Discovering New Challenges in the Pharmacological and Non-Pharmacological Management of Insulin Resistance

INTRODUCTION: Insulin resistance has become a serious health problem over time. As people age, the incidence of insulin resistance increases. Genetic factors in families with a history of type 2 diabetes are also key risk factors. In Indonesia, an increase in the prevalence of type 2 diabetes to 8.5% was reported in 2018. This indicates that insulin resistance necessitates comprehensive management, encompassing both pharmacological and non-pharmacological approaches. This systematic review aims to discuss insulin resistance and its management, which can be achieved both pharmacologically through various available drugs and non-pharmacologically by modifying lifestyle habits that can be applied to patients with type 2 diabetes. METHOD: Studies examining the comprehensive management of insulin resistance with antidiabetic pharmacological drugs and non-pharmaceutical interventions published between 2018 and 2023 were comprehensively searched using advanced searches on PubMed and Google Scholar, according to the specified inclusion and exclusion criteria. RESULTS: Twenty studies were selected that met the inclusion criteria and have low risks of bias in most domains. DISCUSSION: Non-pharmacological therapy, such as lifestyle changes that include a ketogenic diet, a vegetarian diet, a structured exercise intervention program, aerobic exercise, Continuous Positive Airway Pressure (CPAP), and electroacupuncture therapy, can significantly reduce insulin resistance and increase insulin sensitivity. Drugs currently prescribed for type 2 DM stimulate insulin secretion or increase insulin sensitivity. CONCLUSION: There are benefits of a plant-based diet, a ketogenic diet, and physical exercise in reducing insulin resistance non-pharmacologically. Meanwhile, pharmacologically, the first drug often given is metformin monotherapy. Combination therapy may be considered if monotherapy does not achieve the therapeutic target.