Insulin resistance—when your body doesn’t respond well to insulin, a hormone that controls blood sugar—is becoming more common as people age. A new review of 20 studies found that both medicines and lifestyle changes can help. The good news? You don’t have to choose just one approach. Eating healthier (like plant-based or ketogenic diets), exercising regularly, and getting enough sleep all help your body use insulin better. When lifestyle changes alone aren’t enough, doctors can prescribe medications like metformin to help. This research shows that the best treatment combines both strategies for the best results.

The Quick Take

  • What they studied: What are the best ways to treat insulin resistance using both medicines and lifestyle changes like diet and exercise?
  • Who participated: Researchers reviewed 20 high-quality studies published between 2018 and 2023 that looked at people with type 2 diabetes and insulin resistance. The studies examined different treatment approaches from around the world.
  • Key finding: Both lifestyle changes and medications significantly improved how well people’s bodies use insulin. Diet changes (especially plant-based and ketogenic diets), regular exercise, and certain medications all showed real benefits in reducing insulin resistance.
  • What it means for you: If you have insulin resistance or type 2 diabetes, you have multiple proven options. Start with lifestyle changes like eating better and exercising more—these work well and have no side effects. If these alone don’t work well enough, your doctor can add medication. The combination of both approaches often works best.

The Research Details

This was a systematic review, which means researchers looked at 20 different studies that were already published about insulin resistance treatment. They searched two major medical databases (PubMed and Google Scholar) for studies published between 2018 and 2023. They carefully selected only the highest-quality studies that had low risk of bias—meaning the results were likely reliable and not skewed by mistakes or unfair methods.

The researchers looked at two main types of treatment: medicines (pharmacological) and lifestyle changes (non-pharmacological). For lifestyle changes, they examined things like different types of diets, exercise programs, sleep apnea treatment, and acupuncture. For medicines, they looked at various drugs that help the body use insulin better or make more insulin.

By combining information from all 20 studies, the researchers could see patterns in what treatments worked best and how effective they were.

A systematic review is valuable because it combines the best evidence from many studies instead of relying on just one. This gives us a clearer picture of what actually works. By looking at studies from 2018-2023, the researchers captured recent advances in treatment. Focusing on both medicine and lifestyle changes is important because many people need both approaches to manage insulin resistance effectively.

The researchers only included studies with low risk of bias, which means the results are more trustworthy. However, this review doesn’t tell us the exact number of people studied across all 20 studies, which would help us understand how strong the evidence is. The fact that they used two major medical databases and had clear inclusion criteria makes the selection process more reliable. The review was published in a peer-reviewed journal, meaning other experts checked the work before publication.

What the Results Show

The research found that lifestyle changes alone can significantly reduce insulin resistance. A plant-based diet (eating mostly vegetables, fruits, and grains), a ketogenic diet (very low carb, high fat), and regular exercise all showed real improvements in how well the body uses insulin. These changes increased something called ‘insulin sensitivity,’ which means the body responds better to insulin.

When lifestyle changes weren’t enough, medications helped. The most common first medication prescribed was metformin, which helps the body use insulin better. If metformin alone didn’t work well enough, doctors could add other medications to create a combination therapy that worked better.

Some surprising findings included benefits from sleep apnea treatment (using a CPAP machine) and acupuncture, though these need more research. The key takeaway was that combining lifestyle changes with medication when needed gave the best results.

The review found that structured exercise programs and aerobic exercise (like walking, running, or cycling) were particularly effective. Different types of diets worked, but plant-based and ketogenic diets showed the strongest benefits. The research also suggested that treating sleep problems (sleep apnea) with a CPAP machine could help reduce insulin resistance, though this area needs more study. These secondary findings show that there are multiple pathways to improvement, and what works best may vary from person to person.

This review builds on previous research by bringing together recent studies (2018-2023) and showing that the combination of lifestyle and medication approaches is more effective than either alone. It confirms what doctors have long suspected: that lifestyle changes are powerful tools, but some people need medication too. The review also highlights newer approaches like CPAP therapy and acupuncture that haven’t been as thoroughly studied in the past.

The review doesn’t tell us exactly how many people were studied across all 20 studies, which makes it harder to judge how strong the evidence is. It only looked at studies published in English, so some research from other countries might have been missed. The studies came from different countries and used different methods, which can make it harder to compare results. The review doesn’t provide detailed information about which specific medications work best or for whom, so more research is needed on that question.

The Bottom Line

If you have insulin resistance or type 2 diabetes: (1) Start with lifestyle changes—eat more plant-based foods, try a ketogenic diet if appropriate for you, and exercise regularly (moderate confidence, strong evidence). (2) If lifestyle changes alone don’t work after 3-6 months, ask your doctor about metformin or other medications (high confidence, strong evidence). (3) Combine both approaches for best results (moderate-to-high confidence). (4) If you have sleep apnea, get it treated, as this may help (low-to-moderate confidence, emerging evidence).

This research is most relevant for people with type 2 diabetes or insulin resistance, people with a family history of diabetes, and anyone over 40 (since insulin resistance increases with age). It’s also important for people who are overweight or inactive. People with prediabetes should pay attention because these strategies can prevent progression to type 2 diabetes. Healthcare providers should use this to guide treatment decisions. However, this research may be less relevant for people with type 1 diabetes, which is a different condition.

You may notice improvements in blood sugar levels within 2-4 weeks of starting lifestyle changes, though the biggest improvements usually take 8-12 weeks. Medications like metformin typically start working within days to weeks. For the best results, plan to stick with these changes for at least 3-6 months before deciding if you need medication adjustments. Long-term benefits continue to improve over months and years.

Want to Apply This Research?

  • Track your fasting blood sugar levels weekly (if you have a home monitor) or as recommended by your doctor. Also track: (1) minutes of exercise per day, (2) servings of vegetables eaten, (3) sleep hours per night, and (4) weight weekly. This gives you concrete numbers to see progress.
  • Use the app to set a specific, achievable goal like ‘Walk 30 minutes, 5 days per week’ or ‘Eat 5 servings of vegetables daily.’ Start with one behavior change, master it for 2-3 weeks, then add another. Log each day to build momentum and see your progress visually.
  • Set up weekly check-ins to review your exercise, diet, and blood sugar trends. Create a monthly summary to share with your doctor. Use the app’s reminder feature to prompt you for meals, exercise, and medication. Set alerts for when you should get your blood work done (usually every 3-6 months) to measure insulin resistance improvements.

This review summarizes scientific research but is not medical advice. Insulin resistance and type 2 diabetes are serious conditions that require personalized medical care. Before making any changes to your diet, exercise routine, or medications, talk to your doctor or a registered dietitian. This is especially important if you’re taking medications, have other health conditions, or are pregnant. The findings in this review may not apply to everyone, and your doctor can help determine the best treatment plan for your specific situation. Never stop taking prescribed medications without talking to your healthcare provider first.