, Christopher S, Majak M, et al. Pioglitazone use and risk of bladder cancer in patients with type 2 diabetes: retrospective cohort study using datasets from four European countries. BMJ. 2016;354:i3903.

    Article  PubMed  PubMed Central  Google Scholar 

  55. Levin D, Bell S, Sund R, Hartikainen SA, Tuomilehto J, Pukkala E, et al. Pioglitazone and bladder cancer risk: a multipopulation pooled, cumulative exposure analysis. Diabetologia. 2015;58:493–504.

    Article  CAS  PubMed  Google Scholar 

  56. Lasserson DS, Glasziou P, Perera R, Holman RR, Farmer AJ. Optimal insulin regimens in type 2 diabetes mellitus: systematic review and meta-analyses. Diabetologia. 2009;52:1990–2000.

    Article  CAS  PubMed  Google Scholar 

  57. Fonseca VA, Haggar MA. Achieving glycaemic targets with basal insulin in T2DM by individualizing treatment. Nat Rev Endocrinol. 2014;10:276–81.

    Article  CAS  PubMed  Google Scholar 

  58. Roumie CL, Hung AM, Greevy RA, et al. Comparative effectiveness of sulfonylurea and metformin monotherapy on cardiovascular events in type 2 diabetes mellitus: a cohort study. Ann Intern Med. 2012;157:601–10.

    Article  PubMed  PubMed Central  Google Scholar 

  59. Pladevall M, Riera-Guardia N, Margulis AV, Varas-Lorenzo C, Calingaert B, Perez-Gutthann S. Cardiovascular risk associated with the use of glitazones, metformin and sufonylureas: meta-analysis of published observational studies. BMC Cardiovasc Disord. 2016;16:14.

    Article  PubMed  PubMed Central  Google Scholar 

  60. Azoulay L, Suissa S. Sulfonylureas and the risks of cardiovascular events and death: a methodological meta-regression analysis of the observational studies. Diabetes Care. 2017;40:706–14.

    Article  PubMed  Google Scholar 

  61. Guardado-Mendoza R, Prioletta A, Jimenez-Ceja LM, Sosale A, Folli F. The role of nateglinide and repaglinide, derivatives of meglitinide, in the treatment of type 2 diabetes mellitus. Arch Med Sci. 2013;9:936–43.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  62. Marso SP, Daniels GH, Brown-Frandsen K, Kristensen P, Mann JF, Nauck MA, et al. Liraglutide and cardiovascular outcomes in type 2 diabetes. N Engl J Med. 2016;375:311–22.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  63. Marso SP, Bain SC, Consoli A, Eliaschewitz FG, Jodar E, Leiter LA, et al. Semaglutide and cardiovascular outcomes in patients with type 2 diabetes. N Engl J Med. 2016;375:1834–44.

    Article  CAS  PubMed  Google Scholar 

  64. Pfeffer MA, Claggett B, Diaz R, Dickstein K, Gerstein HC, Kober LV, et al. Lixisenatide in patients with type 2 diabetes and acute coronary syndrome. N Engl J Med. 2015;373:2247–57.

    Article  CAS  PubMed  Google Scholar 

  65. Holman RR, Bethel MA, Mentz RJ, Thompson VP, Lokhnygina Y, Buse JB, Chan JC, Choi J, Gustavson SM, Iqbal N, Maggioni AP, Marso SP, Öhman P, Pagidipati NJ, Poulter N, Ramachandran A, Zinman B, Hernandez AF, EXSCEL Study Group. Effects of once-weekly exenatide on cardiovascular outcomes in type 2 diabetes. N Engl J Med. 2017;377:1228–39.

    Article  CAS  PubMed  Google Scholar 

  66. Monami M, Nreu B, Scatena A, Cresci B, Andreozzi F, Sesti G, Mannucci E. Safety issues with glucagon-like peptide-1 receptor agonists (pancreatitis, pancreatic cancer and cholelithiasis): data from randomized controlled trials. Diabetes Obes Metab. 2017;19:1233–41.

    Article  CAS  PubMed  Google Scholar 

  67. Drucker DJ, Rosen CF. Glucagon-like peptide-1 (GLP-1) receptor agonists, obesity and psoriasis: diabetes meets dermatology. Diabetologia. 2011;54:2741–4.

    Article  CAS  PubMed  Google Scholar 

  68. Faurschou A, Pedersen J, Gyldenlove M, Poulsen SS, Holst JJ, Thyssen JP, et al. Increased expression of glucagon-like peptide-1 receptors in psoriasis plaques. Exp Dermatol. 2013;22:150–2.

