Sources by chapter

Every claim in the book points here

The numbered references in Insulin Resistance, Explained match this list. 258 unique sources across 19 chapters, drawn from a pool of about 1,200 gathered. Information reflects research up to June 2, 2026.

• What Insulin Resistance Is
• How Serious Is This?
• Would I Notice Insulin Resistance?
• How Is This Measured — and What Should I Track?
• Where Did This Come From?
• Can This Be Reversed?
• Sleep, Drinking, Smoking, and the Urge to Track
• What Should I Eat?
• How Exercise Helps
• What Do I Actually Do Now?
• Do Supplements Help?
• Should I Just Go on Ozempic? And What About Metformin?
• Is It in My Genes?
• How Do I Talk to My Family Without Making It Worse?
• Pregnancy, and What Comes After
• Why Do I Feel This Way About It?
• What Do I Tell People?
• Common Myths About Insulin Resistance
• Conclusion

What Insulin Resistance Is

• [1]NIDDK / NIH. Insulin Resistance & Prediabetes. https://www.niddk.nih.gov/health-information/diabetes/overview/what-is-diabetes/prediabetes-insulin-resistance
• [2]NIDDK / NIH. Insulin Resistance & Prediabetes. https://www.niddk.nih.gov/health-information/diabetes/overview/what-is-diabetes/prediabetes-insulin-resistance
• [3]NIDDK / NIH. Insulin Resistance & Prediabetes. https://www.niddk.nih.gov/health-information/diabetes/overview/what-is-diabetes/prediabetes-insulin-resistance
• [4]NHLBI (2022). Metabolic Syndrome. https://www.nhlbi.nih.gov/health/metabolic-syndrome
• [5]NHLBI (2022). Metabolic Syndrome. https://www.nhlbi.nih.gov/health/metabolic-syndrome
• [6]NHLBI (2022). Metabolic Syndrome. https://www.nhlbi.nih.gov/health/metabolic-syndrome
• [7]American Diabetes Association (2026). 2. Diagnosis and Classification of Diabetes: Standards of Care in Diabetes-2026. https://diabetesjournals.org/care/article/49/Supplement_1/S27/163926/2-Diagnosis-and-Classification-of-Diabetes
• [8]NIDDK / NIH. Insulin Resistance & Prediabetes. https://www.niddk.nih.gov/health-information/diabetes/overview/what-is-diabetes/prediabetes-insulin-resistance
• [9]Diabetes Tests & Diagnosis. https://www.niddk.nih.gov/health-information/diabetes/overview/tests-diagnosis
• [10]Fazio S et al. (2024). Insulin Resistance/Hyperinsulinemia as an Independent Risk Factor That Has Been Overlooked for Too Long. https://pubmed.ncbi.nlm.nih.gov/39061991/

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How Serious Is This?

• [1]U.S. Centers for Disease Control and Prevention (2024). Prediabetes – Your Chance to Prevent Type 2 Diabetes. https://www.cdc.gov/diabetes/prevention-type-2/prediabetes-prevent-type-2.html
• [2]Knowler WC et al. (2002). Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin. https://pubmed.ncbi.nlm.nih.gov/11832527/
  National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), NIH (2024). Diabetes Prevention Program (DPP) - NIDDK. https://www.niddk.nih.gov/about-niddk/research-areas/diabetes/diabetes-prevention-program-dpp
• [3]hu shengying et al. (2025). Risk factors for progression to type 2 diabetes in prediabetes: a systematic review and meta-analysis. https://doi.org/10.1186/s12889-025-21404-4
• [4]Centers for Disease Control and Prevention (CDC) (2024). About Prediabetes and Type 2 Diabetes — National Diabetes Prevention Program. https://www.cdc.gov/diabetes-prevention/about-prediabetes-type-2/index.html
• [5]Dagogo-Jack S (2025). Pathobiology of Prediabetes: Understanding and Interrupting Progressive Dysglycemia and Associated Complications. https://doi.org/10.2337/dbi25-0006
• [6]Gardner MP et al. (2023). Risk of progression from pre-diabetes to type 2 diabetes in a large UK adult cohort. https://doi.org/10.1111/dme.14996
• [7]Vega-Vázquez MA et al. (2020). Lifestyle and Progression to Type 2 Diabetes in a Cohort of Workers with Prediabetes. https://pmc.ncbi.nlm.nih.gov/articles/PMC7284825/
• [8]Fazio Serafino et al. (2024). Insulin resistance/hyperinsulinemia: an important cardiovascular risk factor that has long been underestimated. https://doi.org/10.3389/fcvm.2024.1380506
• [9]Gast KB et al. (2012). Insulin Resistance and Risk of Incident Cardiovascular Events in Adults without Diabetes: Meta-Analysis. https://doi.org/10.1371/journal.pone.0052036
• [10]Huang Y et al. (2016). Association between prediabetes and risk of cardiovascular disease and all cause mortality: systematic review and meta-analysis. https://doi.org/10.1136/bmj.i5953
• [11]Cai X et al. (2020). Association between prediabetes and risk of all cause mortality and cardiovascular disease: updated meta-analysis. https://doi.org/10.1136/bmj.m2297
• [12]CDC (2024). The Surprising Truth About Prediabetes. https://www.cdc.gov/diabetes/prevention-type-2/truth-about-prediabetes.html
• [13]Su X et al. (2024). The association between the metabolic score for insulin resistance and mortality in patients with cardiovascular disease: a national cohort study. https://doi.org/10.3389/fendo.2024.1479980
• [14]Accili D et al. (2025). Insulin resistance in type 2 diabetes mellitus. https://pubmed.ncbi.nlm.nih.gov/40247011/
• [15]Mohiuddin MS et al. (2025). Metabolic dysfunction associated fatty liver disease and type 2 diabetes: pathophysiological links, epidemiological trends, and clinical implications. https://doi.org/10.3389/fendo.2025.1669478
• [16]Anstee QM et al. (2013). Progression of NAFLD to diabetes mellitus, cardiovascular disease or cirrhosis. https://pubmed.ncbi.nlm.nih.gov/23507799/
• [17]Ndumele CE, et al. (American Heart Association) (2023). A Synopsis of the Evidence for the Science and Clinical Management of Cardiovascular-Kidney-Metabolic (CKM) Syndrome: A Scientific Statement From the American Heart Association. https://doi.org/10.1161/CIR.0000000000001186
• [18]Berlanga Acosta Jorge et al. (2020). Insulin Resistance at the Crossroad of Alzheimer Disease Pathology: A Review. https://doi.org/10.3389/fendo.2020.560375
  Benedict C, Grillo CA (2018). Insulin Resistance as a Therapeutic Target in the Treatment of Alzheimer's Disease: A State-of-the-Art Review. https://doi.org/10.3389/fnins.2018.00215

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Would I Notice Insulin Resistance?

• [1]NIDDK / NIH. Insulin Resistance & Prediabetes. https://www.niddk.nih.gov/health-information/diabetes/overview/what-is-diabetes/prediabetes-insulin-resistance
• [2]U.S. National Library of Medicine (MedlinePlus) (2024). Acanthosis nigricans: MedlinePlus Medical Encyclopedia. https://medlineplus.gov/ency/article/000852.htm
• [3]U.S. National Library of Medicine (MedlinePlus) (2024). Acanthosis nigricans: MedlinePlus Medical Encyclopedia. https://medlineplus.gov/ency/article/000852.htm
  Brady MF, Rawla P (StatPearls Publishing) (2023). Acanthosis Nigricans — StatPearls (NCBI Bookshelf). https://www.ncbi.nlm.nih.gov/books/NBK431057/
  Eggiman Evan et al. (2024). The underlying pathogenesis of obesity-associated acanthosis nigricans: a literature review. https://doi.org/10.1007/s44337-024-00017-7
• [4]Saleh HM, et al. (2025). Skin Tag (Acrochordon) - StatPearls. https://www.ncbi.nlm.nih.gov/sites/books/NBK547724/
  González-Saldivar G, et al. (2017). Skin Manifestations of Insulin Resistance: From a Biochemical Stance to a Clinical Diagnosis and Management. https://pmc.ncbi.nlm.nih.gov/articles/PMC5336429/
  Joseph Chandran B et al. (2025). A Clinico-Morphological Study of Acrochordons and the Association With Diabetes Mellitus. https://pubmed.ncbi.nlm.nih.gov/40062084/
• [5]Yu Q et al. (2017). Malignant acanthosis nigricans: an early diagnostic clue for gastric adenocarcinoma. https://pmc.ncbi.nlm.nih.gov/articles/PMC5702104/
  Mourad AI, Haber RM (2021). Drug-induced acanthosis nigricans: A systematic review and new classification. https://pubmed.ncbi.nlm.nih.gov/33480113/
• [6]Dhokte S, Czaja K (2024). Visceral Adipose Tissue: The Hidden Culprit for Type 2 Diabetes. https://doi.org/10.3390/nu16071015
  Verkouter I et al. (2019). The Association between Adult Weight Gain and Insulin Resistance at Middle Age: Mediation by Visceral Fat and Liver Fat. https://doi.org/10.3390/jcm8101559
  NIDDK / NIH. Insulin Resistance & Prediabetes. https://www.niddk.nih.gov/health-information/diabetes/overview/what-is-diabetes/prediabetes-insulin-resistance
• [7]Verkouter I et al. (2019). The Association between Adult Weight Gain and Insulin Resistance at Middle Age: Mediation by Visceral Fat and Liver Fat. https://doi.org/10.3390/jcm8101559
• [8]Cleveland Clinic (medically reviewed) (2025). Unexplained Weight Gain & Causes of Rapid Weight Gain. https://my.clevelandclinic.org/health/symptoms/unexplained-weight-gain
• [9]Wyatt P et al. (2021). Postprandial glycaemic dips predict appetite and energy intake in healthy individuals. https://pubmed.ncbi.nlm.nih.gov/33846643/
• [10]Rania Marianna et al. (2023). Reactive hypoglycemia in binge eating disorder, food addiction, and the comorbid phenotype: unravelling the metabolic drive to disordered eating behaviours. https://doi.org/10.1186/s40337-023-00891-z
• [11]Fanelli G. et al. (Neuroscience & Biobehavioral Reviews) (2024). Insulin resistance in depression: A large meta-analysis of metabolic parameters and variation. https://pmc.ncbi.nlm.nih.gov/articles/PMC11056930/
• [12]ali mona et al. (2022). The potential impact of insulin resistance and metabolic syndrome on migraine headache characteristics. https://doi.org/10.1186/s12883-022-02966-x
• [13]Chapple Brooke et al. (2025). Type 3 Diabetes: Linking Insulin Resistance to Cognitive Decline. https://doi.org/10.3390/diseases13110359

