Diagnosing Insulin Resistance in the General Population

McAuley, Kirsten A.; Williams, Sheila; Mann, Jim; Walker, Robert J.; Lewis‐Barned, Nick; Temple, Lara; Duncan, Ashley

doi:10.2337/diacare.24.3.460

Cited by 631 publications

(545 citation statements)

References 20 publications

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“…This index performed better than other surrogates (including fasting insulin, HOMA‐IR, insulin‐to‐glucose ratio, and the Bennett index) in predicting IR in normoglycemic individuals in New Zealand, with a specificity of 0.91 and a sensitivity of 0.75 10. In addition, there is evidence from a number of studies that increased triglyceride levels are an additional causal risk factor for CVD 33, 34, 35.…”

Section: Discussionmentioning

confidence: 90%

Sex Differences in the Association Between Insulin Resistance and Incident Coronary Heart Disease and Stroke Among Blacks Without Diabetes Mellitus: The Jackson Heart Study

Effoe

Wagenknecht

Tcheugui

et al. 2017

JAHA

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BackgroundStudies exploring the association between insulin resistance (IR) and cardiovascular disease in blacks have not been conclusive, especially for coronary heart disease (CHD). The McAuley index and homeostasis model assessment of IR (HOMA‐IR) perform differently in predicting cardiovascular disease. We investigated this association in the Jackson Heart Study, a large longitudinal cohort of blacks.Methods and Results IR was estimated for 3565 participants without diabetes mellitus and cardiovascular disease at baseline using the McAuley index and HOMA‐IR, and their associations with incident CHD and stroke (composite outcome) were compared. A lower McAuley index and higher HOMA‐IR are indicative of IR. Cox regression analysis was used to estimate adjusted hazard ratios for incident CHD and/or stroke. There were 158 events (89 CHD‐only, 58 stroke‐only, and 11 CHD/stroke) over a median follow‐up of 8.4 years. After adjustment for demographic factors, the risk of the composite outcome decreased with each SD increase in the McAuley index (hazard ratio 0.80; 95% CI: 0.67–0.96), with no attenuation after further accounting for CHD and stroke risk factors. When considered individually, McAuley index and HOMA‐IR were associated with CHD (hazard ratio 0.71, 95% CI: 0.55–0.92 and hazard ratio 1.33, 95% CI: 1.03–1.72, respectively), but not stroke risk. The logHOMA‐IR and CHD association was present in men, but not in women (P interaction=0.01).ConclusionsBoth HOMA‐IR and the McAuley index demonstrate strong associations with CHD but not stroke risk in blacks. The logHOMA‐IR and CHD association was present in men, but not in women.

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Section: Discussionmentioning

confidence: 90%

Sex Differences in the Association Between Insulin Resistance and Incident Coronary Heart Disease and Stroke Among Blacks Without Diabetes Mellitus: The Jackson Heart Study

Effoe

Wagenknecht

Tcheugui

et al. 2017

JAHA

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“…29 In one study on the effect of cis-9, trans-11 isomer of CLA in obese men with metabolic syndrome mean values of M/I of 4.2-4.3 M mU À1 l (corrected for bw) were measured, 20 which is lower than corresponding values in the present study. Consequently, few subjects were categorized as being insulin resistant according to cutoff values, which have been suggested for M (Mo28 mmol min À1 lbm À1 ; Stern et al 24 ), for M/I (M/Ip6.3 M mU À1 l; McAuley et al 25 ) and for HOMA (HOMA44.65; Stern et al 24 ). The distribution of M, M/I or HOMA did not change significantly during the 6 months of treatment and no pattern of change in insulin resistance status for CLA-or placebo-supplemented subject was seen.…”

Section: Discussionmentioning

confidence: 99%

“…There was no significant change for M/I adjusted for lbm either within or between treatment groups in the sample that completed two clamps (n ¼ 35) ( Table 2). Using published suggestions for insulin resistance based on M/I adjusted for lbm, 25 four subjects at baseline and three subjects receiving CLA and two receiving placebo at 6 months were categorized as insulin resistant.…”

Section: Clamp Studiesmentioning

confidence: 99%

The effect of 6 months supplementation with conjugated linoleic acid on insulin resistance in overweight and obese

