Illuminating Glucose: How to Unveil Organ‐Specific Insulin Resistance and Guide Metabolic Strategies in Diabetes

Recent evidence has shown that muscle insulin resistance is not the only factor contributing to type 2 diabetes (T2D). Organ-specific insulin resistance is increasingly recognised as a significant contributor to the metabolic changes that lead to hyperglycemia, although the precise extent of its impact remains unclear. The qualitative and quantitative aspects of regional insulin-resistance in determining whole body insulin resistance and glucose uptake can be explored through positron emission tomography (PET) combined with computerised tomography images, using specific radio tracers like 2-deoxy-2-[18F]fluoro-D-glucose ([18F]FDG). This approach provides new insight into organ-specific glucose uptake allowing the visualisation of glucose metabolism. This review article seeks to highlight key findings from dynamic imaging, in terms of glucose uptake, focussing on the specific compartments (muscle, liver, adipose organ, heart, kidney and brain) in different metabolic conditions, such as insulin resistance and T2D, and during metabolic treatment. In essence, mapping these distinct organ contributions in the orchestra of glucose metabolism is forging a new frontier in personalised diabetes management, allowing for treatments uniquely tailored to individual metabolic needs.