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Exp Clin Endocrinol Diabetes 2006; 114(5): 249-256
DOI: 10.1055/s-2006-924233
Article

J. A. Barth Verlag in Georg Thieme Verlag KG Stuttgart · New York

Insulin Sensitivity Indices: a Proposal of Cut-Off Points for Simple Identification of Insulin-Resistant Subjects

Z. Radikova1 , J. Koska1 , M. Huckova2 , L. Ksinantova1 , R. Imrich1 , M. Vigas1 , T. Trnovec3 , P. Langer2 , E. Sebokova2 , I. Klimes2
  • 1Laboratory of Human Endocrinology, Institute of Experimental Endocrinology, Slovak Academy of Sciences, Bratislava, Slovak Republic
  • 2Diabetes and Nutrition Laboratory, Institute of Experimental Endocrinology, Slovak Academy of Sciences, Bratislava, Slovak Republic
  • 3Institute of Preventive and Clinical Medicine, Slovak Health University, Bratislava, Slovak Republic
Further Information

Publication History

Received: August 18, 2005 First decision: October 14, 2005

Accepted: February 21, 2006

Publication Date:
28 June 2006 (online)

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Abstract

Demanding measurement of insulin sensitivity using clamp methods does not simplify the identification of insulin resistant subjects in the general population. Other approaches such as fasting- or oral glucose tolerance test-derived insulin sensitivity indices were proposed and validated with the euglycemic clamp. Nevertheless, a lack of reference values for these indices prevents their wider use in epidemiological studies and clinical practice. The aim of our study was therefore to define the cut-off points of insulin resistance indices as well as the ranges of the most frequently obtained values for selected indices. A standard 75 g oral glucose tolerance test was carried out in 1156 subjects from a Caucasian rural population with no previous evidence of diabetes or other dysglycemias. Insulin resistance/sensitivity indices (HOMA‐IR, HOMA‐IR2, ISI Cederholm, and ISI Matsuda) were calculated. The 75th percentile value as the cut-off point to define IR corresponded with a HOMA‐IR of 2.29, a HOMA‐IR2 of 1.21, a 25th percentile for ISI Cederholm, and ISI Matsuda of 57 and 5.0, respectively. For the first time, the cut-off points for selected indices and their most frequently obtained values were established for groups of subjects as defined by glucose homeostasis and BMI. Thus, insulin-resistant subjects can be identified using this simple approach.

Key words

Insulin sensitivity indices - glucose - insulin - oral glucose tolerance test - pre-diabetes - insulin resistance

