Quantitative Insulin Sensitivity Check Index: A Simple, Accurate Method for Assessing Insulin Sensitivity In Humans

Journal of Clinical Endocrinology and Metabolism - Tập 85 Số 7 - Trang 2402-2410 - 2000
Amy K. Katz1, Sridhar Nambi1, Kieren J. Mather2, Alain Baron2, Dean Follmann1, Gail W. Sullivan1, Michael J. Quon1
1Hypertension-Endocrine Branch and Division of Epidemiology and Clinical Applications, National Heart, Lung, and Blood Institute, National Institutes of Health (D.A.F.), Bethesda, Maryland 20892
2Division of Endocrinology and Metabolism, Indiana University School of Medicine (K.M., A.D.B.), Indianapolis, Indiana 46202

Tóm tắt

Insulin resistance plays an important role in the pathophysiology of diabetes and is associated with obesity and other cardiovascular risk factors. The “gold standard” glucose clamp and minimal model analysis are two established methods for determining insulin sensitivity in vivo, but neither is easily implemented in large studies. Thus, it is of interest to develop a simple, accurate method for assessing insulin sensitivity that is useful for clinical investigations. We performed both hyperinsulinemic isoglycemic glucose clamp and insulin-modified frequently sampled iv glucose tolerance tests on 28 non-obese, 13 obese, and 15 type 2 diabetic subjects. We obtained correlations between indexes of insulin sensitivity from glucose clamp studies (SIClamp) and minimal model analysis (SIMM) that were comparable to previous reports (r = 0.57). We performed a sensitivity analysis on our data and discovered that physiological steady state values [i.e. fasting insulin (I0) and glucose (G0)] contain critical information about insulin sensitivity. We defined a quantitative insulin sensitivity check index (QUICKI = 1/[log(I0) + log(G0)]) that has substantially better correlation with SIClamp (r = 0.78) than the correlation we observed between SIMM and SIClamp. Moreover, we observed a comparable overall correlation between QUICKI and SIClamp in a totally independent group of 21 obese and 14 nonobese subjects from another institution. We conclude that QUICKI is an index of insulin sensitivity obtained from a fasting blood sample that may be useful for clinical research.

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Tài liệu tham khảo

1988, Lilly lecture 1987. The triumvirate: β-cell, muscle, liver. A collusion responsible for NIDDM., Diabetes, 37, 667

DeFronzo, 1992, Pathogenesis of NIDDM. A balanced overview., Diabetes Care, 15, 318, 10.2337/diacare.15.3.318

Scherrer, 1997, Insulin as a vascular and sympathoexcitatory hormone: implications for blood pressure regulation, insulin sensitivity, and cardiovascular morbidity., Circulation, 96, 4104, 10.1161/01.CIR.96.11.4104

Reaven, 1996, Hypertension and associated metabolic abnormalities–the role of insulin resistance and the sympathoadrenal system., N Engl J Med, 334, 374, 10.1056/NEJM199602083340607

1996, Do non-insulin-dependent diabetes mellitus and cardiovascular disease share common antecedents?, Ann Intern Med, 124, 110, 10.7326/0003-4819-124-1_Part_2-199601011-00006

DeFronzo, 1979, Glucose clamp technique: a method for quantifying insulin secretion and resistance, Am J Physiol., 237, E214

Andres, 1966, Manual feedback technique for the control of blood glucose concentration. In: Skeggs Jr LT, ed

Bergman, 1987, Equivalence of the insulin sensitivity index in man derived by the minimal model method and the euglycemic glucose clamp., J Clin Invest, 79, 790, 10.1172/JCI112886

1989, Lilly lecture 1989. Toward physiological understanding of glucose tolerance. Minimal-model approach., Diabetes, 38, 1512, 10.2337/diab.38.12.1512

Saad, 1997, Differences between the tolbutamide-boosted and the insulin-modified minimal model protocols., Diabetes, 46, 1167, 10.2337/diab.46.7.1167

Saad, 1994, A comparison between the minimal model and the glucose clamp in the assessment of insulin sensitivity across the spectrum of glucose tolerance. Insulin Resistance Atherosclerosis Study., Diabetes, 43, 1114, 10.2337/diab.43.9.1114

Quon, 1994, Non-insulin-mediated glucose disappearance in subjects with IDDM. Discordance between experimental results and minimal model analysis., Diabetes, 43, 890, 10.2337/diab.43.7.890

Cobelli, 1998, Overestimation of minimal model glucose effectiveness in presence of insulin response is due to undermodeling, Am J Physiol, 275, E1031

Finegood, 1996, Reduced glucose effectiveness associated with reduced insulin release: an artifact of the minimal-model method, Am J Physiol, 271, E485

