A Model-Based Method for Assessing Insulin Sensitivity From the Oral Glucose Tolerance Test. Diabetes Care 2001;24:539–548
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In the article cited above, there is a typographical error in equation (16) (appendix). The equation …Keywords:
Glucose tolerance test
Three-sampled oral glucose tolerance test is the most frequently used method for evaluation of impairment of glucose homeostasis in daily clinical practice. The aim of this study was to answer the question if insulin sensitivity indices (ISI) calculated from standard 3-sampled oral glucose tolerance test (3SoGTT) provide adequate information compared to the outcome when calculated from frequently sampled oral glucose tolerance test (FSoGTT).A total of 73 subjects (aged 17-59 years, BMI 17.9-41.8 kg/m2) underwent a standard frequently sampled oral glucose tolerance test (FSoGTT). Selected indices of insulin sensitivity were calculated using plasma glucose and insulin concentrations from FSoGTT and from samples obtained in 0, 60 and 120 min of the oGTT (3SoGTT). Areas under the peripheral concentration curves of insulin and glucose (AUCi, AUCg) from both approaches were compared.Insulin sensitivity calculated from 3SoGTT was significantly higher compared to the sensitivity calculated from FSoGTT expressed as insulin sensitivity indices ISI Cederholm (ISI(Ced)) and ISI Matsuda (ISI(Mat)), p<0.001 and p<0.05, respectively. There was a difference in AUCg between values estimated from 3SoGTT and FSoGTT (p<0.05). These differences nearly disappeared when the BMI groups (normal weight and overweight/obese) were evaluated separately. No differences were found in AUCi and the AUCg:AUCi ratio between two approaches.It might be supposed that on using 3SoGTT the ISI(Mat) provides greater objectivity in assessing insulin sensitivity than ISI(Ced). Although insulin sensitivity is overestimated when calculated from 3SoGTT, the approach is still valuable for identifying subjects with insulin resistance.
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This chapter contains sections titled: Insulin resistance – definitions and role in the natural history of type 2 diabetes Metabolic syndrome and non - alcoholic fatty liver disease Insulin resistance in the liver Insulin resistance in adipose tissue Insulin resistance in skeletal muscle Resistance to other actions of insulin Conclusions References
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Insulin resistance and compensatory hyperinsulinemia are recognized not only in type 2 diabetes mellitus(DM) but also in essential hypertension(EHT), hyperlipidemia and obesity; these are known as the components of metabolic syndrome and accumulation of these components increase risk of cardiovascular diseases(CVD). When coronary angiographic findings were evaluated in patients with coronary artery disease(CAD), the severity was higher in CAD with DM than that without DM. Even in CAD without DM, the severity of coronary angiographic findings was higher in CAD with insulin resistance than that without insulin resistance. When residents of rural communities in Japan were followed 8 years, the incidence of CVD was 3.5 times higher in subjects with insulin resistance than those without insulin resistance. One of the intracellular signal transduction of insulin receptor; MAP kinase may be concerned atherosclerotic mechanisms of insulin resistance. These findings suggest that insulin resistance is a significant background of atherosclerosis, and insulin resistance is one of the major facilitation factors of genesis and progression of CVD.
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Objective To investigate the characteristics of TCM syndromes and lipid level in patients with insulin resistance of type 2 diabetes.Methods The patients(n=99) with type 2 diabetes were divided into the group of insulin resistance and the group of non-insulin resistance according to insulin resistance index(HOMA-IR).The levels of fasting plasma glucose(FPG),fasting insulin(FINS),total cholesterol(TC) and triglyceride(TG) were detected in two groups respectively.The insulin sensitivity index(ISI) and body mass index(BMI) were calculated and TCM syndromes were determined.Finally the anxious integrals of all patients were judged and compared with those of normal persons.Results The levels of FPG,FINS,TG and BMI all increased and ISI decreased in the group of insulin resistance compared with those in the group of non-insulin resistance.The comparison in TCM syndromes between two groups was not different but there was significantly different in syndrome construction inside the group of insulin resistance.The patients with excess syndrome were less than those with deficient syndrome and those with the syndrome combined deficiency with excess.There was no significant different in syndrome construction inside the group of non-insulin resistance.Conclusion The characteristic of insulin resistance of type 2 diabetes is that the patients with deficiency syndrome is less than those with the syndrome combined deficiency with excess.The insulin resistance of type 2 diabetes is correlated to TG level.
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Polycystic ovary syndrome (PCOS), the commonest endocrinopathy of women in reproductive age, is often accompanied by insulin resistance (IR), hirsutism and/or fertility problems. The aim of the study was to assess the prevalence of IR in women diagnosed with PCOS.The study involved 137 women diagnosed with PCOS, according to the Rotterdam consensus criteria (2003). Insulin resistance was assessed according to the HOMA-IR method and insulin resistance (Belfiore) index (IRI) derived from glucose and insulin during the oral glucose tolerance test.There was a significant (p < 0.0001) but relatively moderate correlation between IRI and HOMA-IR (r = 0.5 and r = 0.57 for a linear and non-linear model, respectively). Insulin resistance was more prevalent according to IRI (49.6%) than according to HOMA-IR (22.6% and 15.8% for 3.46 and 3.8 cut-off points, respectively, p < 0.01). The majority of patients with high HOMA-IR also had high IRI (e.g. 86%, for HOMA > 3.8), but the majority of patients with raised IRI would not be diagnosed as insulin resistant according to HOMA (61.7% and 73.5%, for HOMA-IR3.46 and HOMA-IR3.80, respectively).The insulin resistance (Belfiore) index indicates more cases of insulin resistance than HOMA-IR in women with PCOS. Therefore, detection of insulin resistance among women with PCOS is highly method-dependent with more severe cases being detected with HOMA-IR than with IRI.
