2953 A Novel Tool to Estimate Early Insulin Resistance and Prevent Metabolic Syndrome and Non-Alcoholic Fatty Liver Disease: Retrospective Study in the Veteran Population

Abstract

INTRODUCTION: Previous studies such as the Homeostasis Model Assessment (HOMA) IR1 have been validated tools to estimate Insulin resistance and a predictor of metabolic syndrome (MS) and its related co morbidities such as Non-Alcoholic Fatty liver disease (NAFLD) and Cardiovascular disease (CVD). In the current obesity epidemic, we need simple validated tools to help detect early insulin resistance and curb the growing epidemic of NAFLD. Proinsulin was reported once and in patents as a marker of pancreatic exhaustion hence we propose a novel tool which take proinsulin into account to help predict risk of development of fatty liver disease. AIM: To study proinsulin as a predictor of progression to fatty liver disease in non-diabetic veteran population. METHODS: Single center retrospective chart review of 55 patients. Charts from the gastroenterology department at Las Vegas VA clinic were analyzed and data collected including liver enzymes, insulin, proinsulin, fasting blood sugar, HbA1C, albumin and lipid profile levels (Table 1). Using the data provided a logistic regression model was used to identify strong predictors of fatty liver disease. A novel statistical model called the Random Forrest method was also used to identify predictors of fatty liver disease. RESULTS: Using the logistic regression model, proinsulin and ratio of insulin to proinsulin were found to be significant in predicting fatty liver disease. The overall accuracy was 80%, with precision and recall for both categories ranging from 66.67% to 86.49% (Figure 2). When using the Random Forest methodology, factors such as total cholesterol, ALT, pro-insulin, triglycerides, insulin, ratio IP, and glucose were found to be the most important predictors of Fatty Liver disease (Figure 3). CONCLUSION: Early detection of insulin resistance in non-diabetic patient population and can help intervene with medical and dietary or other management to prevent the development and progression of Metabolic syndrome. Our study suggests that proinsulin should be routinely used in at risk patient population for early detection of insulin resistance and prevention of metabolic syndrome and related comorbidities such as NAFLD. Hence pro insulin is a strong predictor of insulin resistance and future prospective studies can help validate proinsulin as a predictor of NAFLD.