The most common downstream mechanisms of insulin resistance include inhibitory phosphorylation of IRS, growth factor receptor binding protein-2 (GRB-2), GRB-10, SHC transforming protein (SHC), and SH2B adapter protein-2 (SH2B-2) through induced insulin receptor.439,440 Selective glucose transporters exist in different target organs, such as the renal SGLT2 receptor;441 the distribution of GLUT receptors in different target organs and the pathways also differ.78,442 This paper summarizes the new advances in insulin signaling receptor pathways and their roles from 2018 to date (Table 4). The gene discussed is INSR; the disease is Insulin resistance.