Top

Published in:

Open Access 01-12-2011 | Review

Selection of the appropriate method for the assessment of insulin resistance

Authors: Anwar Borai, Callum Livingstone, Ibrahim Kaddam, Gordon Ferns

Published in: BMC Medical Research Methodology | Issue 1/2011

Abstract

Insulin resistance is one of the major aggravating factors for metabolic syndrome. There are many methods available for estimation of insulin resistance which range from complex techniques down to simple indices. For all methods of assessing insulin resistance it is essential that their validity and reliability is established before using them as investigations. The reference techniques of hyperinsulinaemic euglycaemic clamp and its alternative the frequently sampled intravenous glucose tolerance test are the most reliable methods available for estimating insulin resistance. However, many simple methods, from which indices can be derived, have been assessed and validated e.g. homeostasis model assessment (HOMA), quantitative insulin sensitivity check index (QUICKI). Given the increasing number of simple indices of IR it may be difficult for clinicians and researchers to select the most appropriate index for their studies. This review therefore provides guidelines and advices which must be considered before proceeding with a study.

Available only for authorised users

Lillioja S, Mott DM, Howard BV, Bennett PH, Yki-Jarvinen H, Freymond D, Nyomba BL, Zurlo F, Swinburn B, Bogardus C: Impaired glucose tolerance as a disorder of insulin action. Longitudinal and cross-sectional studies in Pima Indians. N Engl J Med. 1988, 318 (19): 1217-1225.CrossRefPubMed

Borai A, Livingstone C, Ferns G: The biochemical assessment of insulin resistance. Ann Clin Biochem. 2007, 44: 324-342.CrossRefPubMed

Birkeland KI, Hanssen KF, Torjesen PA, Vaaler S: Level of sex hormone-binding globulin is positively correlated with insulin sensitivity in men with type 2 diabetes. J Clin Endocrinol Metab. 1993, 76 (2): 275-278.PubMed

Borai A, Livingstone C, Zarif H, Ferns G: Serum insulin-like growth factor binding protein-1: an improvement over other simple indices of insulin sensitivity in the assessment of subjects with normal glucose tolerance. Ann Clin Biochem. 2009, 46 (Pt 2): 109-113.CrossRefPubMed

Maddux BA, Chan A, Mandarino LJ, Goldfine ID: IGF-binding protein-1 levels are related to insulin-mediated glucose disposal and are a potential serum marker of insulin resistance. Diabetes Care. 2006, 29 (7): 1535-1537.CrossRefPubMed

Wallace TM, Matthews DR: The assessment of insulin resistance in man. Diabet Med. 2002, 19 (7): 527-534.CrossRefPubMed

Monzillo LU, Hamdy O: Evaluation of insulin sensitivity in clinical practice and in research settings. Nutr Rev. 2003, 61 (12): 397-412.CrossRefPubMed

Groop LC, Widen E, Ferrannini E: Insulin resistance and insulin deficiency in the pathogenesis of type 2 (non-insulin-dependent) diabetes mellitus: errors of metabolism or of methods?. Diabetologia. 1993, 36 (12): 1326-1331.CrossRefPubMed

Antuna-Puente B, Disse E, Rabasa-Lhoret R, Laville M, Capeau J, Bastard JP: How can we measure insulin sensitivity/resistance?. Diabetes Metab. 2011, 37 (3): 179-188.CrossRefPubMed

10.

DeFronzo RA, Tobin JD, Andres R: Glucose clamp technique: a method for quantifying insulin secretion and resistance. Am J Physiol. 1979, 237 (3): E214-223.PubMed

11.

Bergman RN, Ider YZ, Bowden CR, Cobelli C: Quantitative estimation of insulin sensitivity. Am J Physiol. 1979, 236 (6): E667-677.PubMed

12.

Saad MF, Anderson RL, Laws A, Watanabe RM, Kades WW, Chen YD, Sands RE, Pei D, Savage PJ, Bergman RN: A comparison between the minimal model and the glucose clamp in the assessment of insulin sensitivity across the spectrum of glucose tolerance. Insulin Resistance Atherosclerosis Study. Diabetes. 1994, 43 (9): 1114-1121.CrossRefPubMed

13.

Caumo A, Giacca A, Morgese M, Pozza G, Micossi P, Cobelli C: Minimal models of glucose disappearance: lessons from the labelled IVGTT. Diabet Med. 1991, 8 (9): 822-832.CrossRefPubMed

14.

Choukem SP, Gautier JF: How to measure hepatic insulin resistance?. Diabetes Metab. 2008, 34 (6 Pt 2): 664-673.CrossRefPubMed

15.

