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Horm Metab Res 2003; 35(1): 13-17
DOI: 10.1055/s-2003-38385
Original Basic
© Georg Thieme Verlag Stuttgart · New York

Comparison of Several Insulin Sensitivity Indices Derived from Basal Plasma Insulin and Glucose Levels with Minimal Model Indices

D.  A.  García-Estévez 1 , D.  Araújo-Vilar 1 , G.  Fiestras-Janeiro 2 , Á.  Saavedra-González 2 , J.  Cabezas-Cerrato 1
  • 1Service of Endocrinology and Nutrition, Department of Medicine, Hospital Clínico Universitario de Santiago, Faculty of Medicine. University of Santiago de Compostela, Spain
  • 2Department of Statistics and Operational Research, Faculty of Economic Science, University of Vigo, Spain
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Publication History

Received 5 November 2001

Accepted after revision 19 August 2002

Publication Date:
01 April 2003 (online)

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Abstract

Some techniques for the evaluation of insulin resistance (IR), such as the clamp technique, are not viable for the study of large populations; and for this reason, alternative approaches based on fasting plasma glucose (FPG) and plasma insulin (FPI) have been proposed. The aim of this study was to compare the IR calculations obtained from FPI and FPG values with the insulin sensitivity (IS) index derived from the minimal model. Eighty-seven healthy subjects with a wide range of body mass index (18 - 44 kg × m-2) and 16 DM2 non-obese patients were included in the study. All of the patients underwent a frequently sampled intravenous glucose tolerance test (FSIGTT), and the minimal model of glucose was used for the estimation of insulin sensitivity (ISMINIMAL). The HOMA-IR index, the Avignon index, and the quotient FPG/FPI were used to calculate basal steady-state IR. The basal IR value that best correlated with IS was Log (1/HOMA-IR) (r = 0.70, p < 0.001). All of the basal indices showed a high correlation with each other. In conclusions, insulin sensitivity indices as determined from the basal glycaemia and insulinemia values are not good estimators for metabolic reality from the perspective of the minimal model. Nevertheless, they might well have an IR screening value for epidemiological studies, as long as there is no pancreatic β-cell dysfunction.

Key words

Insulin Resistance - Beta Cell Function - Obesity - Type 2 Diabetes Mellitus - Glucose Metabolism