    Article  CAS  PubMed  Google Scholar 

  69. Andersen ES, Deacon CF, Holst JJ. Do we know the true mechanism of action of the DPP-4 inhibitors? Diabetes Obes Metab. 2017. https://doi.org/10.1111/dom.13018. [Epub ahead of print].

  70. Green JB, Bethel MA, Armstrong PW, Buse JB, Engel SS, Garg J, et al. Effect of sitagliptin on cardiovascular outcomes in type 2 diabetes. N Engl J Med. 2015;373:232–42.

    Article  CAS  PubMed  Google Scholar 

  71. Scirica BM, Bhatt DL, Braunwald E, Steg PG, Davidson J, Hirshberg B, et al. Saxagliptin and cardiovascular outcomes in patients with type 2 diabetes mellitus. N Engl J Med. 2013;369:1317–26.

    Article  CAS  PubMed  Google Scholar 

  72. Gokhale M, Buse JB, Gray CL, Pate V, Marquis MA, Sturmer T. Dipeptidyl-peptidase-4 inhibitors and pancreatic cancer: a cohort study. Diabetes Obes Metab. 2014;16:1247–56.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  73. Zinman B, Wanner C, Lachin JM, Fitchett D, Bluhmki E, Hantel S, et al. Empagliflozin, cardiovascular outcomes, and mortality in type 2 diabetes. N Engl J Med. 2015;373:2117–28.

    Article  CAS  PubMed  Google Scholar 

  74. Neal B, Perkovic V, Mahaffey KW, de Zeeuw D, Fulcher G, Erondu N, et al. Canagliflozin and cardiovascular and renal events in type 2 diabetes. N Engl J Med. 2017;377:644–57.

    Article  CAS  PubMed  Google Scholar 

  75. DeFronzo RA, Norton L, Abdul-Ghani M. Renal, metabolic and cardiovascular considerations of SGLT2 inhibition. Nat Rev Nephrol. 2017;13:11–26.

    Article  CAS  PubMed  Google Scholar 

  76. Bilezikian JP, Watts NB, Usiskin K, Polidori D, Fung A, Sullivan D, et al. Evaluation of bone mineral density and bone biomarkers in patients with type 2 diabetes treated with canagliflozin. J Clin Endocrinol Metab. 2016;101:44–51.

    Article  CAS  PubMed  Google Scholar 

  77. Peters AL, Buschur EO, Buse JB, Cohan P, Diner JC, Hirsch IB. Euglycemic diabetic ketoacidosis: a potential complication of treatment with sodium-glucose cotransporter 2 inhibition. Diabetes Care. 2015;38:1687–93.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  78. Jabbour S, Seufert J, Scheen A, Bailey CJ, Karup C, Langkilde AM. Dapagliflozin in patients with type 2 diabetes mellitus: a pooled analysis of safety data from phase 2b/3 clinical trials. Diabetes Obes Metab. 2017. https://doi.org/10.1111/dom.13124.

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Authors and Affiliations

  1. Division of Endocrinology, Diabetes and Metabolism, University of Florida, Gainesville, FL, USA

    Fernando Bril M.D. & Kenneth Cusi M.D., F.A.C.P., F.A.C.E.

  2. Division of Endocrinology, Diabetes and Metabolism, Malcom Randall VAMC, Gainesville, FL, USA

    Kenneth Cusi M.D., F.A.C.P., F.A.C.E.

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  1. Fernando Bril M.D.
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Correspondence to Kenneth Cusi M.D., F.A.C.P., F.A.C.E. .

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Editors and Affiliations

  1. Dermatology Department, Instituto de Investigaciones Médicas A. Lanari, University of Buenos Aires (UBA), Buenos Aires, Argentina

    Emilia Noemí Cohen Sabban

  2. Division of Diabetology, Department of Medicine, University of Buenos Aires, Buenos Aires, Argentina

    Félix Miguel Puchulu

  3. Division of Endocrinology, Diabetes and Metabolism, The University of Florida, Gainesville, Florida, USA

    Kenneth Cusi

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Bril, F., Cusi, K. (2018). Basic Concepts in Insulin Resistance and Diabetes Treatment. In: Cohen Sabban, E., Puchulu, F., Cusi, K. (eds) Dermatology and Diabetes. Springer, Cham. https://doi.org/10.1007/978-3-319-72475-1_3

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