Repeatability characteristics of insulin response patterns and measures of insulin resistance

Background:  Hyperinsulinaemia is emerging as an independent risk factor for metabolic disease, but diagnostic measures are limited. It is plausible that insulin resistance measures, such as homeostatic model assessment (HOMA) type 2 variants, may model hyperinsulinaemia, but repeatability data are limited. Kraft and Hayashi insulin response patterns may not only add value in diagnosing hyperinsulinaemia, but also lack suitable repeatability data. Aim:  The aim of this study was to investigate the repeatability of insulin response patterns, and fasting and dynamic measures of insulin resistance, and to determine whether these latter measures can predict the insulin response pattern. Setting:  This study was conducted at Auckland University of Technology Millennium Institute’s sports performance laboratories. Methods:  Oral glucose (100 g) tolerance tests were conducted weekly on eight people. Six people completed four tests, while two completed at least two tests. Each test assessed insulin resistance and response patterns. Insulin resistance measures included fasting tests (HOMA2, McAuley Index) and a dynamic test (oral glucose insulin sensitivity [OGIS]). The insulin response patterns were assessed with both Kraft and Hayashi methodologies. Repeatability characteristics of ordinal variables were assessed by Bland and Altman methods, while Fleiss’ κ was applied to categorical variables. Results:  Fasting measures of insulin resistance recorded poor repeatability (HOMA2) or poor sensitivity (McAuley Index) compared to the dynamic measure (OGIS). Kraft insulin response patterns were more repeatable compared to Hayashi patterns, based on a combination of Fleiss’ κ (0.290 vs. 0.186,)  p -value (0.15 vs. 0.798) and 95% confidence intervals. Conclusions:  Both hyperinsulinaemia and insulin resistance should be dynamically assessed with a multi-sampled oral glucose tolerance test. Further investigations are required to confirm a preferred methodology.