References

  • 1 Abate N. Insulin resistance and obesity. The role of fat distribution pattern.  Diabetes Care. 1996;  19 292-294
    PubMedGoogle Scholar
  • 2 Abbasi F, Brown Jr B W, Lamendola C, McLaughlin T, Reaven G M. Relationship between obesity, insulin resistance, and coronary heart disease risk.  J Am Coll Cardiol. 2002;  40 937-943
    CrossrefPubMedGoogle Scholar
  • 3 Alberti K GMM, Zimmet P Z WHO Consultation for the . Definition, diagnosis and classification of diabetes mellitus and its complications. Part 1: Diagnosis and classification of diabetes mellitus, provisional report of a WHO consultation.  Diabet Med. 1998;  15 539-553
    CrossrefPubMedGoogle Scholar
  • 4 American Diabetes Association . Diagnosis and Classification of Diabetes Mellitus.  Diabetes Care. 2004;  27 S5-S10
    CrossrefPubMedGoogle Scholar
  • 5 Ascaso J F, Pardo S, Real J T, Lorente R I, Priego A, Carmena R. Diagnosing insulin resistance by simple quantitative methods in subjects with normal glucose metabolism.  Diabetes Care. 2003;  26 3320-3325
    CrossrefPubMedGoogle Scholar
  • 7 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 Relat Metab Disord. 1999;  23 512-517
    CrossrefPubMedGoogle Scholar
  • 8 Belfiore F, Ianello S, Volpicelli G. Insulin sensitivity indices calculated from basal and OGTT-induced insulin, glucose, and FFA levels.  Mol Genet Metab. 1998;  63 134-141
    CrossrefPubMedGoogle Scholar
  • 9 Bergman R N, Prager R, Volund A, Olefsky J M. Equivalence of the insulin sensitivity in man derived from the Minimal Model method and the euglycemic glucose clamp.  J Clin Invest. 1987;  79 790-800
    PubMedGoogle Scholar
  • 10 Bonora E, Kiechl S, Willeit J, Oberhollenzer F, Egger G, Targher G, Alberiche M, Bonadonna R C, Muggeo M. Prevalence of insulin resistance in metabolic disorders: the Bruneck Study.  Diabetes. 1998;  47 1643-1649
    CrossrefPubMedGoogle Scholar
  • 11 Cederholm J, Wibell L. Insulin release and peripheral sensitivity at the oral glucose tolerance test.  Diabetes Res Clin Pract. 1990;  10 167-175
    CrossrefPubMedGoogle Scholar
  • 12 DeFronzo R A, Tobin J D, Andres R. Glucose clamp technique: a method for quantifying insulin secretion and resistance.  Am J Physiol. 1979;  237 E214-E223
    PubMedGoogle Scholar
  • 13 Duncan M H, Singh B M, Wise P H, Carter G, Alaghband-Zadeh J. A simple measure of insulin resistance.  Lancet. 1995;  346 120-121
    Google Scholar
  • 14 Ferrannini E, Natali A, Bell P, Cavallo-Perin P, Lalic N, Mingore G European group for the Study of Insulin Resistance (EGIR) on behalf of the. Insulin resistance and hypersecretion in obesity.  J Clin Invest. 1997;  100 1166-1173
    CrossrefPubMedGoogle Scholar
  • 15 Gutt M, Davis C L, Spitzer S B, Llabre M M, Kumar M, Czarnecki E M, Schneiderman N, Skyler J S, Marks J B. Validation of the insulin sensitivity index (ISI0, 120): comparison with other measures.  Diabetes Res Clin Pract. 2000;  47 177-184
    CrossrefPubMedGoogle Scholar
  • 16 Hanley A JG, Williams K, Gonzalez C, D'Agostino Jr R B, Wagenknecht L E, Stern M P, Haffner S M. Prediction of Type 2 diabetes using simple measures of insulin resistance. Combined results from the San Antonio Heart Study, the Mexico City Diabetes Study, and the Insulin Resistance Atherosclerosis Study.  Diabetes. 2003;  52 463-469
    PubMedGoogle Scholar
  • 17 Hanson R L, Pratley R E, Bogardus C, Narayan K M, Roumain J M, Imperatore G, Fagot-Campagna A, Pettitt D J, Bennett P H, Knowler W C. Evaluation of simple indices of insulin sensitivity and insulin secretion for use in epidemiological studies.  Am J Epidemiol. 2000;  151 190-198
    PubMedGoogle Scholar
  • 18 Holman R, Hines G, Kennedy I, Stevens R, Matthews D, Levy J. A calculator for HOMA.  Diabetologia. 2004;  47 A222 (Abstract)
    PubMedGoogle Scholar
  • 19 Isomaa B, Almgren P, Tuomi T, Forsen B, Lahti K, Nissen M, Taskinen M R, Groop L. Cardiovascular morbidity and mortality associated with the metabolic syndrome.  Diabetes Care. 2001;  24 683-689
    CrossrefPubMedGoogle Scholar
  • 20 Katz A, Nambi S S, Mather K, Baron A D, Follmann D A, Sullivan G, Quon M J. Quantitative insulin sensitivity check index: a simple, accurate method for assessing insulin sensitivity in humans.  J Clin Endocrinol Metab. 2000;  85 2402-2410
    CrossrefPubMedGoogle Scholar
  • 21 Levy J C, Matthews D R, Hermans M P. Correct Homeostasis Model Assessment (HOMA) Evaluation Uses the Computer Program.  Diabetes Care. 1998;  21 2191-2192
    CrossrefPubMedGoogle Scholar
  • 22 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