1997, Report of the Expert Committee on the Diagnosis and Classification of Diabetes Mellitus., Diabetes Care, 20, 1183, 10.2337/diacare.20.7.1183

Quon, 1994, Direct comparison of standard and insulin modified protocols for minimal model estimation of insulin sensitivity in normal subjects., Diabetes Res, 25, 139

Efron, 1993, An introduction to the bootstrap, 10.1007/978-1-4899-4541-9

Matthews, 1985, Homeostasis model assessment: insulin resistance and β-cell function from fasting plasma glucose and insulin concentrations in man., Diabetologia, 28, 412, 10.1007/BF00280883

Haffner, 1996, A prospective analysis of the HOMA model. The Mexico City Diabetes Study., Diabetes Care, 19, 1138, 10.2337/diacare.19.10.1138

Polonsky, 1998, Temporal profiles and clinical significance of pulsatile insulin secretion., Horm Res, 49, 178

Polonsky, 1988, Twenty-four-hour profiles and pulsatile patterns of insulin secretion in normal and obese subjects., J Clin Invest, 81, 442, 10.1172/JCI113339

Gumbiner, 1996, Abnormalities of insulin pulsatility and glucose oscillations during meals in obese noninsulin-dependent diabetic patients: effects of weight reduction., J Clin Endocrinol Metab, 81, 2061

Polonsky, 1988, Abnormal patterns of insulin secretion in non-insulin-dependent diabetes mellitus., N Engl J Med, 318, 1231, 10.1056/NEJM198805123181903

1993, How good a marker is insulin level for insulin resistance?, Am J Epidemiol, 137, 959, 10.1093/oxfordjournals.aje.a116768

Mykkanen, 1996, Relationship of plasma insulin concentration and insulin sensitivity to blood pressure. Is it modified by obesity?, J Hypertens, 14, 399, 10.1097/00004872-199603000-00018

Haffner, 1997, The homeostasis model in the San Antonio Heart Study., Diabetes Care, 20, 1087, 10.2337/diacare.20.7.1087

Boyko, 1996, Low insulin secretion and high fasting insulin and C-peptide levels predict increased visceral adiposity. 5-year follow-up among initially nondiabetic Japanese-American men., Diabetes, 45, 1010, 10.2337/diab.45.8.1010

Odeleye, 1997, Fasting hyperinsulinemia is a predictor of increased body weight gain and obesity in Pima Indian children., Diabetes, 46, 1341, 10.2337/diab.46.8.1341

Haffner, 1996, Nondiabetic Mexican-Americans do not have reduced insulin responses relative to nondiabetic non-Hispanic whites., Diabetes Care, 19, 67, 10.2337/diacare.19.1.67

Donner, 1985, Presentation of a new method for specific measurement of in vivo insulin-stimulated glucose disposal in humans: comparison of this approach with the insulin clamp and minimal model techniques., J Clin Endocrinol Metab, 60, 723, 10.1210/jcem-60-4-723

Foley, 1985, Estimates of in vivo insulin action in humans: comparison of the insulin clamp and the minimal model techniques., Horm Metab Res, 17, 406, 10.1055/s-2007-1013559

Beard, 1986, The insulin sensitivity index in nondiabetic man. Correlation between clamp-derived and IVGTT-derived values., Diabetes, 35, 362, 10.2337/diab.35.3.362

Galvin, 1992, A simple method for quantitation of insulin sensitivity and insulin release from an intravenous glucose tolerance test., Diabet Med, 9, 921, 10.1111/j.1464-5491.1992.tb01732.x

Swan, 1994, Assessment of insulin sensitivity in man: a comparison of minimal model- and euglycaemic clamp-derived measures in health and heart failure., Clin Sci, 86, 317, 10.1042/cs0860317

Coates, 1995, Comparison of estimates of insulin sensitivity from minimal model analysis of the insulin-modified frequently sampled intravenous glucose tolerance test and the isoglycemic hyperinsulinemic clamp in subjects with NIDDM., Diabetes, 44, 631, 10.2337/diab.44.6.631

Korytkowski, 1995, Comparison of the minimal model and the hyperglycemic clamp for measuring insulin sensitivity and acute insulin response to glucose., Metabolism, 44, 1121, 10.1016/0026-0495(95)90003-9

Anderson, 1995, Exploration of simple insulin sensitivity measures derived from frequently sampled intravenous glucose tolerance (FSIGT) tests. The Insulin Resistance Atherosclerosis Study., Am J Epidemiol, 142, 724, 10.1093/aje/142.7.724

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Thông tin xuất bản

Journal of Clinical Endocrinology and Metabolism

Tập 85 Số 7

2402-2410

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