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How Is This Measured — and What Should I Track?

• [1]American Diabetes Association Professional Practice Committee (2024). 6. Glycemic Goals and Hypoglycemia: Standards of Care in Diabetes—2024. https://doi.org/10.2337/dc24-S006
• [2]Vaidya Rama A et al. (2023). Hyperinsulinemia: an early biomarker of metabolic dysfunction. https://doi.org/10.3389/fcdhc.2023.1159664
• [3]Gutch M et al. (2015). Assessment of insulin sensitivity/resistance. https://doi.org/10.4103/2230-8210.146874
• [4]U.S. Centers for Disease Control and Prevention (2024). Diabetes Testing | Diabetes | CDC. https://www.cdc.gov/diabetes/diabetes-testing/index.html
• [5]U.S. Preventive Services Task Force Evidence Review (adapted from ADA) (2021). Criteria for the Diagnosis of Type 2 Diabetes and Prediabetes (USPSTF Evidence Review, adapted from 2018 ADA guidelines). https://www.ncbi.nlm.nih.gov/books/NBK574060/table/ch1.tab2/
• [6]Alvarez S et al. (2023). Prediabetes - StatPearls (NCBI Bookshelf). https://www.ncbi.nlm.nih.gov/books/NBK459332/
• [7]National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) (2023). Continuous Glucose Monitoring — NIDDK. https://www.niddk.nih.gov/health-information/diabetes/overview/managing-diabetes/continuous-glucose-monitoring
• [8]wilczek filip et al. (2025). Non-Invasive Continuous Glucose Monitoring in Patients Without Diabetes: Use in Cardiovascular Prevention — A Systematic Review. https://doi.org/10.3390/s25010187
• [9]American Diabetes Association (2026). 2026 ADA Diabetes Standards of Medical Care Clinical Guideline Summary (Guideline Central). https://www.guidelinecentral.com/guideline/14119/
• [10]NIDDK / NIH. Insulin Resistance & Prediabetes. https://www.niddk.nih.gov/health-information/diabetes/overview/what-is-diabetes/prediabetes-insulin-resistance
• [11]McCoy RG et al. (2015). HbA1c overtesting and overtreatment among US adults with controlled type 2 diabetes, 2001-13: observational population based study. https://pubmed.ncbi.nlm.nih.gov/26646052/

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Where Did This Come From?

• [1]Yaghootkar H et al. (2014). Genetic Evidence for a Normal-Weight 'Metabolically Obese' Phenotype Linking Insulin Resistance, Hypertension, Coronary Artery Disease, and Type 2 Diabetes. https://doi.org/10.2337/db14-0318
• [2]Cleveland Clinic (institutional) (2024). Insulin Resistance: What It Is, Causes, Symptoms & Treatment (Cleveland Clinic). https://my.clevelandclinic.org/health/diseases/22206-insulin-resistance
• [3]Chandalia M et al. (2007). Insulin Resistance and Body Fat Distribution in South Asian Men Compared to Caucasian Men. https://doi.org/10.1371/journal.pone.0000812
• [4]NIDDK / NIH. Insulin Resistance & Prediabetes. https://www.niddk.nih.gov/health-information/diabetes/overview/what-is-diabetes/prediabetes-insulin-resistance
• [5]Zhao X et al. (2023). The crucial role and mechanism of insulin resistance in metabolic disease. https://doi.org/10.3389/fendo.2023.1149239
• [6]Sarah Glinski et al. (2024). 9 Best Insulin Resistance Supplements to Help Manage Blood Sugar. https://www.nourish.com/blog/insulin-resistance-supplements
• [7]Washington Health and Drug (retail blog). Supplements to Reverse Insulin Resistance — Washington Health and Drug. https://washingtonhealthanddrug.com/blogs/news/supplements-to-reverse-insulin-resistance
• [8]Yan Yu Xiang et al. (2016). Investigation of the Relationship Between Chronic Stress and Insulin Resistance in a Chinese Population. https://doi.org/10.2188/jea.JE20150183
• [9]Pinheiro MC et al. (2025). Sleep Deprivation and Its Impact on Insulin Resistance. https://doi.org/10.3390/endocrines6040049
• [10]Singh T et al. (2022). Does Insufficient Sleep Increase the Risk of Developing Insulin Resistance: A Systematic Review. https://doi.org/10.7759/cureus.23501
• [11]Diamanti-Kandarakis E, Dunaif A (2012). Insulin Resistance and the Polycystic Ovary Syndrome Revisited: An Update on Mechanisms and Implications. https://doi.org/10.1210/er.2011-1034
• [12]Prosperi Sara et al. (2025). Insulin resistance, metabolic syndrome and polycystic ovaries: an intriguing conundrum. https://doi.org/10.3389/fendo.2025.1669716
• [13]Parker Jim et al. (2025). Recognizing the Role of Insulin Resistance in Polycystic Ovary Syndrome: A Paradigm Shift from a Glucose-Centric Approach to an Insulin-Centric Model. https://doi.org/10.3390/jcm14124021
• [14]Teede HJ et al. (2023). Recommendations from the 2023 International Evidence-based Guideline for the Assessment and Management of Polycystic Ovary Syndrome. https://www.asrm.org/practice-guidance/practice-committee-documents/recommendations-from-the-2023-international-evidence-based-guideline-for-the-assessment-and-management-of-polycystic-ovary-syndrome/
• [15]Zhou PZ et al. (2016). Relationship Between Glucocorticoids and Insulin Resistance in Healthy Individuals. https://pubmed.ncbi.nlm.nih.gov/27258456/
• [16]jain akshay b et al. (2024). Medication-Induced Hyperglycemia and Diabetes Mellitus: A Review of Current Literature and Practical Management Strategies. https://doi.org/10.1007/s13300-024-01628-0
• [17]Barker Hannah L et al. (2023). Practical Guide to Glucocorticoid Induced Hyperglycaemia and Diabetes. https://doi.org/10.1007/s13300-023-01393-6
• [18]Burghardt KJ et al. (2018). Atypical antipsychotics, insulin resistance and weight; a meta-analysis of healthy volunteer studies. https://pubmed.ncbi.nlm.nih.gov/29325867/
• [19]Lopez LM, et al. (2014). Steroidal contraceptives: effect on carbohydrate metabolism in women without diabetes mellitus (Cochrane plain-language summary). https://doi.org/10.1002/14651858.CD006133.pub5
• [20]Cree JME et al. (2024). The Effect of the Oral Contraceptive Pill on Acute Glycaemic Response to an Oral Glucose Bolus in Healthy Young Women: A Randomised Crossover Study. https://doi.org/10.3390/nu16203490
• [21]Beuschlein F et al. (2024). European Society of Endocrinology and Endocrine Society Joint Clinical Guideline: Diagnosis and Therapy of Glucocorticoid-induced Adrenal Insufficiency. https://doi.org/10.1210/clinem/dgae250

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Can This Be Reversed?

