Indices of Insulin Action, Disposal, and Secretion Derived From Fasting Samples and Clamps in Normal Glucose-Tolerant Black and White Children

• Published in: Diabetes care Vol. 25; no. 11; pp. 2081 - 2087
• Main Authors: UWAIFO, Gabriel I, FALLON, Erica M, CHIN, Jeff, ELBERG, Jane, PARIKH, Shamik J, YANOVSKI, Jack A
• Format: Journal Article
• Language: English
• Published: Alexandria, VA American Diabetes Association 01.11.2002
• Subjects: African Americans; Biological and medical sciences; Blood Glucose - metabolism; Body Mass Index; C-Peptide - blood; Case studies; Child; Children & youth; Copper - blood; Diabetes; Diabetes in children; Diabetes. Impaired glucose tolerance; Diagnostic tests; District of Columbia; Endocrine pancreas. Apud cells (diseases); Endocrinopathies; Etiopathogenesis. Screening. Investigations. Target tissue resistance; European Continental Ancestry Group; Fasting; Female; Glucose Clamp Technique; Humans; Insulin; Insulin - blood; Insulin - metabolism; Insulin Resistance - physiology; Insulin Secretion; Male; Maryland; Measurement; Medical sciences; Obesity - blood; Physiological aspects; Puberty; Reference Values; Regression Analysis; Reproducibility of Results; Software; Statistics; District of Columbia; Maryland; Human; Pancreatic hormone; Correlation; Fasting; Pathophysiology; Glucose clamp technique; Sample; Negroid; Clearance; Glucose; Insulin; C-Peptide; Biological activity; Endocrine secretion; Protein hormone; Target tissue resistance; Sensitivity; Caucasoid; Fast; Child
• ISSN: 0149-5992; 1935-5548
• DOI: 10.2337/diacare.25.11.2081

Indices of Insulin Action, Disposal, and Secretion Derived From Fasting Samples and Clamps in Normal Glucose-Tolerant Black and White Children Gabriel I. Uwaifo , MD , Erica M. Fallon , BS , Jeff Chin , BS , Jane Elberg , BS , Shamik J. Parikh , MD and Jack A. Yanovski , MD, PHD From the Unit on Growth and Obesity, Developmental Endocrinology Branch, National Institutes of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland Abstract OBJECTIVE —To validate fasting indices of insulin sensitivity and secretion in a diverse pediatric population against gold standard estimates from euglycemic and hyperglycemic clamps. RESEARCH DESIGN AND METHODS —A total of 31 children (mean BMI 25.1 ± 4.9 kg/m 2 , mean age 8.7 ± 1.4 years, 15 girls and 16 boys, 12 black and 19 white) underwent euglycemic and hyperglycemic clamps 2–6 weeks apart to derive insulin sensitivity indices (SI Eug clamp and SI Hyper clamp ). Fasting samples were used to derive the homeostasis model assessment of insulin resistance index (HOMA-IR), HOMA of percent β-cell function (HOMA-B%), quantitative insulin sensitivity check index (QUICKI), insulinogenic index, antilipolytic insulin sensitivity index (ISI-FFA), and C-peptide–to–insulin ratio. RESULTS —The QUICKI correlated best with SI Eug clamp ( r = 0.69, P < 0.05) and had greater correlations to SI Eug clamp than did either SI Hyper clamp ( r = 0.45, P < 0.05) or the HOMA-IR ( r = −0.51, P < 0.05). Both fasting insulin and the insulinogenic index correlated well with first- and steady-phase insulin secretion ( r ’s from 0.79 to 0.86, P < 0.05). HOMA-B% was not as highly correlated ( r = 0.69–0.72, P < 0.05). Fasting C-peptide–to–insulin ratio was not significantly correlated with clamp-derived metabolic clearance rate of insulin. ISI-FFA was not correlated with the degree of free fatty acid suppression obtained from the clamps. CONCLUSIONS —The QUICKI, fasting insulin, and the insulinogenic index all closely correlate with corresponding clamp-derived indices of insulin sensitivity and secretion in this diverse pediatric cohort. These results, if replicated in similarly diverse populations, suggest that estimates based on fasting samples can be used to rank order insulin secretion and sensitivity in pediatric cohorts. BMI SDS, BMI SD score FFA, free fatty acid HOMA-B%, homeostasis model assessment of percent β-cell function HOMA-IR, homeostasis model assessment of insulin resistance index ISI-FFA, antilipolytic insulin sensitivity index MCR, metabolic clearance rate OGTT, oral glucose tolerance test QUICKI, quantitative insulin sensitivity check index SI Eug clamp, insulin sensitivity index derived from a euglycemic clamp SI Hyper clamp, insulin sensitivity index derived from a hyperglycemic clamp Footnotes Address correspondence and reprint requests to Jack A. Yanovski MD, PhD, Head, Unit on Growth and Obesity, DEB, NICHD, National Institutes of Health, 10 Center Dr., Building 10, Rm. 10N262, MSC 1862, Bethesda, MD 20892-1862. E-mail: yanovskj{at}mail.nih.gov . Received for publication 26 April 2002 and accepted in revised form 13 August 2002. A table elsewhere in this issue shows conventional and Système International (SI) units and conversion factors for many substances. DIABETES CARE