Abstract
BackgroundWe developed a simple and new insulin resistance index derived from a glucose clamp and a meal tolerance test (MTT) in Japanese patients with type 2 diabetes mellitus.MethodsFifteen patients [mean age: 53 years, fasting plasma glucose (FPG) 7.7 mmol/L, HbA1c 7.1% (54 mmol/mol), body mass index 26.8 kg/m2] underwent a MTT and a glucose clamp. Participants were given a test meal (450 kcal). Plasma glucose and insulin were measured at 0 (fasting), 30, 60, 120, and 180 min. Serum C-peptide immunoreactivity (CPR) was measured at 0 (fasting; F-CPR) and 120 min. Homeostasis model assessment of insulin resistance (HOMA-IR) and insulin sensitivity indices (ISI) were calculated from the MTT results. The glucose infusion rate (GIR) was measured during hyperinsulinemic–euglycemic glucose clamps.ResultsThe mean GIR in all patients was 5.8 mg·kg–1·min–1. The index 20/(F-CPR × FPG) was correlated strongly with GIR (r = 0.83, P < 0.0005). HOMA-IR (r = −0.74, P < 0.005) and ISI (r = 0.66, P < 0.01) were also correlated with GIR. In 10 patients with mild insulin resistance (GIR 5.0–10.0 mg·kg–1·min–1), 20/(F-CPR × FPG) was very strongly correlated with GIR (r = 0.90, P < 0.0005), but not with HOMA-IR and ISI (r = −0.49, P = 0.15; r = 0.20, P = 0.56, respectively). In patients with mild insulin resistance, plasma adiponectin (r = 0.65, P < 0.05), but not BMI or waist circumstance, was correlated with GIR.Conclusions20/(F-CPR × FPG) is a simple and effective index of insulin resistance, and performs better than HOMA-IR and ISI in Japanese patients with type 2 diabetes mellitus. Our results suggest that 20/(F-CPR × FPG) is a more effective index than HOMA-IR in Japanese patients with mild insulin resistance.
Highlights
We developed a simple and new insulin resistance index derived from a glucose clamp and a meal tolerance test (MTT) in Japanese patients with type 2 diabetes mellitus
We tested various indices based on glucose, insulin, and Cpeptide levels, the correlation was strongest between glucose infusion rate (GIR) and 20/(F-C-peptide immunoreactivity (CPR) × fasting plasma glucose (FPG))
This study revealed that the index 20/(F-CPR × FPG) was more strongly correlated with GIR than were homeostasis model assessment of insulin resistance (HOMA-IR), quantitative insulin sensitivity check index (QUICKI), insulin sensitivity indices (ISI), and C-peptide index (CPI)
Summary
We developed a simple and new insulin resistance index derived from a glucose clamp and a meal tolerance test (MTT) in Japanese patients with type 2 diabetes mellitus. The insulin sensitivity index (ISI, Matsuda–DeFronzo index) is an index of insulin resistance obtained from the glucose clamp technique and a 75-g oral glucose tolerance test (OGTT) [3]. The validity of HOMA-IR may be limited in some patients, those with a low BMI, decreased β cell function, and high fasting glucose levels, which are quite common in lean Korean patients with type 2 diabetes mellitus and insulin secretory defects, for example [5]. The correlation between QUICKI and glucose clamp data is lower in nonobese subjects without diabetes than in obese subjects or patients with type 2 diabetes mellitus [8]
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