Syvertsen¹,

Halse²,

Ho³

et al. 2006

Int J Obes

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Background: Contradicting results have been published regarding the effect of conjugated linoleic acid (CLA) on insulin resistance. However, only a few studies have used the euglycemic hyperinsulinemic clamp method, which is considered the standard for measuring insulin resistance. Objective: To evaluate if CLA as a mixture of the main isomers trans-10 cis-12 and cis-9 trans-11 affects the insulin resistance in healthy overweight and obese male and female adults. Design: The main study was a randomized, double-blind, placebo-controlled trial with change in body composition as primary end point comprising 118 subjects receiving supplementation with either placebo (olive oil) or CLA (Clarinol) for 6 months. A sub-population of 49 subjects agreed additionally to participate in an euglycemic hyperinsulinemic clamp study at baseline and after 6 months of supplementation with study drug. The primary outcome was the change in glucose uptake (M) as measured by the hyperinsulinemic euglycemic glucose clamp method. Secondary outcomes were the correlates between insulin resistance and changes in body composition or blood chemistry parameters. Forty-one subjects completed the clamp test at both time points. Results: The median M of the CLA group was 11.0 mg min À1 lean body mass (lbm) À1 (n ¼ 24) at baseline, 10.3 mg min À1 lbm À1 (n ¼ 24) after 6 months, and the median difference was þ 0.21 mg min À1 lbm À1 (n ¼ 24). The median M of placebo group was 8.4 mg min À1 lbm À1 at baseline and 9.3 mg min À1 lbm À1 after 6 months and the median difference was À0.22 mg min À1 lbm À1 (n ¼ 17). No significant (Po0.05) differences were found within groups or between groups. Likewise, the glucose uptake insulin concentration ratio during clamp (M/I) was independent of treatment and time. Homeostasis model assessment (HOMA) and quantitative insulin sensitivity check index derived from fasting glucose and insulin were also independent of treatment and time, and HOMA for the clamp population (n ¼ 49) corresponded well with HOMA for the per protocol population (n ¼ 83). Correlation analysis showed that changes in M were inversely correlated to changes in glucohemoglobin (P ¼ 0.002), but did not correlate with changes in either glucose, insulin, insulin c-peptide, leptin, adiponectin or percent body fat. Conclusions: CLA does not affect glucose metabolism or insulin sensitivity in a population of overweight or obese volunteers.

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“…15 Other surrogate methods, including fasting insulin, 16 Bennetts index 17 and the insulin-to-glucose ratio, 18 also demonstrate good concordance with values obtained using the more invasive techniques. [19][20][21] The recently developed quantitative insulin-sensitivity check index (QUICKI), 22 which takes the product of both the reciprocal and the logarithm of fasted insulin and glucose concentrations, gives values that correlate well with the glucose-clamp and minimal model techniques and may provide a better surrogate measure of insulin resistance compared to HOMA IR. 22 The revised version of QUICKI (revised QUICKI) 23 that incorporates a value for fasting nonesterified fatty acids (NEFA) into the QUICKI formula is reported to have a stronger relationship with the glucose clamp than QUICKI alone and therefore may provide an adequate substitute for more sophisticated measures of insulin sensitivity.…”

Section: Introductionmentioning

confidence: 99%

Revised QUICKI provides a strong surrogate estimate of insulin sensitivity when compared with the minimal model

et al. 2004

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OBJECTIVE:To compare insulin sensitivity (Si) from a frequently sampled intravenous glucose tolerance test (FSIGT) and subsequent minimal model analyses with surrogate measures of insulin sensitivity and resistance and to compare features of the metabolic syndrome between Caucasians and Indian Asians living in the UK. SUBJECTS: In all, 27 healthy male volunteers (14 UK Caucasians and 13 UK Indian Asians), with a mean age of 51.271.5 y, BMI of 25.870.6 kg/m 2 and Si of 2.8570.37. MEASUREMENTS: Si was determined from an FSIGT with subsequent minimal model analysis. The concentrations of insulin, glucose and nonesterified fatty acids (NEFA) were analysed in fasting plasma and used to calculate surrogate measure of insulin sensitivity (quantitative insulin sensitivity check index (QUICKI), revised QUICKI) and resistance (homeostasis for insulin resistance (HOMA IR), fasting insulin resistance index (FIRI), Bennetts index, fasting insulin, insulin-to-glucose ratio). Plasma concentrations of triacylglycerol (TAG), total cholesterol, high density cholesterol, (HDL-C) and low density cholesterol, (LDL-C) were also measured in the fasted state. Anthropometric measurements were conducted to determine body-fat distribution. RESULTS: Correlation analysis identified the strongest relationship between Si and the revised QUICKI (r ¼ 0.67; P ¼ 0.000). Significant associations were also observed between Si and QUICKI (r ¼ 0.51; P ¼ 0.007), HOMA IR (r ¼ À0.50; P ¼ 0.009), FIRI and fasting insulin. The Indian Asian group had lower HDL-C (P ¼ 0.001), a higher waist-hip ratio (P ¼ 0.01) and were significantly less insulin sensitive (Si) than the Caucasian group (P ¼ 0.02). CONCLUSION:The revised QUICKI demonstrated a statistically strong relationship with the minimal model. However, it was unable to differentiate between insulin-sensitive and -resistant groups in this study. Future larger studies in population groups with varying degrees of insulin sensitivity are recommended to investigate the general applicability of the revised QUICKI surrogate technique.

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Diagnosing Insulin Resistance in the General Population

Abstract: A weighted combination of two routine laboratory measurements, i.e., fasting insulin and triglycerides, provides a simple means of screening for insulin resistance in the general population.

Cited by 631 publications

References 20 publications

Sex Differences in the Association Between Insulin Resistance and Incident Coronary Heart Disease and Stroke Among Blacks Without Diabetes Mellitus: The Jackson Heart Study

Sex Differences in the Association Between Insulin Resistance and Incident Coronary Heart Disease and Stroke Among Blacks Without Diabetes Mellitus: The Jackson Heart Study

The effect of 6 months supplementation with conjugated linoleic acid on insulin resistance in overweight and obese

Revised QUICKI provides a strong surrogate estimate of insulin sensitivity when compared with the minimal model

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