Shen SW, Reaven GM, Farquhar JW: Comparison of impedance to insulin-mediated glucose uptake in normal subjects and in subjects with latent diabetes. J Clin Invest. 1970, 49 (12): 2151-2160.CrossRefPubMedPubMedCentral

16.

Bonora E, Moghetti P, Zancanaro C, Cigolini M, Querena M, Cacciatori V, Corgnati A, Muggeo M: Estimates of in vivo insulin action in man: comparison of insulin tolerance tests with euglycemic and hyperglycemic glucose clamp studies. J Clin Endocrinol Metab. 1989, 68 (2): 374-378.CrossRefPubMed

17.

Hosker JP, Matthews DR, Rudenski AS, Burnett MA, Darling P, Bown EG, Turner RC: Continuous infusion of glucose with model assessment: measurement of insulin resistance and beta-cell function in man. Diabetologia. 1985, 28 (7): 401-411.CrossRefPubMed

18.

Howard G, O'Leary DH, Zaccaro D, Haffner S, Rewers M, Hamman R, Selby JV, Saad MF, Savage P, Bergman R: Insulin sensitivity and atherosclerosis. The Insulin Resistance Atherosclerosis Study (IRAS) Investigators. Circulation. 1996, 93 (10): 1809-1817.CrossRefPubMed

19.

Sanyal AJ, Mofrad PS, Contos MJ, Sargeant C, Luketic VA, Sterling RK, Stravitz RT, Shiffman ML, Clore J, Mills AS: A pilot study of vitamin E versus vitamin E and pioglitazone for the treatment of nonalcoholic steatohepatitis. Clin Gastroenterol Hepatol. 2004, 2 (12): 1107-1115.CrossRefPubMed

20.

Bergman RN: Lilly lecture 1989. Toward physiological understanding of glucose tolerance. Minimal-model approach. Diabetes. 1989, 38 (12): 1512-1527.CrossRefPubMed

21.

Matsuda M, DeFronzo RA: Insulin sensitivity indices obtained from oral glucose tolerance testing: comparison with the euglycemic insulin clamp. Diabetes Care. 1999, 22 (9): 1462-1470.CrossRefPubMed

22.

Matsuda M: Measuring and estimating insulin resistance in clinical and research settings. Nutr Metab Cardiovasc Dis. 2010, 20 (2): 79-86.CrossRefPubMed

23.

Ascaso JF, Pardo S, Real JT, Lorente RI, Priego A, Carmena R: Diagnosing insulin resistance by simple quantitative methods in subjects with normal glucose metabolism. Diabetes Care. 2003, 26 (12): 3320-3325.CrossRefPubMed

24.

Lorenzo C, Haffner SM, Stancakova A, Laakso M: Relation of direct and surrogate measures of insulin resistance to cardiovascular risk factors in nondiabetic finnish offspring of type 2 diabetic individuals. J Clin Endocrinol Metab. 2011, 95 (11): 5082-5090.CrossRef

25.

Carnevale Schianca GP, Sainaghi PP, Castello L, Rapetti R, Limoncini AM, Bartoli E: Comparison between HOMA-IR and ISI-gly in detecting subjects with the metabolic syndrome. Diabetes Metab Res Rev. 2006, 22 (2): 111-117.CrossRefPubMed

26.

Kanauchi M, Kanauchi K, Inoue T, Kimura K, Saito Y: Surrogate markers of insulin resistance in assessing individuals with new categories "prehypertension" and "prediabetes". Clin Chem Lab Med. 2007, 45 (1): 35-39.CrossRefPubMed

27.

Ferrannini E, Balkau B: Insulin: in search of a syndrome. Diabet Med. 2002, 19 (9): 724-729.CrossRefPubMed

28.

Mason C, Foster-Schubert KE, Imayama I, Kong A, Xiao L, Bain C, Campbell KL, Wang CY, Duggan CR, Ulrich CM, et al: Dietary weight loss and exercise effects on insulin resistance in postmenopausal women. American journal of preventive medicine. 2011, 41 (4): 366-375.CrossRefPubMedPubMedCentral

29.

Borai A, Livingstone C, Shafi S, Zarif H, Ferns G: Insulin sensitivity (Si) assessment in lean and overweight subjects using two different protocols and updated software. Scand J Clin Lab Invest. 2010, 70 (2): 98-103.CrossRefPubMed

30.

Abdul-Ghani MA, Matsuda M, Balas B, DeFronzo RA: Muscle and liver insulin resistance indexes derived from the oral glucose tolerance test. Diabetes Care. 2007, 30 (1): 89-94.CrossRefPubMed

31.

