Effect of obesity on insulin resistance in normal subjects and patients with NIDDM

Ludvik, Bernhard; Nolan, JJ; Baloga, J; Sacks, David B.; Olefsky, Jerrold M.

doi:10.2337/diabetes.44.9.1121

Cited by 69 publications

(58 citation statements)

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“…Therefore, it is in good accordance that in the tree restricted to parameters derived from the medical history and clinical examination, BMI was the most important discriminator. Although BMI is well correlated to the degree of insulin resistance in general [47], it is, however, known that insulin resistance is not only observed in obese PCOS women but also occurs in a substantial proportion of lean PCOS patients as reported by us [29] and others [48]. It is therefore of no surprise that the decision tree which used the unrestricted dataset, including more direct parameters and indices of insulin resistance and altered beta cell function, was superior, and did not include BMI.…”

Section: Discussionmentioning

confidence: 99%

Predicting impaired glucose metabolism in women with polycystic ovary syndrome by decision tree modelling

et al. 2006

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Aims/hypothesis Polycystic ovary syndrome (PCOS) is a risk factor of type 2 diabetes. Screening for impaired glucose metabolism (IGM) with an OGTT has been recommended, but this is relatively time-consuming and inconvenient. Thus, a strategy that could minimise the need for an OGTT would be beneficial. Materials and methods Consecutive PCOS patients (n=118) with fasting glucose <6.1 mmol/l were included in the study. Parameters derived from medical history, clinical examination and fasting blood samples were assessed by decision tree modelling for their ability to discriminate women with IGM (2-h OGTT value ≥7.8 mmol/l) from those with NGT. Results According to the OGTT results, 93 PCOS women had NGT and 25 had IGM. The best decision tree consisted of HOMA-IR, the proinsulin:insulin ratio, proinsulin, 17-OH progesterone and the ratio of luteinising hormone: follicle-stimulating hormone. This tree identified 69 women with NGT. The remaining 49 women included all women with IGM (100% sensitivity, 74% specificity to detect IGM). Pruning this tree to three levels still identified 53 women with NGT (100% sensitivity, 57% specificity to detect IGM). Restricting the data matrix used for tree modelling to medical history and clinical parameters produced a tree using BMI, waist circumference and WHR. Pruning this tree to two levels separated 27 women with NGT (100% sensitivity, 29% specificity to detect IGM). The validity of both trees was tested by a leave-10%-out cross-validation. Conclusions/interpretation Decision trees are useful tools for separating PCOS women with NGT from those with IGM. They can be used for stratifying the metabolic screening of PCOS women, whereby the number of OGTTs can be markedly reduced.

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Section: Discussionmentioning

confidence: 99%

Predicting impaired glucose metabolism in women with polycystic ovary syndrome by decision tree modelling

et al. 2006

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“…The mean glucose infusion rate between 80 and 120 min after commencement of the insulin infusion was calculated. The glucose disposal rate was calculated after correction for residual hepatic glucose production using the [6,6-2 H 2 ]glucose tracer [21][22][23].…”

Section: Hyperinsulinaemic-euglycaemic Clamp Studymentioning

confidence: 99%

Early-onset type 2 diabetes in obese white subjects is characterised by a marked defect in beta cell insulin secretion, severe insulin resistance and a lack of response to aerobic exercise training

et al. 2007

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Aims/hypothesis Early-onset type 2 diabetes is associated with marked visceral obesity and extreme insulin resistance, but its pathogenesis and response to treatment are not completely understood. We studied physical fitness, wholebody and hepatic glucose turnover, and insulin secretion in young obese Irish subjects before and after 3 months of aerobic exercise training. We hypothesised that exercise alone, with stable diet, should improve insulin sensitivity. Materials and methods Anthropometric parameters and maximum volume of oxygen utilisation (VO 2max ) were measured in 13 subjects with type 2 diabetes and 18 nondiabetic control subjects, matched for age and BMI. Insulin sensitivity and hepatic glucose turnover were measured using the hyperinsulinaemic-euglycaemic clamp. Insulin secretion was assessed from an OGTT and a modified intravenous glucose tolerance test. Some subjects (seven type 2 diabetic, 14 non-diabetic control subjects) then completed a 12-week supervised aerobic exercise programme. All measurements were repeated on completion of the exercise programme. Results Type 2 diabetic subjects had higher WHR, systolic blood pressure and triacylglycerols than non-diabetic control subjects. They were significantly more insulinresistant as measured both by the clamp and oral glucose insulin sensitivity. They also displayed marked defects in insulin secretion in response to oral and intravenous glucose challenges. Exercise intervention had no significant effect on whole-body or hepatic insulin sensitivity or insulin secretion. VO 2max increased significantly in the non-diabetic control subjects, but not in the type 2 diabetic subjects after exercise training. Conclusions/interpretation Young obese subjects with type 2 diabetes are severely insulin-resistant with marked loss of beta cell function compared with control subjects matched for age and obesity. Neither group responded metabolically to aerobic exercise intervention.