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Insulin resistance is associated with nonalcoholic fatty liver disease (NAFLD) and is a major factor in the pathogenesis of type 2 diabetes. The development of hepatic insulin resistance has been ascribed to multiple causes, including inflammation, endoplasmic reticulum (ER) stress, and accumulation of hepatocellular lipids in animal models of NAFLD. However, it is unknown whether these same cellular mechanisms link insulin resistance to hepatic steatosis in humans. To examine the cellular mechanisms that link hepatic steatosis to insulin resistance, we comprehensively assessed each of these pathways by using flash-frozen liver biopsies obtained from 37 obese, nondiabetic individuals and correlating key hepatic and plasma markers of inflammation, ER stress, and lipids with the homeostatic model assessment of insulin resistance index. We found that hepatic diacylglycerol (DAG) content in cytoplasmic lipid droplets was the best predictor of insulin resistance ( R = 0.80, P < 0.001), and it was responsible for 64% of the variability in insulin sensitivity. Hepatic DAG content was also strongly correlated with activation of hepatic PKCε ( R = 0.67, P < 0.001), which impairs insulin signaling. In contrast, there was no significant association between insulin resistance and other putative lipid metabolites or plasma or hepatic markers of inflammation. ER stress markers were only partly correlated with insulin resistance. In conclusion, these data show that hepatic DAG content in lipid droplets is the best predictor of insulin resistance in humans, and they support the hypothesis that NAFLD-associated hepatic insulin resistance is caused by an increase in hepatic DAG content, which results in activation of PKCε.
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The 25th annual European group for the study of insulin resistance (EGIR) was recently held in Pisa, Italy. The discussions centred around the impact of adipose tissue on insulin sensitivity, β-cell function, liver function and cardiovascular health.
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Objective To investigate the occurrence of insulin resistance in Chinese women with polycystic ovary syndrome(PCOS),and the relationship between insulin resistance and metabolic syndrome(MetS).MethodsTotal of 578 PCOS patients were included in this study.Data were collected to analyze the prevalence of insulin resistance and the risk for metabolic syndrome.ResultsThe prevalence of Homeostasis model assessment of(HOMA-IR)75th,fasting insulin(FIN)95th,2h-insulin(2h-INS)150 U/L,raised both FIN and 2h-INS,and hyperinsulinemia(HIN,raised FIN and/or 2h-INS)were 57.4%,23.0%,12.6%,8.5% and 27.2%,respectively in these PCOS patients.There were 40.6% patients with raised FIN suffered from MetS;41.1%with raised 2h-INS;39.5% with hyperinsulinemia(HIN,raised FIN and/or 2h-INS);26.8% with raised HOMA-IR.Compared to the patients with normal HOMA-IR,FIN or 2h-FIN,the risk for suffering from MetS was higher(P0.001).ConclusionsThe prevalence of insulin resistance varied from different criteria.Patients met any criteria for insulin resistance had a greater risk of developing of metabolic syndrome.It is worthy to find out and treat the insulin resistance in PCOS patients.
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OBJECTIVE: Insulin resistance is characterized by the failure of target cells to respond to normal levels of circulating insulin, and this condition is related to cardiovascular disease.This study sought to evaluate the prevalence of insulin resistance and its association with markers of metabolic abnormalities and metabolic syndrome in bank employees.METHODS: A cross-sectional study was performed on 498 working men and women aged X20 years old.The Homeostasis Model Assessment (HOMA-IR) was used to determine the presence of insulin resistance based on cut-off values of p2.71 for normal insulin levels and 42.71 for insulin resistance, as established for the adult Brazilian population.RESULTS: It was observed that the 52 (10.4%) overweight individuals with insulin resistance were 4.97 times (95%CI 1.31-18.83)more likely to have high HOMA-IR values than the normal-weight participants; among those who were obese, the likelihood increased to 17.87 (95%CI 4.36-73.21).Individuals with large waist circumferences were 3.27 times (95%CI 1.03-10.38)more likely to develop insulin resistance than those who were within normal parameters.The HOMA-IR values differed between subjects with and without metabolic syndrome, with values of 2.83±2.5 and 1.10±0.81(p=0.001),respectively.The levels of insulin, ultrasensitive C-reactive protein and uric acid were also associated with insulin resistance.CONCLUSION: The prevalence of insulin resistance among bank employees is high, and insulin resistance is associated with and serves as a marker of metabolic syndrome.Cardiovascular disease and metabolic syndromeassociated metabolic abnormalities were observed, and insulin resistance may be a risk factor in this group of professionals.
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