• [1]Diabetes Prevention Program (DPP) Research Group (2002). The Diabetes Prevention Program (DPP): Description of lifestyle intervention. https://pmc.ncbi.nlm.nih.gov/articles/PMC1282458/
• [2]Lean MEJ et al. (2019). Two-year results of the randomised Diabetes Remission Clinical Trial (DiRECT). https://www.ncl.ac.uk/mediav8/newcastle-magnetic-resonance-centre/files/DiRECT-2-year-results.pdf
• [3]American Diabetes Association (2017). Standards of Medical Care in Diabetes—2017 Abridged for Primary Care Providers. https://pmc.ncbi.nlm.nih.gov/articles/PMC5241768/
• [4]Centers for Disease Control and Prevention (2024). What Is the National DPP? National Diabetes Prevention Program, CDC. https://www.cdc.gov/diabetes-prevention/programs/what-is-the-national-dpp.html
• [5]Taylor R (2019). Calorie restriction for long-term remission of type 2 diabetes. https://doi.org/10.7861/clinmedicine.19-1-37
• [6]Newcastle University (Taylor research group) (2024). Reversing Type 2 Diabetes and ongoing remission — Newcastle University Magnetic Resonance Centre. https://www.ncl.ac.uk/magres/research/diabetes/reversal/
• [7]Taylor R (2019). Calorie restriction for long-term remission of type 2 diabetes. https://doi.org/10.7861/clinmedicine.19-1-37
• [8]amaravadi sampath kumar et al. (2024). Effectiveness of structured exercise program on insulin resistance and quality of life in type 2 diabetes mellitus — A randomized controlled trial. https://doi.org/10.1371/journal.pone.0302831
• [9]DiMenna FJ, Arad AD (2021). The acute vs. chronic effect of exercise on insulin sensitivity: nothing lasts forever. https://pubmed.ncbi.nlm.nih.gov/34386716/
• [10]DiMenna FJ, Arad AD (2021). The acute vs. chronic effect of exercise on insulin sensitivity: nothing lasts forever. https://pubmed.ncbi.nlm.nih.gov/34386716/
• [11]NIDDK / NIH. Insulin Resistance & Prediabetes. https://www.niddk.nih.gov/health-information/diabetes/overview/what-is-diabetes/prediabetes-insulin-resistance
• [12]Murdoch C, et al. (2019). Adapting diabetes medication for low carbohydrate management of type 2 diabetes: a practical guide. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6592353/
• [13]Yale School of Medicine (faculty article) (2024). How to Reverse Insulin Resistance — Yale School of Medicine. https://medicine.yale.edu/news-article/how-to-reverse-insulin-resistance/
• [14]Jacob Elizabeth et al. (2021). Energy-restricted interventions are effective for the remission of newly diagnosed type 2 diabetes: A systematic review of the evidence base. https://doi.org/10.1002/osp4.504
• [15]Riddle MC et al. (2022). Consensus Report: Definition and Interpretation of Remission in Type 2 Diabetes. https://doi.org/10.1210/clinem/dgab585

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Sleep, Drinking, Smoking, and the Urge to Track

• [1]Murphy AM et al. (2017). Intermittent hypoxia in obstructive sleep apnoea mediates insulin resistance through adipose tissue inflammation. https://pubmed.ncbi.nlm.nih.gov/28424360/
• [2]Framnes SN, Arble DM (2018). The Bidirectional Relationship Between Obstructive Sleep Apnea and Metabolic Disease. https://pubmed.ncbi.nlm.nih.gov/30127766/
• [3]Michalek-Zrabkowska M et al. (2021). Obstructive Sleep Apnea as a Risk Factor of Insulin Resistance in Nondiabetic Adults. https://doi.org/10.3390/life11010050
• [4]Iftikhar IH et al. (2013). Meta-analysis: Continuous Positive Airway Pressure Improves Insulin Resistance in Patients with Sleep Apnea without Diabetes. https://pubmed.ncbi.nlm.nih.gov/23607839/
• [5]Yeghiazarians Y et al. (2021). Obstructive Sleep Apnea and Cardiovascular Disease: A Scientific Statement From the American Heart Association. https://pubmed.ncbi.nlm.nih.gov/34148375/
• [6]American Academy of Sleep Medicine (AASM) (2017). Obstructive Sleep Apnea Screening Health Advisory. https://aasm.org/advocacy/position-statements/sleep-apnea-screening-health-advisory/
• [7]Schrieks IC et al. (2015). The effect of alcohol consumption on insulin sensitivity and glycemic status: a systematic review and meta-analysis of intervention studies. https://pubmed.ncbi.nlm.nih.gov/25805864/
• [8]carr rotonya m et al. (2015). Insulin resistance in clinical and experimental alcoholic liver disease. https://doi.org/10.1111/nyas.12787
• [9]Sumner JA, et al. (2017). The Relation of Light-to-Moderate Alcohol Consumption to Glucose Metabolism and Insulin Resistance in Nondiabetic Adults: the Moderating Effects of Depressive Symptom Severity, Adiposity, and Sex. https://pmc.ncbi.nlm.nih.gov/articles/PMC6037173/
• [10]Buettner C, et al. (Mount Sinai / Science Translational Medicine) (2013). Binge Drinking Increases Risk of Type 2 Diabetes by Causing Insulin Resistance. https://www.mountsinai.org/about/newsroom/2013/binge-drinking-increases-risk-of-type-2-diabetes-by-causing-insulin-resistance
• [11]Emanuele NV et al. (1998). Consequences of Alcohol Use in Diabetics. https://pmc.ncbi.nlm.nih.gov/articles/PMC6761899/
• [12]Bergman BC et al. (2012). Novel and Reversible Mechanisms of Smoking-Induced Insulin Resistance in Humans. https://doi.org/10.2337/db12-0418
• [13]U.S. Centers for Disease Control and Prevention (2024). Diabetes and Smoking. https://www.cdc.gov/diabetes/risk-factors/diabetes-and-smoking.html
• [14]Pan A et al. (2015). Relation of active, passive, and quitting smoking with incident type 2 diabetes: a systematic review and meta-analysis. https://doi.org/10.1016/S2213-8587(15)00316-2
• [15]Yeh HC et al. (2010). Smoking, Smoking Cessation, and the Risk for Type 2 Diabetes Mellitus: A Cohort Study (ARIC). https://pmc.ncbi.nlm.nih.gov/articles/PMC5726255/
  Diabetes (American Diabetes Association) commentary (2012). Nicotine and Insulin Resistance: When the Smoke Clears. https://diabetesjournals.org/diabetes/article/61/12/3078/33680/Nicotine-and-Insulin-Resistance-When-the-Smoke
• [16]NIDDK / NIH (2024). Your Game Plan to Prevent Type 2 Diabetes. https://www.niddk.nih.gov/health-information/diabetes/overview/preventing-type-2-diabetes/game-plan
• [17]Burke LE et al. (2011). Self-Monitoring in Weight Loss: A Systematic Review of the Literature. https://pubmed.ncbi.nlm.nih.gov/21185970/
• [18]cavero redondo ivan et al. (2020). Effect of Behavioral Weight Management Interventions Using Lifestyle mHealth Self-Monitoring on Weight Loss: A Systematic Review and Meta-Analysis. https://doi.org/10.3390/nu12071977
• [19]moody sarah et al. (2025). Associations Between the Use of Fitness and Diet Tracking Technology and Disordered Eating Behaviour: A Systematic Review. https://doi.org/10.1002/erv.70006
• [20]News-Medical / Flinders University (Anderberg et al.) (2025). Research reveals concerning links between fitness apps and disordered eating (Flinders University press release on 38-study review). https://www.news-medical.net/news/20250220/Research-reveals-concerning-links-between-fitness-apps-and-disordered-eating.aspx
• [21]MASS / Stronger by Science (2021). Diet Tracking and Disordered Eating: Which Comes First? (MASS Research Review of Hahn et al. 2021 RCT). https://www.strongerbyscience.com/diet-tracking/
• [22]National Alliance for Eating Disorders (2026). From Tracking to Trapped: When Health Apps Fuel Disordered Eating. https://www.allianceforeatingdisorders.com/health-tracking-apps-and-disordered-eating/
• [23]Van Dyke N, Drinkwater EJ (2014). Relationships between intuitive eating and health indicators: literature review. https://doi.org/10.1017/S1368980013002139
• [24]Soares FLP et al. (2021). Intuitive eating is associated with glycemic control in type 2 diabetes. https://doi.org/10.1007/s40519-020-00894-8

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What Should I Eat?

