SUPPRESSION OF NONESTERIFIED FATTY-ACIDS TO TREAT TYPE-A INSULIN-RESISTANCE SYNDROME

A patient with type A insulin-resistance syndrome resistance presented with severe hypertriglyceridaemia and diabetes. Fasting insulin and n on-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. Sus tained suppression of NEFA with slow-release acipimox for 8 weeks resu lted in substantial reduction of serum fasting NEFA (0.31 mmol/L). Glu cose tolerance became normal and insulin sensitivity increased from 7% to 32%. The glucose fatty-acid cycle may operate in patients with sev ere insulin resistance and hyperlipidaemia: high serum NEFA aggravates insulin resistance and hyperglycaemia by inhibiting glucose uptake an d utilisation.