Balion CM, Raina PS, Gerstein HC, Santaguida PL, Morrison KM, Booker L, Hunt DL: Reproducibility of impaired glucose tolerance (IGT) and impaired fasting glucose (IFG) classification: a systematic review. Clin Chem Lab Med. 2007, 45 (9): 1180-1185.CrossRefPubMed

32.

Atabek ME, Pirgon O: Assessment of insulin sensitivity from measurements in fasting state and during an oral glucose tolerance test in obese children. J Pediatr Endocrinol Metab. 2007, 20 (2): 187-195.CrossRefPubMed

33.

Raynaud E, Perez-Martin A, Brun JF, Benhaddad AA, Mercier J: Revised concept for the estimation of insulin sensitivity from a single sample. Diabetes Care. 1999, 22 (6): 1003-1004.CrossRefPubMed

34.

Hermans MP, Levy JC, Morris RJ, Turner RC: Comparison of insulin sensitivity tests across a range of glucose tolerance from normal to diabetes. Diabetologia. 1999, 42 (6): 678-687.CrossRefPubMed

35.

Disse E, Bastard JP, Bonnet F, Maitrepierre C, Peyrat J, Louche-Pelissier C, Laville M: A lipid-parameter-based index for estimating insulin sensitivity and identifying insulin resistance in a healthy population. Diabetes Metab. 2008, 34 (5): 457-463.CrossRefPubMed

36.

Matthews DR, Hosker JP, Rudenski AS, Naylor BA, Treacher DF, Turner RC: Homeostasis model assessment: insulin resistance and beta-cell function from fasting plasma glucose and insulin concentrations in man. Diabetologia. 1985, 28 (7): 412-419.CrossRefPubMed

37.

Wallace TM, Levy JC, Matthews DR: Use and abuse of HOMA modeling. Diabetes Care. 2004, 27 (6): 1487-1495.CrossRefPubMed

38.

Perseghin G, Caumo A, Caloni M, Testolin G, Luzi L: Incorporation of the fasting plasma FFA concentration into QUICKI improves its association with insulin sensitivity in nonobese individuals. J Clin Endocrinol Metab. 2001, 86 (10): 4776-4781.CrossRefPubMed

39.

Ijzerman RG, Stehouwer CD, Serne EH, Voordouw JJ, Smulders YM, Delemarre-van de Waal HA, van Weissenbruch MM: Incorporation of the fasting free fatty acid concentration into quantitative insulin sensitivity check index improves its association with insulin sensitivity in adults, but not in children. Eur J Endocrinol. 2009, 160 (1): 59-64.CrossRefPubMed

40.

Li X, Zhou ZG, Qi HY, Chen XY, Huang G: [Replacement of insulin by fasting C-peptide in modified homeostasis model assessment to evaluate insulin resistance and islet beta cell function]. Zhong Nan Da Xue Xue Bao Yi Xue Ban. 2004, 29 (4): 419-423.PubMed

41.

Quon MJ: Limitations of the fasting glucose to insulin ratio as an index of insulin sensitivity. J Clin Endocrinol Metab. 2001, 86 (10): 4615-4617.CrossRefPubMed

42.

Albareda M, Rodriguez-Espinosa J, Murugo M, de Leiva A, Corcoy R: Assessment of insulin sensitivity and beta-cell function from measurements in the fasting state and during an oral glucose tolerance test. Diabetologia. 2000, 43 (12): 1507-1511.CrossRefPubMed

43.

Bonora E, Targher G, Alberiche M, Bonadonna RC, Saggiani F, Zenere MB, Monauni T, Muggeo M: Homeostasis model assessment closely mirrors the glucose clamp technique in the assessment of insulin sensitivity: studies in subjects with various degrees of glucose tolerance and insulin sensitivity. Diabetes Care. 2000, 23 (1): 57-63.CrossRefPubMed

44.

Emoto M, Nishizawa Y, Maekawa K, Hiura Y, Kanda H, Kawagishi T, Shoji T, Okuno Y, Morii H: Homeostasis model assessment as a clinical index of insulin resistance in type 2 diabetic patients treated with sulfonylureas. Diabetes Care. 1999, 22 (5): 818-822.CrossRefPubMed

45.

Fukushima M, Taniguchi A, Sakai M, Doi K, Nagata I, Nagasaka S, Tokuyama K, Nakai Y: Assessment of insulin sensitivity from a single sample. Diabetes Care. 2000, 23 (9): 1434-1435.CrossRefPubMed

46.

