Podcast Summary: Healthier World with Quest Diagnostics
Episode: Encore episode: The insulin resistance revolution
Date: January 5, 2026
Host: Dr. Mason Latsko (B)
Guest: Kenneth French, Clinical Consultant (A)
Duration: 17 min
Overview
This encore episode features an in-depth discussion about insulin resistance—its central role in the development of metabolic and cardiometabolic diseases, its early identification via advanced laboratory tests, and its potential for prevention and reversal. Dr. Mason Latsko interviews Kenneth French, who shares clinical insights on the “insulin resistance revolution,” emphasizing both the challenge and opportunity presented by early intervention.
Key Discussion Points & Insights
1. The Growing Crisis of Metabolic Dysfunction
- Obesity rates are accelerating: Prevalence is expected to reach 50% by 2030, with 1 in 4 people facing morbid obesity.
- “We’re not backing out of this… in healthcare, we see some of the bad fruit of what obesity can drive when it leads to kidney disease, liver disease, heart disease. But what's the link?... It's insulin resistance.” (A, 01:56)
- Metabolic syndrome’s emergence: In 2000, clinical guidelines recognized the “metabolic syndrome,” marking insulin resistance as a foundational culprit.
2. Insulin Resistance: The Continuum from Health to Disease
- Disease is a spectrum: Chronic diseases like diabetes don’t appear overnight but progress through stages—healthy → insulin resistance → prediabetes → diabetes.
- “It’s not just a dichotomous split where one day you have a disease, whereas the day before you didn’t.” (B, 03:20)
- Insulin resistance precedes diagnosable diabetes: Many people pass through years of silent insulin resistance before glucose or A1C levels indicate prediabetes or diabetes.
- “It could be five, eight, ten years that we live with that insulin resistance hiding the problem.” (A, 04:29)
- Symptoms and signs: Early, subtle changes include rising liver enzymes, kidney dysfunction, increasing triglycerides, dropping HDL, weight gain, and rising blood pressure.
3. Challenges in Diagnosing Insulin Resistance
- Insulin tests aren’t standardized: Different labs produce different results; traditional antibody-based insulin assays lack precision.
- Gold-standard methods are impractical: Techniques like the euglycemic clamp are labor-intensive and not suitable for routine care.
- “You could have three different laboratories run the quote unquote, same test, and you literally get three different results. So that's very problematic.” (A, 06:33)
4. Advances in Measurement: The Insulin Resistance Panel with Score (IR Score)
- Quest’s breakthrough: Collaborating with Stanford’s Dr. Gerald Reaven, Quest Diagnostics developed a more accurate, reproducible test using liquid chromatography tandem mass spectrometry (LC-MS/MS).
- “Measuring specifically the intact insulin and the C peptide simultaneously... to generate what we call now the insulin resistance panel with score, a score between 1 and 100.” (A, 08:29)
- The IR Score:
- 1–33: Normal insulin sensitivity.
- 33–66: Four times greater odds of insulin resistance.
- 66+ : Fifteen times more likely to be insulin resistant.
- Value: Enables clinicians to identify at-risk patients early—even when standard glucose and A1C are normal—and to track changes over time.
5. Translating Insight to Action: What Providers and Patients Can Do
- Beyond numbers: An individual with normal A1C and glucose may still be high risk if their IR Score is elevated.
- “If we initiate the strategy of managing the insulin resistance the same way we treat somebody with metabolic syndrome and… the score went from 66 to 14, they know they had a positive impact. And then they can look at the dyslipidemia and say, is this resolving itself?” (A, 11:10)
- Evaluating impact: Improvements in the IR Score often precede improvements in traditional markers and are associated with positive shifts in dyslipidemia, liver enzymes, kidney function, weight, and blood pressure.
- Patient empowerment: Early identification means earlier lifestyle or therapeutic intervention, not just for diabetes prevention but for broad chronic disease risk reduction.
6. Systemic Impact & the Power of Targeting Insulin Resistance
- Links to multiple diseases: Insulin resistance drives not only diabetes, but also:
- Non-alcoholic fatty liver disease (now termed metabolic dysfunction-associated steatotic liver disease)
- Chronic kidney disease
- Cardiovascular disease and hypertension
- Neurological and depressive disorders
- Predictive value: IR Score ≥31 or intact insulin ≥10.5 carries an 80% positive predictive value for fatty liver disease even in healthy individuals.