• [1]Centers for Disease Control and Prevention (2024). Choosing Healthy Carbs | Diabetes | CDC. https://www.cdc.gov/diabetes/healthy-eating/choosing-healthy-carbs.html
• [2]ying t et al. (2024). Effects of whole grains on glycemic control: a systematic review and dose-response meta-analysis of prospective cohort studies and randomized controlled trials. https://pubmed.ncbi.nlm.nih.gov/38664726/
• [3]Das R et al. (2025). Long-Term Efficacy and Safety of a Low-Carbohydrate Diet in Type 2 Diabetes Remission: A Systematic Review. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12476234/
• [4]Tricò D et al. (2021). Effects of Low-Carbohydrate versus Mediterranean Diets on Weight Loss, Glucose Metabolism, Insulin Kinetics and β-Cell Function in Morbidly Obese Individuals. https://doi.org/10.3390/nu13041345
• [5]American Diabetes Association (2019). ADA Nutrition Therapy for Adults With Diabetes or Prediabetes — Consensus Recommendations Summary. https://www.guidelinecentral.com/guideline/14102/
• [6]Perfect Keto (Lauren Ciccarelli) (2019). Insulin Resistance Diet: How Keto Helps — Perfect Keto. https://perfectketo.com/ketogenic-insulin-resistance-diet/
• [7]Cucuzzella M, et al. (2021). Adapting Medication for Type 2 Diabetes to a Low Carbohydrate Diet. https://pmc.ncbi.nlm.nih.gov/articles/PMC8380766/
  Isaacs D (clinical recommendations summarized) (2019). Ketogenic, low-carb diets require diabetes medication adjustments. https://www.healio.com/news/endocrinology/20190814/ketogenic-lowcarb-diets-require-diabetes-medication-adjustments
  Murdoch C et al. (2021). Adapting Medication for Type 2 Diabetes to a Low Carbohydrate Diet. https://www.frontiersin.org/journals/nutrition/articles/10.3389/fnut.2021.688540/full
  Murdoch C, et al. (2019). Adapting diabetes medication for low carbohydrate management of type 2 diabetes: a practical guide. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6592353/
• [8]Song Q et al. (2025). Intermittent fasting improves metabolic outcomes in metabolic syndrome: a systematic review and meta-analysis with GRADE evaluation. https://doi.org/10.3389/fnut.2025.1664811
• [9]Alfahl SO (2025). Evaluation of the effectiveness of intermittent fasting versus caloric restriction in weight loss and improving cardiometabolic health: A systematic review and meta-analysis. https://pmc.ncbi.nlm.nih.gov/articles/PMC11930668/
• [10]Obermayer A. et al. (2023). Efficacy and Safety of Intermittent Fasting in People With Insulin-Treated Type 2 Diabetes (INTERFAST-2)—A Randomized Controlled Trial. https://diabetesjournals.org/care/article/46/2/463/148123/Efficacy-and-Safety-of-Intermittent-Fasting-in
• [11]Shukla AP et al. (2019). The impact of food order on postprandial glycemic excursions in prediabetes. https://doi.org/10.1111/dom.13503
• [12]Clinical Nutrition Research (e-cnr) authors (2025). Effects of meal sequence intervention on blood glucose response in healthy adults: a systematic review. https://www.e-cnr.org/journal/view.php?number=403
• [13]Glucose Goddess (Jessie Inchauspé brand site) (2025). 10 Hacks to Reduce Blood Sugar Spikes | Glucose Goddess Guide. https://www.glucosegoddess.com/pages/science-episode-the-10-glucose-goddess-hacks

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How Exercise Helps

• [1]shen jiawen et al. (2024). Potential molecular mechanism of exercise reversing insulin resistance and improving neurodegenerative diseases. https://doi.org/10.3389/fphys.2024.1337442
• [2]Kanaley JA et al. (2022). Exercise/Physical Activity in Individuals with Type 2 Diabetes: A Consensus Statement from the American College of Sports Medicine. https://doi.org/10.1249/MSS.0000000000002800
• [3]Conn VS et al. (2014). Insulin Sensitivity Following Exercise Interventions. https://doi.org/10.1177/2150131913520328
• [4]Huang Li et al. (2021). Comparisons of different exercise interventions on glycemic control and insulin resistance in prediabetes: a network meta-analysis. https://doi.org/10.1186/s12902-021-00846-y
• [5]American Diabetes Association (2026). ADA Standards of Care in Diabetes 2026 — Physical Activity (rec 5.36, 5.37). https://diabetesjournals.org/care/issue/49/Supplement_1
• [6]Colberg SR (2017). Key Points from the Updated Guidelines on Exercise and Diabetes (synthesis of ADA Position Statement). https://doi.org/10.3389/fendo.2017.00033
• [7]Pan Y et al. (2025). Effect of nine different exercise interventions on insulin sensitivity in diabetic patients: a systematic review and mesh meta-analysis. https://doi.org/10.3389/fendo.2025.1409474
• [8]Silva Fernanda M et al. (2024). The effects of combined exercise training on glucose metabolism and inflammatory markers in sedentary adults: a systematic review and meta-analysis. https://doi.org/10.1038/s41598-024-51832-y

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What Do I Actually Do Now?

• [1]NIDDK / NIH. Insulin Resistance & Prediabetes. https://www.niddk.nih.gov/health-information/diabetes/overview/what-is-diabetes/prediabetes-insulin-resistance
  American Diabetes Association Professional Practice Committee (2024). Introduction: Standards of Care in Diabetes—2024 Abridged for Primary Care Professionals. https://doi.org/10.2337/cd24-aint
• [2]University of Utah Health (2025). When Should You See a Diabetes Specialist?. https://healthcare.utah.edu/diabetes/when-should-you-see-diabetes-specialist
• [3]NIDDK / NIH. Insulin Resistance & Prediabetes. https://www.niddk.nih.gov/health-information/diabetes/overview/what-is-diabetes/prediabetes-insulin-resistance
• [4]University of Utah Health (2025). When Should You See a Diabetes Specialist?. https://healthcare.utah.edu/diabetes/when-should-you-see-diabetes-specialist
• [5]University of Utah Health (2025). When Should You See a Diabetes Specialist?. https://healthcare.utah.edu/diabetes/when-should-you-see-diabetes-specialist
• [6]University of Utah Health (2025). When Should You See a Diabetes Specialist?. https://healthcare.utah.edu/diabetes/when-should-you-see-diabetes-specialist
• [7]NHLBI (2022). Metabolic Syndrome. https://www.nhlbi.nih.gov/health/metabolic-syndrome
• [8]Swarup S et al. (2024). Metabolic Syndrome (StatPearls). https://www.ncbi.nlm.nih.gov/books/NBK459248/
• [9]Bjornstad P, Eckel RH (2018). Pathogenesis of Lipid Disorders in Insulin Resistance: A Brief Review. https://doi.org/10.1007/s11892-018-1101-6
• [10]American Diabetes Association Professional Practice Committee (2024). 10. Cardiovascular Disease and Risk Management: Standards of Care in Diabetes-2024. https://doi.org/10.2337/dc24-S010
  American Diabetes Association Professional Practice Committee (2024). 10. Cardiovascular Disease and Risk Management: Standards of Care in Diabetes-2024 (PubMed abstract record). https://pubmed.ncbi.nlm.nih.gov/38078592/
• [11]Cleveland Clinic (2024). Medical Nutrition Therapy (MNT) - Cleveland Clinic. https://my.clevelandclinic.org/health/treatments/medical-nutrition-therapy-mnt
• [12]Evert AB et al. (2019). Nutrition Therapy for Adults With Diabetes or Prediabetes: A Consensus Report (ADA). https://pmc.ncbi.nlm.nih.gov/articles/PMC7011201/
• [13]Briggs Early K, Stanley K. (2018). Position of the Academy of Nutrition and Dietetics: The Role of Medical Nutrition Therapy and Registered Dietitian Nutritionists in the Prevention and Treatment of Prediabetes and Type 2 Diabetes. https://doi.org/10.1016/j.jand.2017.11.021
• [14]Evert AB et al. (2019). Nutrition Therapy for Adults With Diabetes or Prediabetes: A Consensus Report (ADA). https://pmc.ncbi.nlm.nih.gov/articles/PMC7011201/#rec
• [15]U.S. Centers for Disease Control and Prevention (CDC) (2024). 5 Questions to Ask Your Health Care Team — CDC Diabetes. https://www.cdc.gov/diabetes/caring/5-questions-health-care-team.html
• [16]U.S. Centers for Disease Control and Prevention (CDC) (2024). 5 Questions to Ask Your Health Care Team — CDC Diabetes. https://www.cdc.gov/diabetes/caring/5-questions-health-care-team.html
• [17]GoodRx editorial (2024). How Much Does Blood Work Cost Without Insurance?. https://www.goodrx.com/health-topic/diagnostics/how-much-is-blood-work-without-insurance
• [18]GoodRx editorial (2024). How Much Does Blood Work Cost Without Insurance?. https://www.goodrx.com/health-topic/diagnostics/how-much-is-blood-work-without-insurance
• [19]SingleCare. How much is metformin without insurance?. https://www.singlecare.com/blog/metformin-without-insurance/
• [20]Nourish (commercial telehealth dietitian platform) (2024). Can a Dietitian Help With Insulin Resistance? - Nourish. https://www.usenourish.com/blog/can-a-dietitian-help-with-insulin-resistance

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Do Supplements Help?

