Fasting and OGTT-derived Measures of Insulin Resistance as Compared With the Euglycemic-Hyperinsulinemic Clamp in Nondiabetic Finnish Offspring of Type 2 Diabetic Individuals
Fasting and OGTT-derived Measures of Insulin Resistance as Compared With the Euglycemic-Hyperinsulinemic Clamp in Nondiabetic Finnish Offspring of Type 2 Diabetic Individuals
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DOI：
10.1210/jc.2014-2299
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发表时间：
2015-02-01
影响因子：
5.8
通讯作者：
Laakso, Markku
中科院分区：
文献类型：
--
作者：
Lorenzo, Carlos;Haffner, Steven M.;Laakso, Markku
目的：我们评估了松田胰岛素敏感性指数(ISI)对胰岛素抵抗稳态模型评估(HOMA-IR)检测胰岛素抵抗的增量价值。设计和地点：这是一项对EUGENE2 Kuopio队列的横断面分析。参与者：参与者包括266名2型糖尿病患者(年龄24-50岁)的非糖尿病芬兰人后代。主要观察指标：胰岛素抵抗(最低全身葡萄糖摄取四分位数)通过正血糖-高胰岛素钳夹来测量。我们使用了接收器工作特性曲线下面积，这是一种不敏感的方法来改进模型。通过净重分类改进和综合辨别改进来评估重分类。我们以发生胰岛素抵抗的概率分别为0.05、0.25和0.70作为切入点，生成了四个层级。结果：松田ISI在0、30、60、90、120min 5个时间点的受试者工作特征曲线下面积与HOMA-IR的受试者工作特征曲线下面积(0.897和0.875，P=0.080)无统计学差异。然而，松田ISI增加了HOMA-IR在检测胰岛素抵抗个体方面的增量价值(净重新分类改进，26.2%，P<；.001；综合辨别改进，6.3%，P<；.001)。以0、30、60、120分钟4个时间点为基础的改良松田ISI检测结果相似。结论：松田ISI在检测胰岛素抵抗方面具有超出HOMA-IR能力的额外价值。松田ISI对26%的个人进行了更恰当的重新分类。
Context: It remains to be established which surrogate marker is the most predictive of insulin resistance.Objective: We evaluated the incremental value of the Matsuda insulin sensitivity index (ISI) to homeostasis model assessment of insulin resistance (HOMA-IR) for detecting insulin resistance.Design and Setting: This was a cross-sectional analysis of the EUGENE2 Kuopio cohort.Participants: Participants included 266 nondiabetic Finnish offspring of type 2 diabetic individuals (aged 24-50 years).Main Outcome Measures: Insulin resistance (the lowest whole-body glucose uptake quartile) was measured by the euglycemic-hyperinsulinemic clamp. We used the area under the receiver operating characteristic curve, an insensitive method to model improvement. Reclassification was assessed by the net reclassification improvement and integrated discrimination improvement. We generated four strata using, as cut points, the 0.05, 0.25, and 0.70 probabilities of having insulin resistance. These were observed probabilities at body mass index of 20, 27, and 35 kg/m(2), respectively.Results: The area under the receiver operating characteristic curve of the Matsuda ISI based on 5 time points (0, 30, 60, 90, and 120 minutes) did not differ statistically from that of HOMA-IR (0.897 and 0.875, P = .080). However, the Matsuda ISI added incremental value to HOMA-IR for the detection of insulin-resistant individuals (net reclassification improvement, 26.2%, P < .001; integrated discrimination improvement, 6.3%, P < .001). A modified Matsuda ISI based on 4 time points (0, 30, 60, and 120 minutes) yielded similar results.Conclusion: The Matsuda ISI has additional value for the detection of insulin resistance beyond the ability of HOMA-IR. The Matsuda ISI reclassifies a net of 26% of individuals more appropriately.