Insulin sensitivity indices obtained from oral glucose tolerance testing - Comparison with the euglycemic insulin clamp
Insulin sensitivity indices obtained from oral glucose tolerance testing - Comparison with the euglycemic insulin clamp
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DOI：
10.2337/diacare.22.9.1462
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发表时间：
1999-09-01
期刊：
影响因子：
16.2
通讯作者：
DeFronzo, RA
中科院分区：
文献类型：
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作者：
Matsuda, M;DeFronzo, RA
目的-几种方法已被提出来评估从口服葡萄糖耐量试验（OGTT）获得的数据的胰岛素敏感性。然而，这些指标的有效性还没有得到严格的评价，通过比较它们与正常血糖胰岛素钳夹技术获得的胰岛素敏感性的直接测量。在这项研究中，我们比较了各种胰岛素敏感性指数来自OGTT与全身胰岛素敏感性测量的正葡萄糖胰岛素钳夹技术。（66名男性和87名女性，年龄18-71岁，BMI 20-65 kg/m2），具有不同程度的葡萄糖耐量（62名葡萄糖耐量正常受试者，31名葡萄糖耐量受损受试者和60名2型糖尿病受试者）进行了研究。在禁食10小时过夜后，所有受试者随机接受75 g OGTT和正常血糖胰岛素钳夹试验，并输注[3（-3）H]葡萄糖。结果：OGTT时平均血浆葡萄糖浓度除以平均血浆胰岛素浓度与正常葡萄糖胰岛素钳夹时全身葡萄糖代谢率无相关性（r =-0.02，NS）。根据OGTT，我们开发了一个全身胰岛素敏感性指数（10，000/[空腹葡萄糖X空腹胰岛素] X [OGTT期间平均葡萄糖X平均胰岛素]的平方根），其高度相关（r = 0.73，P < 0.0001）与正常血糖胰岛素钳夹期间全身葡萄糖处置率的关系。用于从OGTT导出胰岛素敏感性指数的先前方法依赖于OGTT期间血浆葡萄糖与胰岛素浓度的比率。我们的研究结果证明了这种方法的局限性。我们已经推导出一种新的胰岛素敏感性的估计值，该估计值计算简单，并且提供了来自OGTT的全身胰岛素敏感性的合理近似值。
OBJECTIVE - Several methods have been proposed to evaluate insulin sensitivity from the data obtained from the oral glucose tolerance test (OGTT). However, the validity of these indices has not been rigorously evaluated by comparing them with the direct measurement of insulin sensitivity obtained with the euglycemic insulin clamp technique. In this study, we compare various insulin sensitivity indices derived from the OGTT with whole-body insulin sensitivity measured by the euglycemic insulin clamp technique.RESEARCH DESIGN AND METHODS- In this study, 153 subjects (66 men and 87 women, aged 18-71 years, BMI 20-65 kg/m(2)) with varying degrees of glucose tolerance (62 subjects with normal glucose tolerance, 31 subjects with impaired glucose tolerance, and 60 subjects with type 2 diabetes) were studied. After a 10-h overnight fast, all subjects underwent, in random order, a 75-g OGTT and a euglycemic insulin clamp, which was performed with the infusion of [3(-3)H]glucose. The indices of insulin sensitivity derived from OGTT data and the euglycemic insulin clamp were compared by correlation analysis.RESULTS - The mean plasma glucose concentration divided by the mean plasma insulin concentration during the OGTT displayed no correlation with the rate of whole-body glucose disposal during the euglycemic insulin clamp (r = -0.02, NS). From the OGTT, we developed an index of whole-body insulin sensitivity (10,000/square root of [fasting glucose X fasting insulin] X [mean glucose X mean insulin during OGTT]), which is highly correlated (r = 0.73, P < 0.0001) with the rate of whole-body glucose disposal during the euglycemic insulin clamp.CONCLUSIONS - Previous methods used to derive an index of insulin sensitivity from the OGTT have relied on the ratio of plasma glucose to insulin concentration during the OGTT. Our results demonstrate the limitations of such an approach. We have derived a novel estimate of insulin sensitivity that is simple to calculate and provides a reasonable approximation of whole-body insulin sensitivity from the OGTT.