References

  • 1 DeFronzo R A. The triumvirate: B-cell, muscle, liver. A collusion responsible for NIDDM.  Diabetes. 1987;  37 667-687
    PubMedGoogle Scholar
  • 2 Bonadonna R C, de Fronzo R A. Glucose metabolism in obesity and type 2 diabetes.  Diabete Metab. 1991;  17 112-135
    PubMedGoogle Scholar
  • 3 Felber J P. From obesity to diabetes. Pathophysiological considerations.  Int J Obes. 1992;  16 937-952
    PubMedGoogle Scholar
  • 4 Bergman R N, Finegood D T, Ader M. Assessment of insulin sensitivity in vivo.  Endocrine Reviews. 1985;  6 45-86
    PubMedGoogle Scholar
  • 5 Matthews D R, Hosker J P, Rudenski A S, Naylor B A, Treacher D F, Turner R C. Homeostais model assessment: insulin resistance and β-cell function from fasting plasma glucose and insulin concentrations in man.  Diabetologia. 1985;  28 412-419
    Google Scholar
  • 6 Avignon A, Boegner C, Mariano-Goulart D, Colette C, Monnier L. Assessment of insulin sensitivity from plasma insulin and glucose in the fasting or post oral glucose-load state.  Int J Obes. 1999;  23 512-517
    CrossrefPubMedGoogle Scholar
  • 7 Haffner S M, Miettinen H, Stern M P. The homeostasis model in the San Antonio Heart Stady.  Diabetes Care. 1997;  20 1087-1092
    CrossrefPubMedGoogle Scholar
  • 8 Bavdekar A, Yajnik C S, Fall C H, Bapat S, Pandit A N, Deshpande V, Bhave S, Kellingray S D, Joglekar C. Insulin resistance syndrome in 8-year-old Indian children: small at birth, big at 8 years, or both?.  Diabetes. 1999;  48 2422-2429
    CrossrefPubMedGoogle Scholar
  • 9 Tripathy D, Carlsson M, Almgren P, Isomaa B, Taskinen M R, Tuomi T, Groop L C. Insulin secretion and insulin sensitivity in relation to glucose tolerance. Lessons from the Botnia Study.  Diabetes. 2000;  49 975-980
    PubMedGoogle Scholar
  • 10 Snehalata C, Satyavani K, Sivansakari S, Vijay V, Ramachandran A. Insulin secretion and action in different stages of glucose tolerance in Asian Indians.  Diabet Med. 1999;  16 408-414
    CrossrefPubMedGoogle Scholar
  • 11 Haffner S M, Mykkanen L, Festa A, Burke J P, Stern M P. Insulin-resistant prediabetic subjects have more atherogenic risk factors than insulin-sensitive prediabetic subjects: implications for preventing coronary heart disease during the prediabetic state.  Circulation. 2000;  7 975-980
    PubMedGoogle Scholar
  • 12 Kashiwabara H, Inaba M, Maruno Y. et al . Insulin levels during fasting and the glucose tolerance test and the Homa’s index predict subsequent development of hypertension.  J Hypertens. 2000;  18 83-88
    PubMedGoogle Scholar
  • 13 The Expert Committee on the Diagnosis and Classification of Diabetes Mellitus. Report of the Expert Committee on the diagnosis and classification of Diabetes. Diabetes Care 1997 20: 1183-1197
    Google Scholar
  • 14 Araújo-Vilar D, García-Estévez D A, Cabezas-Cerrato J. Both a reduced acute insulin response to glucose and lower glucose effectiveness are responsible for the worsening of intravenous glucose tolerance in healthy subjects independently of the degree of obesity.  Metabolism. 1998;  47 313-320
    CrossrefPubMedGoogle Scholar
  • 15 García-Estévez D A, Araújo-Vilar D, Cabezas-Cerrato J. Non-insulin-mediated glucose uptake in several insulin-resistant states in the postabsorptive period.  Diabetes Res Clin Pract. 1998;  39 107-113
    CrossrefPubMedGoogle Scholar
  • 16 Cabezas-Cerrato J, García-Estévez D A, Araújo D, Iglesias M. Insulin sensitivity, glucose effectiveness and β-cell function in obese males with essential hypertension: Investigation of the effects of treatment with a calcium channel blocker (diltiazem) or an angiotensin-converting enzyme inhibitor (quinapril).  Metabolism. 1997;  46 173-178
    CrossrefPubMedGoogle Scholar
  • 17 Cabezas-Cerrato J, García-Estévez D A, Araújo-Vilar D. Insulin sensitivity and beta-cell function in essential hypertension and normotensive first-degree relatives of hypertensive subjects.  Diabetes Metab. 1997;  23 402-408
    PubMedGoogle Scholar
  • 18 Araújo-Vilar D, García-Estévez D A, Cabezas-Cerrato J. Insulin sensitivity, glucose effectiveness, and insulin secretion in nondiabetic offspring of patients with non-insulin-dependent diabetes mellitus: A cross-sectional study.  Metabolism. 1999;  48 978-983
    CrossrefPubMedGoogle Scholar
  • 19 World Medical Association Declaration of Helsinki .Ethical principles for medical research involving human subjects. Bull. WHO 2001 79: 373-374
    Google Scholar
  • 20 Bergman R N, Ider Y Z, Bowden C R, Cobelli C. Quantitative estimation of insulin sensitivity.  Am J Phisiol. 1979;  236 E667-E677
    PubMedGoogle Scholar