- “What this is showing is… insulin resistance has the ability… to predict who is potentially on the trajectory towards type 2 diabetes, but it can also help us understand who likely has non alcoholic fatty liver disease and otherwise healthy individuals. The link is inescapable.” (A, 14:23)
- Key takeaway: Treating insulin resistance stands to benefit multiple organ systems and can reverse or prevent chronic illnesses at their root.
Notable Quotes & Memorable Moments
- On the escalation of metabolic dysfunction:
- “The number of people who will have morbid obesity will be 1 in 4... And in healthcare, we see some of the bad fruit of what obesity can drive...”
(Kenneth French, 01:56)
- “The number of people who will have morbid obesity will be 1 in 4... And in healthcare, we see some of the bad fruit of what obesity can drive...”
- On early detection:
- “During the insulin resistant years, the body is exposed to more and more glucose... And our own cells and our own organ systems are not responding to the insulin... And it’s not until later that we actually see the issue manifest in the glucose or an A1C.”
(Kenneth French, 03:50–04:29)
- “During the insulin resistant years, the body is exposed to more and more glucose... And our own cells and our own organ systems are not responding to the insulin... And it’s not until later that we actually see the issue manifest in the glucose or an A1C.”
- On need for better testing:
- “Insulin has never been a standardized test… you could have three different laboratories run the … same test, and you literally get three different results.”
(Kenneth French, 06:33)
- “Insulin has never been a standardized test… you could have three different laboratories run the … same test, and you literally get three different results.”
- On the IR Score’s clinical impact:
- “If we initiate the strategy of managing the insulin resistance... we hope to see the score going from a higher number, like 66 to 40 to hopefully 14. But... the glucose and A1C may not change at all.”
(Kenneth French, 11:10)
- “If we initiate the strategy of managing the insulin resistance... we hope to see the score going from a higher number, like 66 to 40 to hopefully 14. But... the glucose and A1C may not change at all.”
- On the promise of treating insulin resistance:
- “Imagine the consequences of solving the insulin resistance problem for our population. When you solve insulin resistance before it hits prediabetes and diabetes, that means you've diverted those patients from that condition. But not only have you done that, you've also reduced the burden of kidney disease... and hypertension crisis for a lot of individuals... all because we're addressing the root cause.”
(Kenneth French, 15:25)
- “Imagine the consequences of solving the insulin resistance problem for our population. When you solve insulin resistance before it hits prediabetes and diabetes, that means you've diverted those patients from that condition. But not only have you done that, you've also reduced the burden of kidney disease... and hypertension crisis for a lot of individuals... all because we're addressing the root cause.”
Timestamps for Key Segments
- 01:27 – Link between obesity, metabolic dysfunction, and insulin resistance
- 03:20 – Disease as a continuum: progression from health to diabetes
- 06:33 – Problems with current insulin testing and the need for accurate measures
- 08:29 – Development of the IR Score test at Quest
- 09:54 – Explaining what IR Score results mean in practice
- 11:10 – Using IR Score for patient management and tracking improvement
- 12:58 – Broader systemic effects and prediction of non-alcoholic fatty liver disease
- 15:25 – Summary takeaways and the potential of targeting insulin resistance to reduce chronic disease burden
Key Takeaways
- Insulin resistance is the root cause of many modern chronic diseases—but is highly treatable and even reversible.
- Standard glucose and A1C screening often miss early-stage insulin resistance—advanced tests like the IR Score allow earlier identification and intervention.
- Managing insulin resistance can prevent progression to diabetes, reduce risks of fatty liver, kidney disease, cardiovascular disease, and improve neurological health.
- Intervening early leads to measurable, multi-system improvements—even before classic clinical signs appear.
- Providers are urged to look beyond standard glucose/A1C and use new diagnostic tools to catch and manage insulin resistance sooner.
This episode delivers an urgent call: Early detection and treatment of insulin resistance, using robust modern diagnostics, offers a path to reversing the tide of chronic metabolic diseases.