Insulin resistance is a key factor in the pathogenesis of the metabolic syndrome and type 2 diabetes, but the underlying mechanisms remain poorly understood. Adipocytokines, including tumour necrosis factor α (TNFα), interleukin 6, leptin and adiponectin,^1,2 are increasingly recognised as important regulators of both insulin sensitivity, as well as inflammation, and a dysregulation of their levels and/or functions has been shown in both obesity and rheumatoid arthritis.³ Further investigations have substantiated the important negative effects of TNFα on insulin-mediated glucose uptake and the development of insulin resistance.⁴ In this study, the influence of therapeutic TNFα blockade on insulin sensitivity was investigated in regularly treated patients with rheumatic diseases.

A group of eight patients who were non-diabetic and having various chronic inflammatory disorders (table 1) were investigated in an open prospective …