Limitations in the Use of Indices Using Glucose and Insulin Levels to Predict Insulin Sensitivity

Abstract

OBJECTIVETo examine the utility of commonly used insulin sensitivity indices in nondiabetic European Americans (EAs) and African Americans (AAs).RESEARCH DESIGN AND METHODSTwo-hundred forty nondiabetic participants were studied. Euglycemic-hyperinsulinemic clamp was the gold standard approach to assess glucose disposal rates (GDR) normalized by lean body mass. The homeostatic model assessment for insulin resistance (HOMA-IR) and the quantitative insulin sensitivity check index (QUICKI) were calculated from fasting plasma glucose and insulin (FIL). Oral glucose tolerance test (OGTT) was performed to determine Matsuda index, the simple index assessing insulin sensitivity (SIisOGTT), Avignon index, and Stomvoll index. Relationships among these indices with GDR were analyzed by multiple regression.RESULTSGDR values were similar in EA and AA subgroups; even so, AA exhibited higher FIL and were insulin-resistant compared with EA, as assessed by HOMA-IR, QUICKI, Matsuda index, SIisOGTT, Avignon index, and Stumvoll index. In the overall study population, GDR was significantly correlated with all studied insulin sensitivity indices (/r/ = 0.381–0.513); however, these indices were not superior to FIL in predicting GDR. Race and gender affected the strength of this relationship. In AA males, FIL and HOMA-IR were not correlated with GDR. In contrast, Matsuda index and SIisOGTT were significantly correlated with GDR in AA males, and Matsuda index was superior to HOMA-IR and QUICKI in AAs overall.CONCLUSIONSInsulin sensitivity indices based on glucose and insulin levels should be used cautiously as measures of peripheral insulin sensitivity when comparing mixed gender and mixed race populations. Matsuda index and SIisOGTT are reliable in studies that include AA males.

Insulin Sensitivity and Albuminuria: The RISC Study

“…These inconsistent associations may reflect differences or advantages of the gold standard method for assessment of insulin sensitivity, the hyperinsulinemiceuglycemic clamp technique, in comparison with indirect measures such as OGIS or HOMA-IR (28,29). In particular HOMA-IR is considered a poor measure of peripheral insulin sensitivity as shown by Pisprasert et al (36).…”

Inflammatory adipokines contribute to insulin resistance in active acromegaly and respond differently to different treatment modalities

“…HOMA-IR is derived from fasting glucose and insulin levels and reflects primarily basal hepatic insulin sensitivity (24). By contrast, the hyperinsulinemic clamp reflects insulin-stimulated glucose disposal predominantly into skeletal muscle (35). It is therefore likely that four weeks' treatment with PGV mainly improved insulin sensitivity in the skeletal muscle (21).…”

Homeostastic Model Assessment and Insulin Sensitivity/Resistance

“…HOMA-S I /IR have been widely applied, often in large-scale population studies, and frequently compared with other methods of S I determination. Largely, they correlate with more detailed indices of S I (clamp, IVGTT) (11)(12)(13)(14) and in some longitudinal studies (15,16), but less so in others (17), and not as well in some populations such as African American men (18) and Asian-Indian men that include a preponderance of lean diabetic patients (19). In animal models, mice (20) and rats (21) do not do so well with HOMA, but rhesus monkeys do better (22).…”