Validity assessment of the single-point insulin sensitivity estimator (spise) for diagnosis of cardiometabolic risk in post-pubertal hispanic adolescents

Abstract

insulin measurements are not advised for cardiometabolic risk screening in large groups. Here we assessed the accuracy of the single-point insulin sensitivity estimator (SpiSe) to diagnose cardiometabolic risk in Chilean adolescents. In 678 post-pubertal adolescents (52% males, M(SD) age = 16.8 (0.2) years), height, weight, waist circumference, blood lipids, glucose, insulin, and blood pressure were measured. BMI, HOMA-IR, and SPISE were estimated; HOMA-IR values ≥ 2.6 were considered insulin resistance (IR). Metabolic syndrome (MetS) was defined with the joint IDF/AHA/ nHBLi standard. Using receiver operating characteristic curves, we obtained optimal SpiSe cutpoints for IR and MetS diagnosis. The prevalence of MetS and IR was 8.2% and 17.1%, respectively. In males, the optimal cutoff for MetS diagnosis was 5.0 (sensitivity: 97%; specificity: 82%), and the optimal cutoff for IR diagnosis was 5.9 (sensitivity: 71%; specificity: 83%). In females, a SPISE of 6.0 had the highest sensitivity (90%) and specificity (74%) for MetS diagnosis. A SPISE of 6.4 was the optimal cutoff for IR diagnosis; however, sensitivity and specificity were 61% and 75%. In males and female post-pubertal adolescents, SpiSe had a very good and good diagnostic performance, respectively, in predicting MetS. It was an accurate diagnostic tool for IR prediction in males, but not necessarily in females. Insulin resistance (IR), reduced responsiveness of a target cell or a whole organism to the insulin concentration to which it is exposed, is the prelude of major cardiometabolic disorders, such as coronary heart disease, stroke, Metabolic Syndrome (MetS), non-alcoholic fatty liver disease (NAFLD) and type-2 diabetes (T2D) 1,2. IR may be due to several causes, including the excess of adipose tissue, especially visceral adiposity. In children and adolescents, IR has grown dramatically, closely linked to the obesity epidemic, and the spread of Western-type dietary habits and sedentary behaviors 2,3. In Chile, one in four adolescents between 15 and 19 years of age have obesity, and 14% have MetS 4 , which suggests a rising number of individuals exposed to an early onset of serious and economically burdensome chronic illnesses. Early recognition of insulin-resistant youths may be beneficial for both clinical practice and population-based health promotion efforts. The reference standard to evaluate IR is the hyperinsulinemic-euglycemic clamp; however, it is invasive, costly, and difficult to perform in clinical and epidemiological settings 1. Several surrogate biomarkers have been proposed based on fasting measurements of glucose and/or insulin: HOMA-IR, QUICKI, 1/HOMA, log(HOMA), and 1/insulin 1-3. Pulsatility of insulin release, a relatively short half-life (~ 4-6 min), the fact that insulin assays are poorly standardized and may provide different results on the same sample, and difficulties in handling and storage can all cause problems in insulin determination and interpretation of results 5-7. Thus, insulin measurements are

The single-point insulin sensitivity estimator (SPISE) index is a strong predictor of abnormal glucose metabolism in overweight/obese children: a long-term follow-up study

“…A number of studies previously investigated the relationship between the SPISE index and insulin-derived indicators of insulin homeostasis [23,24,[36][37][38][39]; data showed that the SPISE index was comparable to Matsuda-ISI, QUICKI and HOMA-IR when used for the identification of conditions of altered insulin sensitivity in adults [23]. Moreover, lower SPISE index significantly correlated in adults or adolescents with the presence of T2D [36], metabolic syndrome [37,39], risk of cardiovascular diseases [36], non-alcoholic fatty liver disease (NAFLD) [38], abdominal obesity, higher levels of C-reactive protein (CRP) and lower levels of adiponectin [24]. Finally, in line with our results obtained in youths, Sagesaka et al demonstrated that basal SPISE index was significantly lower in adults who developed T2D 10 years later in comparison to those who did not progress to diabetes, in a longitudinal investigation on over 27,000 individuals without diabetes [40].…”

“…However, standards for assessing insulin resistance in children in the clinical setting are still lacking, and insulin-derived indexes of insulin resistance/ sensitivity are affected by methodological issues, such as the poor standardization of insulin measurement [16,[20][21][22]. Among the non-insulin-derived indices, the single-point insulin sensitivity estimator (SPISE) index is a lipids and BMI-based index of insulin sensitivity that showed better accuracy than other indicators, such as its forerunner TG/ HDL-C ratio and HOMA-IR, in the prediction of metabolic syndrome and has been recently validated in adolescents and adults [23,24]. To date, the usefulness of the SPISE index has not been investigated in a pediatric population.…”

Prediabetes in Adolescents: Prevalence, Management and Diabetes Prevention Strategies

“…Recent studies have discussed the further need of new markers of insulin resistance that do not rely on insulin pulsatility, like single-point insulin sensitivity estimator (SPISE) based on BMI, triglycerides and highdensity lipoprotein (HDL) cholesterol. 92 A metabolic syndrome severity score accurately tracked reduction in the risk for future T2DM and CVD among adults in the Diabetes Prevention Program 93,94 and was linked to future risk for T2DM and CVD among adolescents. [95][96][97][98] Still additional studies are required to assess the validity of these surrogate markers during long-term treatment of adolescents with prediabetes.…”

Single Point Insulin Sensitivity Estimator in Pediatric Non-Alcoholic Fatty Liver Disease

“…Among these, the SPISE was developed as an easy and affordable tool for the evaluation of whole-body insulin sensitivity, which is comparable to clamp-derived M-value in sensitivity as well as specificity (19). Several studies have evaluated the SPISE in adult as well as juvenile populations (20,(41)(42)(43)(44)(45)(46). Correa-Burrows et al assessed SPISE for its validity in diagnosing cardiometabolic risks, namely IR and metabolic syndrome, in post-pubertal Hispanic adolescents.…”