Improving the action of insulin.

Improving the action of insulin is a relatively new concept in diabetes management. Insulin sensitivity can be improved by reduction of excessive body weight, regular physical activity and, possibly, by correcting a subclinical magnesium deficiency. Pharmacological means of improving insulin action include metformin, antiobesity serotoninergic agents and, possibly, benfluorex. New compounds aiming at improving the action of insulin are in development and include thiazolidinedione derivatives (known as "insulin sensitizers"), inhibitors of adipose tissue lipolysis (e.g. acipimox), and inhibitors of free fatty acid oxidation (e.g. etomoxir). Avoidance of drugs that reduce insulin sensitivity, such as beta blockers and thiazide diuretics, is recommended. Finally, cigarette smoking is associated with resistance to insulin but it remains to be demonstrated that cessation of cigarette smoking does in fact increase sensitivity to insulin.