Development, validation and use of an insulin sensitivity score in youths with diabetes: the SEARCH for Diabetes in Youth study.
Development, validation and use of an insulin sensitivity score in youths with diabetes: the SEARCH for Diabetes in Youth study.
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DOI：
10.1007/s00125-010-1911-9
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发表时间：
2011-01
期刊：
影响因子：
8.2
通讯作者：
Nadeau K
中科院分区：
文献类型：
--
作者：
Dabelea D;D'Agostino RB Jr;Mason CC;West N;Hamman RF;Mayer-Davis EJ;Maahs D;Klingensmith G;Knowler WC;Nadeau K
测量整个糖尿病表型谱的胰岛素敏感性的能力可能有助于更准确地表征糖尿病类型。我们的目标是在参与美国科罗拉多州 SEARCH 研究的 12 至 19 岁糖尿病青少年子集 (n=85) 中使用正常血糖-高胰岛素钳夹来开发和验证胰岛素敏感性 (IS) 评分。诊断为 1 型糖尿病 (n=60) 或 2 型糖尿病 (n=25) 的青少年接受 3 小时钳夹测量葡萄糖处理率 (GDR，mg kg−1 min−1)。人口统计（年龄、性别、种族）、临床（BMI、腰围、Tanner 分期）和代谢特征（HbA1c、血脂、血压、尿白蛋白：肌酐）用于通过模型开发集 (n=53) 的逐步线性回归来估计 logeIS 评分。在两个验证集上评估了估计 IS 分数的再现性：患有糖尿病的青少年 (n=33) 和健康对照青少年 (n=22)。最佳模型包括腰围、三酰甘油 (TG) 和 HbA1c 水平 (R2=0.74)。糖尿病类型未进入模型，糖尿病类型与其他预测因子之间没有显着的相互作用。估计的 IS 分数与两个验证集上的 GDR 相关性良好（r=0.65，p<0.0001；r=0.62，p=0.002）。基于此分析，我们提出以下公式来估计青少年糖尿病患者的胰岛素敏感性：logeIS = 4.64725 – 0.02032（腰围，cm） – 0.09779（HbA1c，%） – 0.00235（TG，mg/dl；将TG值从mmol/l转换为mg/dl，除以0.0113）。可以使用常规收集的测量值来估计患有糖尿病的青少年的胰岛素敏感性。该分数可应用于青少年糖尿病的流行病学研究，以表征糖尿病类型维度之间的关系。
The ability to measure insulin sensitivity across the phenotypic spectrum of diabetes may contribute to a more accurate characterisation of diabetes type. Our goal was to develop and validate an insulin sensitivity (IS) score using the euglycaemic–hyperinsulinaemic clamp in a subset (n=85) of 12– to 19-year-old youths with diabetes participating in the SEARCH study in Colorado, USA. Youths with a diagnosis of type 1 (n=60) or type 2 diabetes (n=25) underwent a 3 h clamp to measure glucose disposal rate (GDR, mg kg−1 min−1). Demographic (age, sex, race), clinical (BMI, waist, Tanner stage) and metabolic characteristics (HbA1c, lipids, blood pressure, urine albumin:creatinine) were used to estimate logeIS score via stepwise linear regression on a model- development set (n=53). Estimated IS score was evaluated for reproducibility on two validation sets: youths with diabetes (n=33) and healthy control youths (n=22). The best model included waist, triacylglycerol (TG) and HbA1c levels (R2=0.74). Diabetes type did not enter the model and there were no significant interactions between diabetes type and other predictors. Estimated IS score correlated well (r=0.65, p<0.0001; r=0.62, p=0.002) with GDR on the two validation sets. Based on this analysis, we propose the following formula to estimate insulin sensitivity in youths with diabetes: logeIS = 4.64725 – 0.02032 (waist, cm) – 0.09779 (HbA1c, %) – 0.00235 (TG, mg/dl;to convert TG values from mmol/l to mg/dl, divide by 0.0113). Insulin sensitivity can be estimated in adolescents with diabetes using routinely collected measures. This score can be applied to epidemiological studies of youths with diabetes to characterise relationships between dimensions of diabetes type.