Katz A, Nambi SS, Mather K, Baron AD, Follmann DA, Sullivan G, Quon MJ: Quantitative insulin sensitivity check index: a simple, accurate method for assessing insulin sensitivity in humans. J Clin Endocrinol Metab. 2000, 85 (7): 2402-2410.CrossRefPubMed

47.

Yokoyama H, Emoto M, Fujiwara S, Motoyama K, Morioka T, Komatsu M, Tahara H, Koyama H, Shoji T, Inaba M, et al: Quantitative insulin sensitivity check index and the reciprocal index of homeostasis model assessment are useful indexes of insulin resistance in type 2 diabetic patients with wide range of fasting plasma glucose. J Clin Endocrinol Metab. 2004, 89 (3): 1481-1484.CrossRefPubMed

48.

Borai A, Livingstone C, Farzal A, Kholeif M, Wang T, Ferns G: Reproducibility of HOMA and QUICKI among individuals with variable glucose tolerance. Diabetes Metab. 2010, 36 (3): 247-249.CrossRefPubMed

49.

Jayagopal V, Kilpatrick ES, Jennings PE, Hepburn DA, Atkin SL: Biological variation of homeostasis model assessment-derived insulin resistance in type 2 diabetes. Diabetes Care. 2002, 25 (11): 2022-2025.CrossRefPubMed

50.

Liang L, Fu JF, Zou CC, Hong F, Wang CL, Wang XM: [Metformin hydrochloride ameliorates adiponectin levels and insulin sensitivity in adolescents with metabolic syndrome]. Zhonghua Er Ke Za Zhi. 2006, 44 (2): 118-121.PubMed

51.

Borai A, Callum L, Hawazen Z, Shweta M, Mona K, Mohammed A, Hanin A, Gordon F: A comparative study of insulin resistance for Saudi and Caucasian subjects across a range of glycaemic categories. Diabetes and Metabolic Syndrome: Clinical Research and Reviews. 2009, 3: 204-210.CrossRef

52.

Manley SE, Stratton IM, Clark PM, Luzio SD: Comparison of 11 human insulin assays: implications for clinical investigation and research. Clin Chem. 2007, 53 (5): 922-932.CrossRefPubMed

53.

Manley SE, Luzio SD, Stratton IM, Wallace TM, Clark PM: Preanalytical, analytical, and computational factors affect homeostasis model assessment estimates. Diabetes Care. 2008, 31 (9): 1877-1883.CrossRefPubMedPubMedCentral

54.

Esteghamati A, Ashraf H, Esteghamati AR, Meysamie A, Khalilzadeh O, Nakhjavani M, Abbasi M: Optimal threshold of homeostasis model assessment for insulin resistance in an Iranian population: the implication of metabolic syndrome to detect insulin resistance. Diabetes Res Clin Pract. 2009, 84 (3): 279-287.CrossRefPubMed

55.

Merino-Ibarra E, Cenarro A, Martin P, Garcia-Otin AL, Goicoechea J, Guallar A, Calvo L, Civeira F: [Sensitivity and specificity of metabolic syndrome criteria for insulin resistance diagnosis in Spanish population]. Medicina clinica. 2007, 128 (5): 168-171.CrossRefPubMed

56.

Ferrara CM, Goldberg AP: Limited value of the homeostasis model assessment to predict insulin resistance in older men with impaired glucose tolerance. Diabetes Care. 2001, 24 (2): 245-249.CrossRefPubMed

57.

Katsuki A, Sumida Y, Urakawa H, Gabazza EC, Murashima S, Morioka K, Kitagawa N, Tanaka T, Araki-Sasaki R, Hori Y, et al: Neither homeostasis model assessment nor quantitative insulin sensitivity check index can predict insulin resistance in elderly patients with poorly controlled type 2 diabetes mellitus. J Clin Endocrinol Metab. 2002, 87 (11): 5332-5335.CrossRefPubMed

58.

Legro RS, Finegood D, Dunaif A: A fasting glucose to insulin ratio is a useful measure of insulin sensitivity in women with polycystic ovary syndrome. J Clin Endocrinol Metab. 1998, 83 (8): 2694-2698.PubMed

59.

Hoffman RP: Indices of insulin action calculated from fasting glucose and insulin reflect hepatic, not peripheral, insulin sensitivity in African-American and Caucasian adolescents. Pediatric diabetes. 2008, 9 (3 Pt 2): 57-61.CrossRefPubMed

60.