• [1]Guo J, et al. (2021). The Effect of Berberine on Metabolic Profiles in Type 2 Diabetic Patients: A Systematic Review and Meta-Analysis of RCTs. https://doi.org/10.1155/2021/2074610
• [2]Nazari A, et al. (2024). The Effect of Berberine Supplementation on Glycemic Control and Inflammatory Biomarkers in Metabolic Disorders: An Umbrella Meta-analysis of RCTs. https://doi.org/10.1016/j.clinthera.2023.10.019
• [3]NCCIH (NIH) (2023). Berberine and Weight Loss: What You Need To Know. https://www.nccih.nih.gov/health/berberine-and-weight-loss-what-you-need-to-know
• [4]Veronese N et al. (2021). Oral Magnesium Supplementation for Treating Glucose Metabolism Parameters in People with or at Risk of Diabetes: A Systematic Review and Meta-Analysis of Double-Blind Randomized Controlled Trials. https://doi.org/10.3390/nu13114074
• [5]Xu L et al. (2023). Effects of magnesium supplementation on improving hyperglycemia, hypercholesterolemia, and hypertension in type 2 diabetes: A pooled analysis of 24 randomized controlled trials. https://doi.org/10.3389/fnut.2022.1020327
• [6]Mooren FC et al. (2011). Oral magnesium supplementation reduces insulin resistance in non-diabetic subjects - a double-blind, placebo-controlled, randomized trial. https://pubmed.ncbi.nlm.nih.gov/21205110/
• [7]Delavar Mouloud Agajani et al. (2025). Inositol supplementation efficacy in improving key cardiometabolic and anthropometric indices: a GRADE-assessed systematic review and meta-analysis of randomized controlled trials. https://doi.org/10.1186/s13098-025-01980-6
• [8]Greff D, et al. (2023). Inositol is an effective and safe treatment in polycystic ovary syndrome: a systematic review and meta-analysis of randomized controlled trials. https://doi.org/10.1186/s12958-023-01055-z
• [9]Fitz V, et al. (2024). Inositol for Polycystic Ovary Syndrome: A Systematic Review and Meta-analysis to Inform the 2023 Update of the International Evidence-based PCOS Guidelines. https://doi.org/10.1210/clinem/dgad762
• [10]KINDNATURE (2024). Myo-Inositol for Insulin Resistance: How It Supports Blood Sugar Balance — KINDNATURE. https://kindnature.com/blogs/journal/myo-inositol-insulin-resistance
• [11]Asbaghi O et al. (2020). Effects of chromium supplementation on glycemic control in patients with type 2 diabetes: a systematic review and meta-analysis of randomized controlled trials. https://pubmed.ncbi.nlm.nih.gov/32730903/
• [12]NIH Office of Dietary Supplements (2024). Chromium - Health Professional Fact Sheet. https://ods.od.nih.gov/factsheets/Chromium-HealthProfessional/
• [13]Costello RB et al. (2016). Chromium supplements for glycemic control in type 2 diabetes: limited evidence of effectiveness. https://doi.org/10.1093/nutrit/nuw011
• [14]WebMD editorial (2024). Cinnamon: Health Benefits, Uses, Nutrition, and Side Effects — WebMD supplement guide. https://www.webmd.com/diet/supplement-guide-cinnamon
• [15]MedicalNewsToday editorial (2023). Cinnamon and diabetes: Effect on blood sugar and overall health. https://www.medicalnewstoday.com/articles/317207
• [16]Frontiers in Nutrition authors (umbrella review) (2025). The effects of cinnamon on patients with metabolic diseases: an umbrella review of meta-analyses of randomized controlled trials. https://pmc.ncbi.nlm.nih.gov/articles/PMC12620228/
• [17]Leach MJ, Kumar S (2012). Cinnamon for diabetes mellitus. https://doi.org/10.1002/14651858.CD007170.pub2
• [18]Jibril AT et al. (2022). Efficacy and safety of oral alpha-lipoic acid supplementation for type 2 diabetes management: a systematic review and dose-response meta-analysis of randomized trials. https://doi.org/10.1530/EC-22-0322
• [19]University of Rochester Medical Center. Alpha Lipoic Acid - Health Encyclopedia. https://www.urmc.rochester.edu/encyclopedia/content?contentid=AlphalipoicAcid&contenttypeid=19
• [20]Health Canada (2016). Summary Safety Review - Alpha Lipoic Acid - Assessing the Potential Risk of Low Blood Sugar. https://www.canada.ca/en/health-canada/services/drugs-health-products/medeffect-canada/safety-reviews/summary-safety-review-alpha-lipoic-acid-assessing-potential-risk-low-blood-sugar-hypoglycemic.html

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Should I Just Go on Ozempic? And What About Metformin?

• [1]Liu Y, et al. (2023). The Weight-loss Effect of GLP-1RAs in Non-diabetic Individuals with Overweight or Obesity: SR with Meta-Analysis and Trial Sequential Analysis of RCTs. https://doi.org/10.1016/j.ajcnut.2023.04.017
• [2]Novo Nordisk; FDA (DailyMed) (2025). OZEMPIC (semaglutide) Prescribing Information - Indications and Usage (DailyMed/FDA). https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=979e4df4-0597-48ea-b51c-0f699fa6d166
• [3]Ismaiel A, et al. (2025). Gastrointestinal adverse events associated with GLP-1 RA in non-diabetic patients with overweight or obesity: a systematic review and network meta-analysis. https://doi.org/10.1038/s41366-025-01859-6
• [4]Corcoran C, Jacobs TF (2023). Metformin - StatPearls. https://www.ncbi.nlm.nih.gov/books/NBK518983/
• [5]Aroda VR et al. (2017). Metformin for diabetes prevention: insights gained from the Diabetes Prevention Program/Diabetes Prevention Program Outcomes Study. https://doi.org/10.1007/s00125-017-4361-9
• [6]American Diabetes Association Professional Practice Committee (2024). 3. Prevention or Delay of Diabetes and Associated Comorbidities: Standards of Care in Diabetes—2024. https://pmc.ncbi.nlm.nih.gov/articles/PMC10725807/
• [7]American Diabetes Association Professional Practice Committee (2024). 3. Prevention or Delay of Diabetes and Associated Comorbidities: Standards of Care in Diabetes—2024. https://pmc.ncbi.nlm.nih.gov/articles/PMC10725807/
• [8]Aroda VR et al. (2017). Metformin for diabetes prevention: insights gained from the Diabetes Prevention Program/Diabetes Prevention Program Outcomes Study. https://doi.org/10.1007/s00125-017-4361-9
• [9]Corcoran C, Jacobs TF (2023). Metformin - StatPearls. https://www.ncbi.nlm.nih.gov/books/NBK518983/
• [10]Aroda VR et al. (2017). Metformin for diabetes prevention: insights gained from the Diabetes Prevention Program/Diabetes Prevention Program Outcomes Study. https://doi.org/10.1007/s00125-017-4361-9
• [11]Infante M et al. (2021). Long-term metformin therapy and vitamin B12 deficiency: an association to bear in mind. https://doi.org/10.4239/wjd.v12.i7.916
  American Diabetes Association Professional Practice Committee (2025). Prevention or Delay of Diabetes and Associated Comorbidities: Standards of Care in Diabetes - 2025. https://diabetesjournals.org/care/article/48/Supplement_1/S50/157550#b12
  Aroda VR et al. (2017). Metformin for diabetes prevention: insights gained from the Diabetes Prevention Program/Diabetes Prevention Program Outcomes Study. https://doi.org/10.1007/s00125-017-4361-9
• [12]American Diabetes Association Professional Practice Committee (2025). Prevention or Delay of Diabetes and Associated Comorbidities: Standards of Care in Diabetes - 2025. https://diabetesjournals.org/care/article/48/Supplement_1/S50/157550
  American Diabetes Association Professional Practice Committee (2024). 3. Prevention or Delay of Diabetes and Associated Comorbidities: Standards of Care in Diabetes—2024. https://pmc.ncbi.nlm.nih.gov/articles/PMC10725807/
• [13]Corcoran C, Jacobs TF (2023). Metformin - StatPearls. https://www.ncbi.nlm.nih.gov/books/NBK518983/
  Corcoran C, Jacobs TF (2023). Metformin - StatPearls. https://www.ncbi.nlm.nih.gov/books/NBK518983/#advfx
  VA Evidence Synthesis Program (2011). Metformin Use in Patients with Contraindications or Precautions. https://www.hsrd.research.va.gov/publications/esp/metformin-APP.pdf
• [14]Corcoran C, Jacobs TF (2023). Metformin - StatPearls. https://www.ncbi.nlm.nih.gov/books/NBK518983/
  Corcoran C, Jacobs TF (2023). Metformin - StatPearls. https://www.ncbi.nlm.nih.gov/books/NBK518983/#contra
• [15]Corcoran C, Jacobs TF (2023). Metformin - StatPearls. https://www.ncbi.nlm.nih.gov/books/NBK518983/
• [16]Haber R, et al. (2024). The impact of metformin on weight and metabolic parameters in patients with obesity: A systematic review and meta-analysis of randomized controlled trials. https://pubmed.ncbi.nlm.nih.gov/38468148/
• [17]pu ruiyang et al. (2020). Effects of metformin in obesity treatment in different populations: a meta-analysis. https://doi.org/10.1177/2042018820926000
• [18]Sesame Care (telehealth marketplace) (2024). Metformin for Weight Loss: Risks and Benefits. https://sesamecare.com/blog/metformin-for-weight-loss
• [19]American Diabetes Association (2023). The American Diabetes Association Releases the Standards of Care in Diabetes—2024. https://diabetes.org/newsroom/press-releases/american-diabetes-association-releases-standards-care-diabetes-2024
• [20]TCTMD news (reporting on Choi/Laiteerapong et al., Ann Intern Med 2022) (2022). Sky-high Cost of SGLT2i and GLP1 Agonists Deter First-line Use. https://www.tctmd.com/news/sky-high-cost-sglt2i-and-glp1-agonists-deter-first-line-use
• [21]andraos john et al. (2024). Narrative review of data supporting alternate first-line therapies over metformin in type 2 diabetes. https://doi.org/10.1007/s40200-024-01406-6
• [22]TCTMD news (reporting on Choi/Laiteerapong et al., Ann Intern Med 2022) (2022). Sky-high Cost of SGLT2i and GLP1 Agonists Deter First-line Use. https://www.tctmd.com/news/sky-high-cost-sglt2i-and-glp1-agonists-deter-first-line-use
• [23]StatPearls (2024). Compare and Contrast the Glucagon-Like Peptide-1 Receptor Agonists (GLP1RAs) - StatPearls. https://www.ncbi.nlm.nih.gov/books/NBK572151/
• [24]Wilding JPH et al. (2022). Weight regain and cardiometabolic effects after withdrawal of semaglutide: The STEP 1 trial extension. https://doi.org/10.1111/dom.14725
• [25]Wilding JPH et al. (2022). Weight regain and cardiometabolic effects after withdrawal of semaglutide: The STEP 1 trial extension. https://doi.org/10.1111/dom.14725
• [26]Wilding JPH et al. (2022). Weight regain and cardiometabolic effects after withdrawal of semaglutide: The STEP 1 trial extension. https://doi.org/10.1111/dom.14725
• [27]Medical News Today (Peter Morales-Brown) (2023). Stopping metformin with diabetes: What to know first. https://www.medicalnewstoday.com/articles/323128
• [28]Medical News Today (Peter Morales-Brown) (2023). Stopping metformin with diabetes: What to know first. https://www.medicalnewstoday.com/articles/323128

