Insulin resistance: Is it time for primary prevention?

Table 2 Therapeutic approaches to insulin resistance

	Metformin	Thiazolidinediones	Berberine
Main mechanism of action:	Activation of AMPK	Activation of PPARγ	Activation of AMPK Up-regulation of insulin receptor expression Inhibition of intestinal disaccharidases
Metabolic effects:	Reduction in plasma FFA concentration Reduction in blood glucose, hemoglobin A1c, triglycerides, total and LDL-C, body weight and fat mass	Reduction in the amount of circulating FFA and in the lipolysis Improvement of hepatic production of glucose and insulin sensitivity	Reduction in plasma FFA concentration Reduction of blood glucose, hemoglobin A1c, total and LDL-C, triglycerides, body weight and fat mass
Side effects:	Abdominal discomfort, diarrhea and anorexia, lactic acidosis	Increase in total, LDL-C levels and body weight, hepatotoxicity, cardiotoxicity	Constipation

LDL-C: Low density lipoprotein-cholesterol; FFA: Free fatty acids; AMPK: AMP-activated protein kinase; PPAR: Peroxisome proliferator-activated receptors .