Relationship between several surrogate estimates of insulin resistance and quantification of insulin-mediated glucose disposal in 490 healthy nondiabetic volunteers
Relationship between several surrogate estimates of insulin resistance and quantification of insulin-mediated glucose disposal in 490 healthy nondiabetic volunteers
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DOI：
10.2337/diacare.23.2.171
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发表时间：
2000-02-01
期刊：
影响因子：
16.2
通讯作者：
Reaven, GM
中科院分区：
文献类型：
--
作者：
Yeni-Komshian, H;Carantoni, M;Reaven, GM
目的：本研究的目的是确定生理性高胰岛素血症刺激葡萄糖处置能力的定量测量与胰岛素抵抗的几种替代测量之间的关系。研究设计和方法——490名健康的非糖尿病志愿者在连续输注生长抑素、胰岛素和葡萄糖后，通过测定稳态血浆葡萄糖（SSPG）浓度来量化胰岛素介导的葡萄糖处理：因为在输注期间，所有受试者的稳态血浆胰岛素浓度相似（类似于60 μ U/ml）， SSPG浓度提供了胰岛素介导的葡萄糖处理的直接估计。然后定义了这种胰岛素抵抗的特定测量与基于血浆葡萄糖和胰岛素浓度的几种替代胰岛素抵抗估计之间的关系。结果：与直接测定胰岛素作用最密切相关的胰岛素抵抗替代指标是75g口服葡萄糖刺激时的总胰岛素综合反应，相关系数(r)在0.67至0.79之间变化。空腹血浆胰岛素浓度与胰岛素作用特异性估计显著相关（r = 0.61, P < 0.001）。另外两种胰岛素作用的替代评估，空腹血糖与空腹胰岛素浓度的比值和胰岛素抵抗的稳态模型评估，与SSPG的关系并不比空腹血浆胰岛素浓度密切。结论：口服葡萄糖的总胰岛素综合反应是胰岛素抵抗的最佳替代指标，约占胰岛素介导的葡萄糖处理变异性的三分之二。空腹胰岛素浓度约占胰岛素介导的葡萄糖处理变异性的三分之一，使用空腹血浆葡萄糖和胰岛素浓度来计算更复杂的胰岛素抵抗估计似乎比空腹血浆胰岛素浓度提供的优势不大。考虑到本研究中有大量的非糖尿病个体，该结果应该在基于人群的研究中具有普遍的适用性，为这些替代测量方法的实用性和局限性提供证据。
OBJECTIVE - The goal of this study was to define the relationship between a quantitative measure of the ability of physiological hyperinsulinemia to stimulate glucose disposal and several surrogate measures of insulin resistance.RESEARCH DESIGN AND METHODS - insulin-mediated glucose disposal was quantified in 490 healthy nondiabetic volunteers by determining the steady-state plasma glucose (SSPG) concentration in response to a continuous infusion of somatostatin, insulin, and glucose: Because the steady-state plasma insulin concentration was similar in all subjects during the infusion (similar to 60 mu U/ml), the SSPG concentration provided a direct estimate of insulin-mediated glucose disposal. Relationships between this specific measure of insulin resistance and several surrogate estimates of insulin resistance based on plasma glucose and insulin concentrations were then defined.RESULTS - The surrogate measure of insulin resistance most closely related to the direct determination of insulin action was the total integrated insulin response to a 75-g oral glucose challenge with correlation coefficients (r) varying from 0.67 to 0.79. Fasting plasma insulin concentration was significantly correlated (r = 0.61, P < 0.001) to the specific estimate of insulin action. Two other surrogate estimates of insulin action, the ratio of fasting glucose-to-fasting insulin concentration and the homeostasis model assessment for insulin resistance, were no more closely related to SSPG than the fasting plasma insulin concentration.CONCLUSIONS - The total integrated insulin response to oral glucose is the best surrogate measure of insulin resistance, accounting for approximately two-thirds of the variability in insulin-mediated glucose disposal. Fasting insulin concentration accounted for approximately one-third of the variability in insulin-mediated glucose disposal, and the use of fasting plasma glucose and insulin concentrations to calculate more sophisticated estimates of insulin resistance appears to offer little advantage over the fasting plasma insulin concentration. Given the large number of nondiabetic individuals in this study: the results should have general application in population-based studies, providing evidence for both the utility and limitation of the use of these surrogate measures.