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Is It in My Genes?

• [1]U.S. Preventive Services Task Force (2022). Recommendation: Prediabetes and Type 2 Diabetes in Children and Adolescents: Screening. https://www.uspreventiveservicestaskforce.org/uspstf/recommendation/prediabetes-type2-diabetes-children-adolescents-screening
• [2]Wallace AS et al. (2020). Screening and Diagnosis of Prediabetes and Diabetes in US Children and Adolescents. https://pmc.ncbi.nlm.nih.gov/articles/PMC7461138/
• [3]U.S. Preventive Services Task Force (2022). Recommendation: Prediabetes and Type 2 Diabetes in Children and Adolescents: Screening. https://www.uspreventiveservicestaskforce.org/uspstf/recommendation/prediabetes-type2-diabetes-children-adolescents-screening
• [4]American Diabetes Association Professional Practice Committee (2025). 14. Children and Adolescents: Standards of Care in Diabetes—2026 (ADA). https://pmc.ncbi.nlm.nih.gov/articles/PMC12690182/
• [5]Serbis A, et al. (2024). Pediatric Type 2 Diabetes — StatPearls (NCBI Bookshelf). https://www.ncbi.nlm.nih.gov/books/NBK431046/
• [6]Serbis A, et al. (2024). Pediatric Type 2 Diabetes — StatPearls (NCBI Bookshelf). https://www.ncbi.nlm.nih.gov/books/NBK431046/
• [7]American Diabetes Association Professional Practice Committee (2025). 14. Children and Adolescents: Standards of Care in Diabetes—2026 (ADA). https://pmc.ncbi.nlm.nih.gov/articles/PMC12690182/
• [8]American Diabetes Association Professional Practice Committee (2025). 14. Children and Adolescents: Standards of Care in Diabetes—2026 (ADA). https://pmc.ncbi.nlm.nih.gov/articles/PMC12690182/
• [9]Petersen KF et al. (2004). Impaired mitochondrial activity in the insulin-resistant offspring of patients with type 2 diabetes. https://pubmed.ncbi.nlm.nih.gov/14960743/
• [10]Petersen KF et al. (2004). Impaired mitochondrial activity in the insulin-resistant offspring of patients with type 2 diabetes. https://pubmed.ncbi.nlm.nih.gov/14960743/
• [11]MedlinePlus Genetics (NIH/NLM) (2024). Type A insulin resistance syndrome: MedlinePlus Genetics. https://medlineplus.gov/genetics/condition/type-a-insulin-resistance-syndrome/
• [12]Ali O (2013). Genetics of type 2 diabetes. https://doi.org/10.4239/wjd.v4.i4.114
• [13]Ali O (2013). Genetics of type 2 diabetes. https://doi.org/10.4239/wjd.v4.i4.114
• [14]Ali O (2013). Genetics of type 2 diabetes. https://doi.org/10.4239/wjd.v4.i4.114
• [15]Ali O (2013). Genetics of type 2 diabetes. https://doi.org/10.4239/wjd.v4.i4.114
• [16]NIDDK / NIH. Insulin Resistance & Prediabetes. https://www.niddk.nih.gov/health-information/diabetes/overview/what-is-diabetes/prediabetes-insulin-resistance
• [17]NIDDK / NIH. Insulin Resistance & Prediabetes. https://www.niddk.nih.gov/health-information/diabetes/overview/what-is-diabetes/prediabetes-insulin-resistance
• [18]duschek elena et al. (2023). A polygenic and family risk score are both independently associated with risk of type 2 diabetes in a population-based study. https://doi.org/10.1038/s41598-023-31496-w
• [19]Levy-Marchal C et al. (2010). Insulin Resistance in Children: Consensus, Perspective, and Future Directions. https://pmc.ncbi.nlm.nih.gov/articles/PMC3206517/
• [20]U.S. Preventive Services Task Force (2022). Recommendation: Prediabetes and Type 2 Diabetes in Children and Adolescents: Screening. https://www.uspreventiveservicestaskforce.org/uspstf/recommendation/prediabetes-type2-diabetes-children-adolescents-screening

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How Do I Talk to My Family Without Making It Worse?