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“…When the cut-off point of fasting insulin level for insulin resistance was accepted as 13 mU/mL according to Ludvig et al [9], the proportion of insulin resistance was 53 % in IH group.…”

Section: Fasting Insulinmentioning

confidence: 99%

Evaluation of various insulin sensitivity indices in lean idiopathic hirsutism patients

2012

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Hirsutism is characterized by excessive growth of terminal hair in a male pattern. Excessive hair growth in the absence of demonstrable androgen excess in ovulatory women is also referred to as idiopathic hirsutism (IH). IH is diagnosed in women who have hirsutism, normal ovulatory function and normal total or free testosterone levels. IH is a common cause of hirsutism. IH is not associated with any sign of virilization. Its cause is not understood completely. It has been proposed that women with IH have significantly increased cutaneous 5α-reductase activity. The presence or absence of such an association is not clear [1].Polycystic ovary syndrome (PCOS), another cause of hirsutism, is an insulin resistance related syndrome. Abstract. Hirsutism is characterized by excessive growth of terminal hair in a male pattern. Idiopathic hirsutism (IH) is a common cause of hirsutism. Since there are few data demonstrating IH is associated with insulin resistance, we tried to assess various insulin sensitivity indices in lean IH and compare with healthy subjects. A cross-sectional study was performed in 71 lean (BMI between 20-25 kg/m 2 ) women (17-39 years old), 31 with IH and 40 healthy individuals. Blood glucose, insulin, homeostasis model assessment of insulin resistance (HOMA-IR), hepatic insulin sensitivity (ISI HOMA ), Quicky index, reciprocal fasting insulin resistance index, fasting Belfiore index, and fasting glucose/insulin ratio (GIR) were estimated using a single fasting sample of glucose and insulin levels. Raynaud indices calculated using the mathematical estimation in a single fasting sample of insulin levels were determined and compared in two groups. Fasting insulin, Raynaud index, HOMA-IR and Fasting insulin resistance index (FIRI) results were higher in IH group than in controls (p<0.01, for all). Fasting Belfiore index, QUICKI index, ISI HOMA and FIRI -1 results were lower in IH group than in controls (p<0.01, for all). Our study showed that lean IH patients were more insulin resistant than healthy subjects. We propose that insulin sensitivity indices are useful methods for measuring insulin resistance in IH.Key words: Idiopathic hirsutism, Insulin resistance, Lean patients, Insulin sensitivity indices insulin resistance. There are few data demonstrating IH is associated with insulin resistance. Since the pathogenesis of IH is still unclear, we tried to assess various insulin sensitivity indices in lean IH and compare with healthy subjects. materials and methodsA cross-sectional study was performed in 71 lean (BMI between 20-25 kg/m 2 ) women (17-39 years old), 31 with IH and 40 healthy individuals. The protocol was approved by the hospital-based ethics committee. The protocol of the study was explained to all of the subjects. Informed consent was obtained before beginning the study.None of the control subjects had ovarian dysfunction, hirsutism, or hyperandrogenemia. The diagnosis of IH was based on the presence of hirsutism (modified Ferriman-Gallwey score, >8) [2], regular ovulatory menstrual cycles...

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Effect of obesity on insulin resistance in normal subjects and patients with NIDDM

Cited by 69 publications

References 0 publications

Predicting impaired glucose metabolism in women with polycystic ovary syndrome by decision tree modelling

Predicting impaired glucose metabolism in women with polycystic ovary syndrome by decision tree modelling

Early-onset type 2 diabetes in obese white subjects is characterised by a marked defect in beta cell insulin secretion, severe insulin resistance and a lack of response to aerobic exercise training

Evaluation of various insulin sensitivity indices in lean idiopathic hirsutism patients

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