  • 21 Bergman R N. Toward physiological understanding of glucose tolerance: Minimal model approach.  Diabetes. 1989;  38 1512-1527
    CrossrefPubMedGoogle Scholar
  • 22 Araújo-Vilar D, Rega-Liste C A, García-Estévez D A, Sarmiento-Escalona F, Mosquera-Tallon V, Cabezas-Cerrato J. Minimal model of glucose metabolism: Modified equations and its application in the study of insulin sensitivity in obese subjects.  Diabetes Res Clin Pract. 1998;  39 129-141
    CrossrefPubMedGoogle Scholar
  • 23 Toffolo G, Bergman R N, Finegood D T, Bowden C R, Cobelli C. Quantitative estimation of beta cell sensitivity to glucose in the intact organism. A minimal model of insulin kinectics in the dog.  Diabetes. 1980;  29 979-990
    PubMedGoogle Scholar
  • 24 Ferrari P, Alleman Y, Shaw S, Riesen W, Weidmann P. Reproducibility of insulin sensitivity measured by the minimal model method.  Diabetologia. 1991;  34 527-530
    CrossrefPubMedGoogle Scholar
  • 25 Steil G M, Murray J, Bergman R N, Buchanan T A. Repeatability of insulin sensitivity and glucose effectiveness from the minimal model. Implications for study design.  Diabetes. 1994;  43 1365-1371
    PubMedGoogle Scholar
  • 26 Bergman R N, Prager R, Volund A, Olefsky J M. Equivalence of the insulin sensitivity index in man derived by the minimal model method and the euglycemic glucose clamp.  J Clin Invest. 1987;  79 790-800
    PubMedGoogle Scholar
  • 27 van Haeften T W. Glucose tolerance, insulin sensitivity, and the homeostasis model assessment method.  Diabetes Care. 1998;  21 673
    PubMedGoogle Scholar
  • 28 Kahn S E, Pringeon R L, Mcculloch D K. et al . Quantification of the relationship between insulin sensitivity and β-cell function in human subjects.  Diabetes. 1993;  42 1663-1672
    CrossrefPubMedGoogle Scholar
  • 29 Hermans M P, Levy J C, Morris R J, Turner R C. Comparison of insulin sensitivity tests across a range of glucose tolerance from normal to diabetes.  Diabetologia. 1999;  42 678-687
    CrossrefPubMedGoogle Scholar
  • 30 Bonora E, Targher G, Bonadonna R C. et al . Homeostasis model assessment closely mirrors the glucose clamp technique in the assessment of insulin sensitivity. Studies in subjects with various degrees of glucose tolerance and insulin sensitivity.  Diabetes Care. 2000;  23 57-63
    CrossrefPubMedGoogle Scholar
  • 31 Mari A, Pacini G, Murphy E, Ludvik B, Nolan J J. A model-based method for assessing insulin sensitivity from the oral glucose tolerance test.  Diabetes Care. 2001;  24 539-548
    CrossrefPubMedGoogle Scholar
  • 32 Pérez-Martín A, Raynaud E, Hentgen C, Bringer J, Mercier J, Brun J F. Simplified measurement of insulin sensitivity with the minimal model procedure in type 2 diabetic patients without measurement of insulinemia.  Horm Metab Res. 2002;  34 102-106
    Article in Thieme ConnectPubMedGoogle Scholar
  • 33 Stumvoll M, Mitrakou A, Pimenta W. et al . Use of the oral glucose tolerance test to assess insulin release and insulin sensitivity.  Diabetes Care. 2000;  23 295-301
    CrossrefPubMedGoogle Scholar
  • 34 Bruce D G, Chisholm D J, Storlein L H, Kraegen E W. Physiological importance of deficiency in early prandial insulin secretion in non-insulin-dependent diabetes.  Diabetes. 1988;  37 735-744
    PubMedGoogle Scholar
  • 35 Luzi L, DeFronzo R A. Effect of loss of first-phase insulin secretion on hepatic glucose production and tissue glucose disposal in humans.  Am J Physiol. 1989;  257 241-246
    PubMedGoogle Scholar
  • 36 Araúxo D, Camarero E, Iglesias-Guerrero M, Cabezas-Cerrato J. Insulin sensitivity in non insulin dependent diabetes mellitus and obesity using the minimal model approach. In: Crepaldi G, Tiengo A, Enzy G (eds) Importance of early insulin secretion on the carbohydrate tolerance, in diabetes, obesity, and hyperlipidedemias IV. Elsevier Science Publisher BV Amsterdam; 1990: 211-213
    Google Scholar
  • 37 Haffner S M, Miettinen H, Gaskill S P, Stern M P. Decreased insulin action and insulin secretion predict the development of impaired glucose tolerance.  Diabetologia. 1996;  39 1201-1207
    PubMedGoogle Scholar
  • 38 Bergman R N, Phillips L S, Cobelli C. Physiologic evaluation of factors controlling glucose tolerance in man. Measurement of insulin sensitivity and b-cell glucose sensitivity from the response to intravenous glucose.  J Clin Invest. 1981;  68 1456-1467
    CrossrefPubMedGoogle Scholar

Prof. Dr. J. Cabezas-Cerrato

Service of Endocrinology and Nutrition · Hospital Clínico Universitario de Santiago

Tv Choupana s/n · 15706 Santiago de Compostela · Spain

Phone: + 34 (981) 951 246

Fax: + 34 (981) 520 410

Email: me836jcc@usc.es