• [1]U.S. Centers for Disease Control and Prevention (CDC) (2024). Preventing Type 2 Diabetes - CDC. https://www.cdc.gov/diabetes/prevention-type-2/index.html
• [2]U.S. Centers for Disease Control and Prevention (CDC) (2024). On Your Way to Preventing Type 2 Diabetes - CDC. https://www.cdc.gov/diabetes/prevention-type-2/type-2-diabetes-prevention-guide.html
• [3]National Institute of Diabetes and Digestive and Kidney Diseases (2022). Diabetes Tests & Diagnosis (NIDDK) — family-history context. https://www.niddk.nih.gov/health-information/diabetes/overview/tests-diagnosis#kind
• [4]Centers for Disease Control and Prevention (CDC) (2024). Additional 12 Million U.S. Adults Eligible for Diabetes Screening. https://www.cdc.gov/diabetes/data-research/research/diabetes-screening-eligible.html
• [5]U.S. Preventive Services Task Force (2021). USPSTF Recommendation: Screening for Prediabetes and Type 2 Diabetes. https://www.uspreventiveservicestaskforce.org/uspstf/recommendation/screening-for-prediabetes-and-type-2-diabetes
• [6]Centers for Disease Control and Prevention (2024). Risk Factors for Diabetes (CDC). https://www.cdc.gov/diabetes/risk-factors/index.html
• [7]National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), NIH (2024). Diabetes Prevention Program (DPP) - NIDDK. https://www.niddk.nih.gov/about-niddk/research-areas/diabetes/diabetes-prevention-program-dpp
• [8]Diabetes Prevention Program Research Group (2017). The cost-effectiveness of diabetes prevention: results from the DPP and DPPOS. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5471886/
  National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), NIH (2024). Diabetes Prevention Program (DPP) - NIDDK. https://www.niddk.nih.gov/about-niddk/research-areas/diabetes/diabetes-prevention-program-dpp
• [9]Centers for Disease Control and Prevention (2024). What Is the National DPP? National Diabetes Prevention Program, CDC. https://www.cdc.gov/diabetes-prevention/programs/what-is-the-national-dpp.html
  CDC (2024). About the Lifestyle Change Program. https://www.cdc.gov/diabetes-prevention/lifestyle-change-program/lifestyle-change-program-details.html
• [10]Noom (2024). Noom Earns Highest CDC Recognition for Diabetes Prevention Program. https://www.noom.com/in-the-news/noom-earns-highest-cdc-recognition-for-diabetes-prevention-program/
• [11]Centers for Disease Control and Prevention (CDC) (2024). Are You Eligible to Join the National DPP Lifestyle Change Program?. https://www.cdc.gov/diabetes-prevention/eligible-lifestyle-change-program/index.html#one-of
• [12]Centers for Disease Control and Prevention (CDC) (2024). Are You Eligible to Join the National DPP Lifestyle Change Program?. https://www.cdc.gov/diabetes-prevention/eligible-lifestyle-change-program/index.html
• [13]National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) (2023). Risk Factors for Type 2 Diabetes. https://www.niddk.nih.gov/health-information/diabetes/overview/risk-factors-type-2-diabetes
• [14]Centers for Disease Control and Prevention (CDC) (2024). Are You Eligible to Join the National DPP Lifestyle Change Program?. https://www.cdc.gov/diabetes-prevention/eligible-lifestyle-change-program/index.html#mdpp
• [15]Hu Lirong et al. (2026). Ultra-Processed Food Intake and Risk of Type 2 Diabetes Mellitus: A Dose-Response Meta-Analysis of Prospective Studies. https://doi.org/10.4093/dmj.2025.0925
• [16]NIDDK (summary of American Diabetes Association Standards of Care 2024) (2024). What's New in the 2024 ADA Standards of Care? (NIDDK summary of ADA Standards of Care). https://www.niddk.nih.gov/health-information/professionals/diabetes-discoveries-practice/ada-2024-standards-of-care
• [17]vetrani claudia et al. (2023). The Mediterranean Diet: Effects on Insulin Resistance and Secretion in Individuals with Overweight or Obesity. https://doi.org/10.3390/nu15214524
• [18]U.S. Centers for Disease Control and Prevention (CDC) (2024). On Your Way to Preventing Type 2 Diabetes - CDC. https://www.cdc.gov/diabetes/prevention-type-2/type-2-diabetes-prevention-guide.html
• [19]ullah inayat et al. (2025). Long-Term Cardiovascular and Metabolic Health Outcomes of Gestational Diabetes Mellitus: A Systematic Review. https://doi.org/10.7759/cureus.79555
• [20]American Diabetes Association Professional Practice Committee (2024). 15. Management of Diabetes in Pregnancy: Standards of Care in Diabetes—2024. https://pmc.ncbi.nlm.nih.gov/articles/PMC10725801/
• [21]U.S. Centers for Disease Control and Prevention (2024). Diabetes During Pregnancy. https://www.cdc.gov/maternal-infant-health/pregnancy-diabetes/index.html
• [22]Berge JM et al. (2013). Parent Conversations about Healthful Eating and Weight: Associations with Adolescent Disordered Eating Behaviors. https://pubmed.ncbi.nlm.nih.gov/23797808/
  Berge JM et al. (2013). Parent Conversations About Healthful Eating and Weight. https://doi.org/10.1001/jamapediatrics.2013.78
• [23]Berge JM et al. (2013). Parent Conversations About Healthful Eating and Weight. https://doi.org/10.1001/jamapediatrics.2013.78
• [24]Golden NH et al. (2016). Preventing Obesity and Eating Disorders in Adolescents (AAP Clinical Report). https://doi.org/10.1542/peds.2016-1649
• [25]Warnick JL et al. (2022). Weight Stigma and Mental Health in Youth: A Systematic Review and Meta-Analysis. https://doi.org/10.1093/jpepsy/jsab110
• [26]Golden NH et al. (2016). Preventing Obesity and Eating Disorders in Adolescents (AAP Clinical Report). https://doi.org/10.1542/peds.2016-1649
• [27]McKenna KA, American Family Physician (2023). Breaking Down the AAP Guideline on Childhood Obesity (editorial summarizing the 2023 AAP clinical practice guideline). https://www.aafp.org/pubs/afp/issues/2023/1000/editorial-aap-guideline-childhood-obesity.html
• [28]Vallabhan MK et al. (2018). Motivational Interviewing to Treat Adolescents With Obesity: A Meta-analysis. https://doi.org/10.1542/peds.2018-0733

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Pregnancy, and What Comes After

• [1]Centers for Disease Control and Prevention (2024). Gestational Diabetes. https://www.cdc.gov/diabetes/about/gestational-diabetes.html
• [2]American Diabetes Association Professional Practice Committee (2024). 15. Management of Diabetes in Pregnancy: Standards of Care in Diabetes—2024. https://doi.org/10.2337/dc24-S015
• [3]Dai Bo et al. (2026). Association of metabolic score for insulin resistance with gestational diabetes mellitus: a systematic review and meta-analysis. https://doi.org/10.3389/fnut.2026.1855104
• [4]Dai Bo et al. (2026). Association of metabolic score for insulin resistance with gestational diabetes mellitus: a systematic review and meta-analysis. https://doi.org/10.3389/fnut.2026.1855104
• [5]hashemipour sima et al. (2023). The yield of early-pregnancy HOMA-IR for predicting gestational diabetes mellitus in different BMI and age groups. https://doi.org/10.1186/s12884-023-06113-3
• [6]Buschur EO, et al. (2024). Gestational Diabetes (Endotext). https://www.ncbi.nlm.nih.gov/books/NBK572755/
• [7]U.S. Preventive Services Task Force (2021). Final Recommendation Statement: Gestational Diabetes: Screening. https://www.uspreventiveservicestaskforce.org/uspstf/recommendation/gestational-diabetes-screening
• [8]Centers for Disease Control and Prevention (2024). Gestational Diabetes. https://www.cdc.gov/diabetes/about/gestational-diabetes.html
• [9]American Diabetes Association Professional Practice Committee (2024). 15. Management of Diabetes in Pregnancy: Standards of Care in Diabetes—2024. https://doi.org/10.2337/dc24-S015
• [10]Buschur EO, et al. (2024). Gestational Diabetes (Endotext). https://www.ncbi.nlm.nih.gov/books/NBK572755/
• [11]U.S. Preventive Services Task Force (2021). Final Recommendation Statement: Gestational Diabetes: Screening. https://www.uspreventiveservicestaskforce.org/uspstf/recommendation/gestational-diabetes-screening
• [12]American Diabetes Association Professional Practice Committee (2024). 15. Management of Diabetes in Pregnancy: Standards of Care in Diabetes—2024. https://doi.org/10.2337/dc24-S015
• [13]Buschur EO, et al. (2024). Gestational Diabetes (Endotext). https://www.ncbi.nlm.nih.gov/books/NBK572755/
• [14]U.S. National Library of Medicine (2024). Polycystic ovary syndrome — MedlinePlus Genetics. https://medlineplus.gov/genetics/condition/polycystic-ovary-syndrome/
• [15]U.S. National Library of Medicine (2024). Polycystic ovary syndrome — MedlinePlus Genetics. https://medlineplus.gov/genetics/condition/polycystic-ovary-syndrome/
• [16]U.S. National Library of Medicine (2024). Polycystic Ovary Syndrome (PCOS) — MedlinePlus. https://medlineplus.gov/polycysticovarysyndrome.html
• [17]Peña AS et al. (2020). Adolescent polycystic ovary syndrome according to the international evidence-based guideline. https://pmc.ncbi.nlm.nih.gov/articles/PMC7092491/

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Why Do I Feel This Way About It?

