Abstract
BackgroundInsulin resistance is core cause of metabolic syndrome. Determining insulin resistance is one of the foremost requirements imperative to understanding the pathophysiology of disease. The gold standard “Euglycaemic clamp test” is cumbersome, long and non-feasible in routine clinical setups to diagnose metabolic syndrome. Various continuous and steady state insulin resistance indices are now available in literature. We plan to evaluate commonly utilized steady state insulin resistance indices directly and Homeostasis Model Assessment for Insulin Resistance (HOMAIR) with added triglyceride (HOMA-TG index).MethodsThe cross-sectional study was carried from Jan-2016 to Dec-2018 at PNS HAFEEZ and department of chemical pathology, AFIP with following objectives: (1) To evaluate steady state insulin resistance markers for diagnosing metabolic syndrome as per IDF defined criteria by ROC curve analysis, (2) to measure Kendal Concordance between various insulin resistance indices and (3) to correlate steady state insulin resistance markers with anthropometric and lipid indices. After several exclusions we selected 224 subjects based upon “non-probability convenience sampling” for inclusion in study. Clinical history, anthropometric measures were calculated and sampling was done for insulin, glucose and other biochemical parameters. Metabolic syndrome was diagnosed as per IDF criteria, while HbA1c was utilized to diagnose diabetes mellitus. Pearson correlation was used to correlate various steady state insulin resistance indices including HOMAIR, HOMA2 index, QUICKI, G/I ratio, HOMA-TG index and serum insulin. AUC was calculated by ROC analysis for all surrogate insulin measures in diagnosis of metabolic syndrome.Results“HOMA-TG index” has shown the highest AUC for diagnosing metabolic syndrome along with higher correlation with lipid markers and anthropometric indices in comparison to other steady-state insulin resistance markers. Furthermore, QUICKI and G/I ratio showed the lowest AUC for detection of metabolic syndrome.Conclusion“HOMA-TG index” has shown highest AUC for metabolic syndrome diagnosis. However, QUICKI and G/I ration showed the lowest AUC for detection of metabolic syndrome. It is hoped that the potential “HOMA-TG index” may provide better diagnostic efficiency for diagnosing metabolic syndrome.
Highlights
Insulin resistance is core cause of metabolic syndrome
The disordered metabolic pathways underlying the overall entity are lined with massive morbidity and mortality due to atherosclerotic cardiovascular disease (ASCVD) and other metabolic ailments like polycystic ovarian syndrome (PCOS) and non-alcoholic stetohepatitis (NASH) [5]
We proposed a combine “HOMA-triglyceride index” (HOMATG index) to allow the combined assessment of insulin resistance with triglycerides
Summary
Insulin resistance is core cause of metabolic syndrome. Determining insulin resistance is one of the foremost requirements imperative to understanding the pathophysiology of disease. While the entity seems to omnipresent in every society around the world, still there are no universal criteria defining it [2,3,4] This syndrome definition in general includes certain anthropometric measures and biochemical parameters with a scoring system to label someone as having the disease or otherwise. While there are variable definitions of metabolic syndrome so compelling need is there to develop a definitive biomarker to conclude its presence In this regard the gold standard technique “Euglycaemic clamp test” is considered to be very useful but not feasible and difficult to deploy in busy clinics [6]. There was a clear need established to develop surrogate insulin resistance marker for routine clinical use to identify a biochemical measure to diagnose and monitor subjects with metabolic syndrome [7]
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