Methods for quantifying insulin resistance in human immunodeficiency virus-positive patients

• Published in: Metabolism, clinical and experimental Vol. 52; no. 7; pp. 858 - 861
• Main Authors: Chu, James W, Abbasi, Fahim, Beatty, George W, Khalili, Mandana, Koch, Johannes, Rosen, Alan, Schmidt, Jamey M, Stansell, John D, Reaven, Gerald M
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 01.07.2003; Elsevier
• Subjects: Adult; Biological and medical sciences; Blood Glucose - analysis; Blood Glucose - metabolism; Diabetes. Impaired glucose tolerance; Endocrine pancreas. Apud cells (diseases); Endocrinopathies; Etiopathogenesis. Screening. Investigations. Target tissue resistance; Fasting; Fatty Acids, Nonesterified - blood; Female; Glucose Tolerance Test; HIV Infections - blood; HIV Infections - complications; HIV Infections - drug therapy; HIV Protease Inhibitors - therapeutic use; Human immunodeficiency virus; Human viral diseases; Humans; Infectious diseases; Insulin - pharmacology; Insulin Resistance; Male; Medical sciences; Middle Aged; Viral diseases; Viral diseases of the lymphoid tissue and the blood. Aids; Human; Immunopathology; Pathophysiology; Etiopathogenesis; Retroviridae; Exploration; AIDS; Glucose; Immune deficiency; Lentivirus; Insulin; Infection; Virus; Resistance; Metabolic disorder; Viral disease; Adult; Human immunodeficiency virus; Quantitative analysis
• ISSN: 0026-0495; 1532-8600
• DOI: 10.1016/S0026-0495(03)00056-8

Various indirect indices have been used in human immunodeficiency virus (HIV)-infected individuals to assess insulin resistance, but the validity of these measures has not been rigorously assessed by comparison with physiologic methods of quantifying insulin-mediated glucose uptake (IMGU). We directly measured IMGU in 50 nondiabetic HIV-positive subjects by determining the steady-state plasma glucose (SSPG) concentration in response to a 3-hour continuous infusion of insulin, glucose, and somatostatin. Because steady-state plasma insulin concentrations were similar (∼60 μU/mL) in all subjects, the SSPG concentrations provided direct assessments of insulin action. Relationships between SSPG levels and various surrogate measures of IMGU derived from the 75-g oral glucose tolerance test (OGTT) were determined. The indirect measure of IMGU most closely related to SSPG concentrations was the total integrated insulin response to a 75-g glucose load ( r = 0.78, P < .01), accounting for approximately two thirds of the variability in SSPG ( r 2 = 0.61). Other indirect measures of IMGU, including the homeostasis assessment for insulin resistance (HOMA-IR), were also significantly related to SSPG values, but had lower magnitudes of correlation ( r = 0.43 to 0.61), thereby possessing limited ability to predict SSPG variability ( r 2 = 0.18 to 0.37). In conclusion, indirect measures of IMGU need to be applied with caution when evaluating insulin action in HIV-infected patients.