empirical index of insulin sensitivity from short IVGTT: validation against the minimal model and glucose clamp indices in patients with different clinical characteristics

• Published in: Diabetologia Vol. 53; no. 1; pp. 144 - 152
• Main Authors: Tura, A, Sbrignadello, S, Succurro, E, Groop, L, Sesti, G, Pacini, G
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Berlin/Heidelberg : Springer-Verlag 2010; Springer-Verlag; Springer; Springer Nature B.V
• Subjects: Adult; Area Under Curve; Biological and medical sciences; blood; Blood Glucose; Blood Glucose - drug effects; Blood Glucose - metabolism; Body Mass Index; Clinical Medicine; Diabetes; Diabetes Mellitus, Type 1; Diabetes Mellitus, Type 1 - blood; Diabetes Mellitus, Type 2; Diabetes Mellitus, Type 2 - blood; Diabetes. Impaired glucose tolerance; drug effects; Endocrine pancreas. Apud cells (diseases); Endocrinology and Diabetes; Endocrinopathies; Endokrinologi och diabetes; Etiopathogenesis. Screening. Investigations. Target tissue resistance; Glucose; Glucose Clamp Technique; Glucose Clamp Technique - methods; Glucose Intolerance; Glucose Intolerance - blood; Glucose tolerance; Glucose Tolerance Test; Glucose Tolerance Test - methods; Human Physiology; Humans; Hyperinsulinism; Hyperinsulinism - blood; Hyperparathyroidism; Hyperparathyroidism - blood; Hyperparathyroidism - surgery; Insulin; Insulin - pharmacology; Insulin action; Insulin resistance; Internal Medicine; intravenous glucose tolerance test; Kidney Diseases; Kidney Diseases - blood; Klinisk medicin; Mathematical models; Medical and Health Sciences; Medical sciences; Medicin och hälsovetenskap; Medicine; Medicine & Public Health; Metabolic Diseases; Metabolism; methods; Middle Aged; Models, Biological; One hour; One hour intravenous glucose tolerance test; pharmacology; Regression Analysis; Reproducibility of Results; surgery; Glucose tolerance; One hour intravenous glucose tolerance test; Insulin resistance; Insulin action; Endocrinopathy; Human; Pancreatic hormone; Diabetes mellitus; Tolerance; Metabolic diseases; Glucose tolerance test; Glucose; Insulin; Target tissue resistance; Sensitivity; Models
• ISSN: 0012-186X; 1432-0428; 1432-0428
• DOI: 10.1007/s00125-009-1547-9

Aims/hypothesis Minimal model analysis for insulin sensitivity has been validated against the glucose clamp and is an accepted method for estimating insulin sensitivity from IVGTT. However minimal model analysis requires a 3 h test and relevant expertise to run the mathematical model. The aim of this study was to suggest a simple predictor of minimal model analysis index using only 1 h IVGTT. Methods We studied participants with different clinical characteristics who underwent 3 h regular (n = 336) or insulin-modified (n = 160) IVGTT, or 1 h IVGTT and euglycaemic-hyperinsulinaemic clamp (n = 247). Measures of insulin sensitivity were insulin sensitivity index estimated by minimal model analysis (SI) and the mean glucose infusion rate (clamp) (M). A calculated SI (CSI) predictor, [graphic removed] , was suggested, based on the calculation of the rate of glucose disappearance K G and the suprabasal AUC of insulin concentration ΔAUCINS over T = 40 min. For all the participants, α was assumed equal to the regression line slope between K G/(ΔAUCINS/T) and SI in control participants. Results CSI and SI showed high correlation (R ² = 0.68-0.96) and regression line slopes of approximately one in the majority of groups. CSI tended to overestimate SI in type 2 diabetic participants, but results were more reliable when CSI was computed with insulin-modified rather than regular IVGTT. CSI showed behaviours similar to SI as regards relationships with BMI, acute insulin response and sex. CSI showed good correlation with M (R ² = 0.82). Conclusions/interpretation A short test can achieve a good approximation of minimal model analysis and clamp insulin sensitivity. The importance of a method such as CSI is that it allows analysis of IVGTT datasets with samples limited to 1 h.