  • 23 Mari A, Pacini G, Brazzale A R, Ahrén B. Comparative evaluation of simple insulin sensitivity methods based on the oral glucose tolerance test.  Diabetologia. 2005;  48 748-751
    CrossrefPubMedGoogle Scholar
  • 24 Matsuda M, DeFronzo R A. Insulin sensitivity indices obtained from oral glucose tolerance testing: comparison with the euglycemic insulin clamp.  Diabetes Care. 1999;  22 1462-1470
    CrossrefPubMedGoogle Scholar
  • 25 Matthews D R, Hosker J P, Rudenski A S, Naylor B A, Treacher D F, Turner R C. Homeostasis model assessment: insulin resistance and beta-cell function from fasting plasma glucose and insulin concentrations in man.  Diabetologia. 1985;  28 412-419
    Google Scholar
  • 26 McAuley K A, Williams S M, Mann J I, Walker R J, Ledwis-Barned N J, Temple L A, Duncan A S. Diagnosing insulin resistance in the general population.  Diabetes Care. 2001;  24 460-464
    CrossrefPubMedGoogle Scholar
  • 27 Melchionda N, Forlani G, Marchesini G, Baraldi L, Natale S. WHO and ADA criteria for the diagnosis of diabetes mellitus in relation to body mass index. Insulin sensitivity and secretion in resulting subcategories of glucose tolerance.  Obesity. 2002;  26 90-96
    PubMedGoogle Scholar
  • 28 Pacini G, Mari A. Methods for clinical assessment of insulin sensitivity and beta-cell function.  Best Pract Res Clin Endocrinol Metab. 2003;  17 305-322
    CrossrefPubMedGoogle Scholar
  • 29 Pavuk M, Cerhan J R, Lynch C F, Schecter A, Petrik J, Chovancova J, Kocan A. Environmental exposure to PCBs and cancer incidence in eastern Slovakia.  Chemosphere. 2004;  54 1509-1520
    CrossrefPubMedGoogle Scholar
  • 30 Radikova Z. Assessment of insulin sensitivity/resistance in epidemiological studies.  Endocr Regul. 2003;  37 189-194
    PubMedGoogle Scholar
  • 31 Ruderman N, Chisholm D, Pi-Sunyer X, Schneider S. The metabolically obese, normal-weight individual revisited.  Diabetes. 1998;  47 699-713
    CrossrefPubMedGoogle Scholar
  • 32 Soonthornpun S, Setasuban W, Thamprasit A, Chayanunnukul W, Rattarsarn C, Geater A. Novel insulin sensitivity index derived from oral glucose tolerance test.  J Clin Endocrinol Metab. 2003;  88 1019-1023
    CrossrefPubMedGoogle Scholar
  • 33 Stern S E, Williams K, Ferrannini E, DeFronzo R, Bogardus C, Stern M P. Identification of individuals with insulin resistance using routine clinical measurements.  Diabetes. 2005;  54 333-339
    CrossrefPubMedGoogle Scholar
  • 34 Stumvoll M, Mitrakou A, Pimenta W, Jenssen T, Yki-Järvinen H, Van Haeften T, Renn W, Gerich J. Use of the oral glucose tolerance test to assess insulin release and insulin sensitivity.  Diabetes Care. 2000;  23 295-301
    CrossrefPubMedGoogle Scholar
  • 35 Stumvoll M, Van Haeften T, Fritsche A, Gerich J. Oral glucose tolerance test indexes for insulin sensitivity and secretion based on various availabilities of sampling times.  Diabetes Care. 2001;  24 796-797
    CrossrefPubMedGoogle Scholar
  • 36 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
  • 37 Tripathy D, Almgren P, Tuomi T, Groop L. Contribution of insulin-stimulated glucose uptake and basal hepatic insulin sensitivity to surrogate measures of insulin sensitivity.  Diabetes Care. 2004;  27 2204-2210
    CrossrefPubMedGoogle Scholar
  • 38 Trnovec T, Kocan A, Langer P, Sovcikova E, Tajtakova M, Bergman A, Berg M V, Brouwer A, Machala M, Winneke G, Sampson B, Brunekreef B, Bencko V. Project proposal. Evaluating human health risk from low-dose and long-term exposure to polychlorinated biphenyls.  Endocr Regul. 2000;  34 167-168
    PubMedGoogle Scholar
  • 39 Vaccaro O, Masulli M, Cuomo V, Rivellese A A, Uusitupa M, Vessby B, Hermansen K, Tapsell L, Riccardi G. Comparative evaluation of simple indices of insulin resistance.  Metabolism. 2004;  53 1522-1526
    CrossrefPubMedGoogle Scholar
  • 40 Wallace T M, Levy J C, Matthews D R. Use and abuse of HOMA modeling.  Diabetes Care. 2004;  27 1487-1495
    Google Scholar
  • 41 World Medical Association .Declaration of Helsinki. Available from http://www.wma.net/e/policy/b3.htm; accessed 9 October 2004. 2004
    Google Scholar
  • 42 Yeckel C W, Weiss R, Dziura J, Taksali S E, Dufour S, Burgert T S, Tamborlane W V, Caprio S. Validation of insulin sensitivity indices from oral glucose tolerance test parameters in obese children and adolescents.  J Clin Endocrinol Metab. 2004;  89 1096-1101
    CrossrefPubMedGoogle Scholar

Prof. MD, DSc Iwar Klimes

Institute of Experimental Endocrinology, SAS

Vlarska 3

833 06 Bratislava

Slovakia

Phone: + 421-2-5477 2687

Fax: + 421-2-5477 2687

Email: Iwar.Klimes@savba.sk