Mechanisms for Insulin Resistance: Common Threads and Missing Links
Open accessAbstract
Insulin resistance is a complex metabolic disorder that defies explanation by a single etiological pathway. Accumulation of ectopic lipid metabolites, activation of the unfolded protein response (UPR) pathway, and innate immune pathways have all been implicated in the pathogenesis of insulin resistance. However, these pathways are also closely linked to changes in fatty acid uptake, lipogenesis, and energy expenditure that can impact ectopic lipid deposition. Ultimately, these cellular changes may converge to promote the accumulation of specific lipid metabolites (diacylglycerols and/or ceramides) in liver and skeletal muscle, a common final pathway leading to impaired insulin signaling and insulin resistance.
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Administration of glucocorticoids to bolster late afternoon and early evening cortisol levels induces insulin resistance through post-receptor mechanisms.
“Administration of glucocorticoids to bolster cortisol levels in the late afternoon and early evening also induces insulin resistance [69, 73, 74] through post-receptor mechanisms [90–92].”
From Sleep, testosterone and cortisol balance, and ageing men (2022) · cites this paper as [92]
The Ectopic Lipid Accumulation section describes insulin resistance arising from impaired insulin signaling, and the References section lists a study of glucocorticoid-induced insulin resistance. The paper does not link post-receptor mechanisms to glucocorticoid administration or discuss raising cortisol in the late afternoon or early evening. Page numbers are unavailable in our copy. (LLM, conf=0.78)
Experimental — accuracy not yet measuredA mismatch between lipid availability and lipid oxidation may induce ectopic fat deposition and lipotoxicity.
“A mismatch between availability and oxidation of lipids might induce ectopic fat deposition and lipotoxicity (17,24).”
From Metabolic flexibility to lipid availability during exercise is enhanced in individuals with high insulin sensitivity (2018) · cites this paper as [24]
When adipose tissue cannot store excess fat, lipids accumulate inappropriately in the liver, muscle, and pancreas.
“When the adipose tissue cannot store excess fat, lipids accumulate inappropriately in the liver, muscle, and pancreas.”
From Mitochondrial fatty acid oxidation in obesity (2013) · cites this paper as [145]
Increased circulating free fatty acids and triglyceride accumulation in ectopic sites is produced.
“and increased circulating FFA and TG accumulation in ectopic sites is produced ([145](#B145)).”
From Mitochondrial fatty acid oxidation in obesity (2013) · cites this paper as [145]
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“, 2013) as well as a number of proteins of the GLUT4 vesicle fusion machinery (Aslamy and Thurmond, 2017); the underlying defects include alterations in the maintenance of the storage compartment (Foley et al., 2011; Samuel and Shulman, 2012) and in the insulin-derived signals that trigger GLUT4 vesicle release from s…”
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The manifold role of the mitochondria in skeletal muscle insulin resistance
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Sustained-release mitochondrial protonophore reverses nonalcoholic fatty liver disease in rats
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Plant Foods, Healthy Plant-Based Diets, and Type 2 Diabetes: A Review of the Evidence
del Carmen Fernández-Fígares Jiménez, M. (2024) · Nutrition Reviews · doi:10.1093/nutrit/nuad099 · Cited by 20 · see citing works
- Authors
- Samuel, V. T., & Shulman, G. I.
- Affiliations
- Veterans Health Administration (US)
- Howard Hughes Medical Institute (US)
- Corresponding author
- Samuel, Varman T.
- Shulman, Gerald I.
- Venue
- Cell
- Publisher
- Elsevier BV
- Published
- 2012-03
- Volume
- 148
- Issue
- 5
- Pages
- 852-871
- ISSN
- 0092-8674 (ISSN-L)
- PMC
- PMC3294420
- OpenAlex
- W2086102771
- Cited by
- 2,294
- References
- 182
- Citations by year
- 2026: 202 · 2025: 153 · 2024: 126 · 2023: 107 · 2022: 116 · 2021: 145 · 2020: 137 · 2019: 155 · 2018: 169 · 2017: 171 · 2016: 177 · 2015: 206 · 2014: 183 · 2013: 186 · 2012: 59
- FWCI
- 18.49
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- Locations
- Cell (publishedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- Funders
- Howard Hughes Medical Institute
- National Institute of Diabetes and Digestive and Kidney Diseases (DK-49230, R01DK049230, DK40936, DK 45735, R01DK040936, U24DK059635, DK-08638, R24DK085638, DK059635, P30DK045735, P01DK068229)
- Topics
- Life Sciences › Biochemistry, Genetics and Molecular Biology › Molecular Biology › Metabolism, Diabetes, and Cancer
- Health Sciences › Medicine › Epidemiology › Adipokines, Inflammation, and Metabolic Diseases
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes, Cardiovascular Risks, and Lipoproteins
- Keywords
- insulin resistance, ectopic fat deposition, unfolded protein response, innate immunity, fatty acid uptake, lipogenesis, energy expenditure, diacylglycerol, ceramide, hepatic insulin signaling, skeletal muscle insulin signaling, pathogenesis
- MeSH terms
- Animals, Diabetes Mellitus, Type 2, Diet, Fatty Liver, Humans, Insulin, Insulin Resistance, Liver, Signal Transduction, Muscle, Skeletal, Lipid Metabolism, Unfolded Protein Response, Endoplasmic Reticulum Stress, Non-alcoholic Fatty Liver Disease
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