• [1]NIDDK / Jeffrey Gonzalez (2020). Diabetes Distress and Depression (NIDDK Diabetes Discoveries and Practice Blog, interview with Dr. Jeffrey Gonzalez). https://www.niddk.nih.gov/health-information/professionals/diabetes-discoveries-practice/diabetes-distress-and-depression
  Diabetes UK (2019). Chapter 3 - Diabetes distress (Diabetes and Emotional Health: a practical guide). https://www.diabetes.org.uk/for-professionals/improving-care/good-practice/psychological-care/emotional-health-professionals-guide/chapter-3-diabetes-distress
• [2]Alexander DS, et al. (2025). Diabetes Distress Among US Adults With Diagnosed Diabetes, 2021. https://doi.org/10.5888/pcd22.240287
  NIDDK / Jeffrey Gonzalez (2020). Diabetes Distress and Depression (NIDDK Diabetes Discoveries and Practice Blog, interview with Dr. Jeffrey Gonzalez). https://www.niddk.nih.gov/health-information/professionals/diabetes-discoveries-practice/diabetes-distress-and-depression
  Diabetes UK (2019). Chapter 3 - Diabetes distress (Diabetes and Emotional Health: a practical guide). https://www.diabetes.org.uk/for-professionals/improving-care/good-practice/psychological-care/emotional-health-professionals-guide/chapter-3-diabetes-distress
  AlOzairi A et al. (2024). Prevalence and predictors of diabetes distress and depression in people with type 1 diabetes. https://doi.org/10.3389/fpsyt.2024.1367876
• [3]Diabetes UK (2019). Chapter 3 - Diabetes distress (Diabetes and Emotional Health: a practical guide). https://www.diabetes.org.uk/for-professionals/improving-care/good-practice/psychological-care/emotional-health-professionals-guide/chapter-3-diabetes-distress
• [4]Fernandes BS et al. (2022). Insulin resistance in depression: A large meta-analysis of metabolic parameters and variation. https://pubmed.ncbi.nlm.nih.gov/35777578/
  Kan C et al. (2013). A systematic review and meta-analysis of the association between depression and insulin resistance. https://pubmed.ncbi.nlm.nih.gov/23349152/
• [5]Centers for Disease Control and Prevention (2024). Diabetes and Mental Health. https://www.cdc.gov/diabetes/living-with/mental-health.html
  NIDDK / Jeffrey Gonzalez (2020). Diabetes Distress and Depression (NIDDK Diabetes Discoveries and Practice Blog, interview with Dr. Jeffrey Gonzalez). https://www.niddk.nih.gov/health-information/professionals/diabetes-discoveries-practice/diabetes-distress-and-depression
• [6]Ji S et al. (2023). Association between anxiety and metabolic syndrome: An updated systematic review and meta-analysis. https://doi.org/10.3389/fpsyt.2023.1118836
• [7]Cleveland Clinic (institutional) (2024). Insulin Resistance: What It Is, Causes, Symptoms & Treatment (Cleveland Clinic). https://my.clevelandclinic.org/health/diseases/22206-insulin-resistance
  Cleveland Clinic (2024). Insulin Resistance: What It Is, Causes, Symptoms & Treatment. https://my.clevelandclinic.org/health/diseases/22206-insulin-resistance#inherited
• [8]Puhl RM et al. (2022). Weight Stigma and Diabetes Stigma: Implications for Weight-Related Health Behaviors in Adults With Type 2 Diabetes. https://pmc.ncbi.nlm.nih.gov/articles/PMC8865787/
  Puhl RM et al. (2022). Weight Stigma and Diabetes Stigma: Implications for Weight-Related Health Behaviors in Adults With Type 2 Diabetes. https://pmc.ncbi.nlm.nih.gov/articles/PMC8865787/#internalized
• [9]NIDDK / NIH. Insulin Resistance & Prediabetes. https://www.niddk.nih.gov/health-information/diabetes/overview/what-is-diabetes/prediabetes-insulin-resistance
• [10]Centers for Disease Control and Prevention (CDC) (2026). Prediabetes: Could It Be You?. https://www.cdc.gov/diabetes/communication-resources/prediabetes-statistics.html
  NIDDK / NIH. Insulin Resistance & Prediabetes. https://www.niddk.nih.gov/health-information/diabetes/overview/what-is-diabetes/prediabetes-insulin-resistance
  U.S. Preventive Services Task Force (2021). USPSTF Recommendation: Screening for Prediabetes and Type 2 Diabetes. https://www.uspreventiveservicestaskforce.org/uspstf/recommendation/screening-for-prediabetes-and-type-2-diabetes
• [11]Tseng E et al. (2019). National Survey of Primary Care Physicians' Knowledge, Practices, and Perceptions of Prediabetes. https://doi.org/10.1007/s11606-019-05245-7
• [12]U.S. Preventive Services Task Force (2021). USPSTF Recommendation: Screening for Prediabetes and Type 2 Diabetes. https://www.uspreventiveservicestaskforce.org/uspstf/recommendation/screening-for-prediabetes-and-type-2-diabetes
• [13]Diabetes UK (2019). Chapter 3 - Diabetes distress (Diabetes and Emotional Health: a practical guide). https://www.diabetes.org.uk/for-professionals/improving-care/good-practice/psychological-care/emotional-health-professionals-guide/chapter-3-diabetes-distress
  NIDDK / Jeffrey Gonzalez (2020). Diabetes Distress and Depression (NIDDK Diabetes Discoveries and Practice Blog, interview with Dr. Jeffrey Gonzalez). https://www.niddk.nih.gov/health-information/professionals/diabetes-discoveries-practice/diabetes-distress-and-depression
  NIDDK / interview with Marisa Hilliard, PhD (2023). Addressing Depression and Suicide Risk in Patients with Diabetes. https://www.niddk.nih.gov/health-information/professionals/diabetes-discoveries-practice/addressing-depression-suicide-risk
• [14]NIDDK / interview with Marisa Hilliard, PhD (2023). Addressing Depression and Suicide Risk in Patients with Diabetes. https://www.niddk.nih.gov/health-information/professionals/diabetes-discoveries-practice/addressing-depression-suicide-risk

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What Do I Tell People?

• [1]U.S. Equal Employment Opportunity Commission (2013). Diabetes in the Workplace and the ADA. https://www.eeoc.gov/laws/guidance/diabetes-workplace-and-ada
• [2]Moonesinghe R et al. (2018). The Impact of Family History on the Public Health Burden of Diabetes and Prediabetes — Genomics and Precision Health Blog. https://blogs.cdc.gov/genomics/2018/01/26/the-impact-of-family-history/
• [3]Ledford CJW et al. (2022). Patient Decision-Making About Self-Disclosure of a Type 2 Diabetes Diagnosis: A Qualitative Study. https://pubmed.ncbi.nlm.nih.gov/36082012/
• [4]Miller K et al. (2025). Eating Out With Diabetes (UGA Cooperative Extension, C1364-10). https://fieldreport.caes.uga.edu/publications/C1364-10/eating-out-with-diabetes/

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Common Myths About Insulin Resistance

• [1]NIDDK / NIH. Insulin Resistance & Prediabetes. https://www.niddk.nih.gov/health-information/diabetes/overview/what-is-diabetes/prediabetes-insulin-resistance
• [2]Lv Jia Le et al. (2024). Ultra-processed food consumption and metabolic disease risk: an umbrella review of systematic reviews with meta-analyses of observational studies. https://doi.org/10.3389/fnut.2024.1306310
• [3]Ludwig DS et al. (2022). Competing paradigms of obesity pathogenesis: energy balance versus carbohydrate-insulin models. https://doi.org/10.1038/s41430-022-01179-2
• [4]Chief Nutrition (commercial blog) (2024). The Ugly Truth about Seed Oils. https://wearechief.com/blogs/articles/the-ugly-truth-about-seed-oils
• [5]Della Corte K et al. (2021). The Prospective Association of Dietary Sugar Intake in Adolescence With Risk Markers of Type 2 Diabetes in Young Adulthood. https://doi.org/10.3389/fnut.2020.615684
• [6]Pluta W et al. (2022). Metabolic Obesity in People with Normal Body Weight (MONW)—Review of Diagnostic Criteria. https://doi.org/10.3390/ijerph19020624
• [7]Cleveland Clinic (institutional) (2024). Insulin Resistance: What It Is, Causes, Symptoms & Treatment (Cleveland Clinic). https://my.clevelandclinic.org/health/diseases/22206-insulin-resistance
• [8]U.S. Centers for Disease Control and Prevention (2024). Details About the Program — National Diabetes Prevention Program. https://www.cdc.gov/diabetes-prevention/hcp/lifestyle-change-program/program-details.html
• [9]Lin YH et al. (2019). Eight-week of low-intensive lifestyle modification does improve insulin resistance in adults with metabolic syndrome. https://pubmed.ncbi.nlm.nih.gov/31118723/
• [10]Listonic Team (2024). 30-day meal plan for insulin resistance. https://listonic.com/meal-plans/en/30-day-meal-plan-for-insulin-resistance
• [11]Delish Study investigators (ClinicalTrials.gov NCT03207711) (2017). Delish Study: Diabetes Education to Lower Insulin, Sugars, and Hunger (Safety Assessments section). https://cdn.clinicaltrials.gov/large-docs/11/NCT03207711/Prot_SAP_001.pdf

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Conclusion

• [1]Anderson JW et al. (2001). Long-term weight-loss maintenance: a meta-analysis of US studies. https://pubmed.ncbi.nlm.nih.gov/11684524/
• [2]Mann T et al. (2007). Medicare's search for effective obesity treatments: diets are not the answer. https://pubmed.ncbi.nlm.nih.gov/17469900/

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