Nearly half the men and women over age 50 in the U.S. have metabolic syndrome with its associated insulin resistance and increased risk for type 2 diabetes and coronary artery disease. The good news is that people with the syndrome can improve their body's responsiveness to insulin and reduce both of these risks. They can also address the main features of the syndrome: excessive weight, high blood triglycerides, low blood HDL cholesterol, high blood pressure, and modestly elevated blood sugar levels.

The first step in overcoming insulin resistance is to change dietary and exercise habits. Weight loss and exercise each independently increase insulin sensitivity, lower blood pressure, reduce blood triglyceride levels, and decrease the likelihood of developing type 2 diabetes. Studies have shown that medications like metformin (Glucophage) or thiazolidinediones (Actos and Avandia), when given to people at high risk for the disorder, also reduce their risk of developing type 2 diabetes. However, these drugs are not recommended for the prevention of diabetes.

Insulin resistance heightens the danger of elevated cholesterol levels as a risk factor for coronary heart disease. People with metabolic syndrome should therefore follow a diet low in saturated fat and cholesterol to lower their total cholesterol and low-density lipoprotein (LDL) cholesterol. They should also consider asking their doctor whether they need to take a medication to bring their LDL cholesterol level even lower than can be achieved by diet alone (to below 100 mg/dL, for example). This is especially important for people who smoke cigarettes or have a family history of premature heart attacks. To further lessen their risk of a heart attack, medications might also be prescribed to lower triglycerides and blood pressure or to raise their high-density lipoprotein (HDL) cholesterol level. And, of course, they should stop smoking.