The present invention provides compositions and methods for treating hyperglycemia, insulin resistance, and associated organ damage, including in some embodiments diabetes mellitus (type 1 or 2), metabolic syndrome, obesity, fatty liver diseases, or kidney disease. In various embodiments, the invention involves administering a regimen of larazotide (or a derivative of larazotide) to a subject. In various embodiments, the regimen reduces dysfunction of the gastrointestinal epithelial barrier, thereby improving glycemic control. In various embodiments, the regimen of larazotide improves the effectiveness of conventional pharmaceutical interventions for hyperglycemia or diabetes mellitus.