Kalme T, Seppala M, Qiao Q, Koistinen R, Nissinen A, Harrela M, Loukovaara M, Leinonen P, Tuomilehto J: Sex hormone-binding globulin and insulin-like growth factor-binding protein-1 as indicators of metabolic syndrome, cardiovascular risk, and mortality in elderly men. J Clin Endocrinol Metab. 2005, 90 (3): 1550-1556.CrossRefPubMed

61.

Heald AH, Kaushal K, Siddals KW, Rudenski AS, Anderson SG, Gibson JM: Insulin-like growth factor binding protein-2 (IGFBP-2) is a marker for the metabolic syndrome. Exp Clin Endocrinol Diabetes. 2006, 114 (7): 371-376.CrossRefPubMed

62.

Kupelian V, Page ST, Araujo AB, Travison TG, Bremner WJ, McKinlay JB: Low sex hormone-binding globulin, total testosterone, and symptomatic androgen deficiency are associated with development of the metabolic syndrome in nonobese men. J Clin Endocrinol Metab. 2006, 91 (3): 843-850.CrossRefPubMed

63.

Roa Barrios M, Arata-Bellabarba G, Valeri L, Velazquez-Maldonado E: [Relationship between the triglyceride/high-density lipoprotein-cholesterol ratio, insulin resistance index and cardiometabolic risk factors in women with polycystic ovary syndrome]. Endocrinol Nutr. 2009, 56 (2): 59-65.CrossRefPubMed

64.

Oda N, Imamura S, Fujita T, Uchida Y, Inagaki K, Kakizawa H, Hayakawa N, Suzuki A, Takeda J, Horikawa Y, et al: The ratio of leptin to adiponectin can be used as an index of insulin resistance. Metabolism. 2008, 57 (2): 268-273.CrossRefPubMed

65.

Finucane FM, Luan J, Wareham NJ, Sharp SJ, O'Rahilly S, Balkau B, Flyvbjerg A, Walker M, Hojlund K, Nolan JJ, et al: Correlation of the leptin:adiponectin ratio with measures of insulin resistance in non-diabetic individuals. Diabetologia. 2009, 52 (11): 2345-2349.CrossRefPubMedPubMedCentral

66.

Hoffman RP: Metabolic syndrome racial differences in adolescents. Curr Diabetes Rev. 2009, 5 (4): 259-265.CrossRefPubMed

67.

Jayagopal V, Kilpatrick ES, Jennings PE, Holding S, Hepburn DA, Atkin SL: The biological variation of sex hormone-binding globulin in type 2 diabetes: implications for sex hormone-binding globulin as a surrogate marker of insulin resistance. Diabetes Care. 2004, 27 (1): 278-280.CrossRefPubMed

68.

Borai A, Livingstone C, Mehta S, Zarif H, Abdelaal F, Ferns G: Biological variation in fasting serum insulin-like growth factor binding protein-1 (IGFBP-1) among individuals with a varying glucose tolerance. Clin Biochem. 2009, 42 (12): 1270-1274.CrossRefPubMed

69.

Ricos C, Iglesias N, Garcia-Lario JV, Simon M, Cava F, Hernandez A, Perich C, Minchinela J, Alvarez V, Domenech MV, et al: Within-subject biological variation in disease: collated data and clinical consequences. Ann Clin Biochem. 2007, 44 (Pt 4): 343-352.CrossRefPubMed

70.

Hanson RL, Pratley RE, Bogardus C, Narayan KM, Roumain JM, Imperatore G, Fagot-Campagna A, Pettitt DJ, Bennett PH, Knowler WC: Evaluation of simple indices of insulin sensitivity and insulin secretion for use in epidemiologic studies. Am J Epidemiol. 2000, 151 (2): 190-198.CrossRefPubMed

71.

Kim SM, Cho KH, Park HS: Relationship between Plasma Adiponectin Levels and the Metabolic Syndrome among Korean People. Endocr J. 2006, 53 (2): 247-254.CrossRefPubMed

72.

Pigeon E, Riou ME, St-Onge J, Couillard E, Tremblay A, Marette A, Weisnagel SJ, Joanisse DR: Validation of a simple index (SIisOGTT) of insulin sensitivity in a population of sedentary men. Diabetes Metab. 2009, 35 (5): 398-403.CrossRefPubMed

73.

Sarafidis PA, Lasaridis AN, Nilsson PM, Pikilidou MI, Stafilas PC, Kanaki A, Kazakos K, Yovos J, Bakris GL: Validity and reproducibility of HOMA-IR, 1/HOMA-IR, QUICKI and McAuley's indices in patients with hypertension and type II diabetes. J Hum Hypertens. 2007, 21 (9): 709-716.CrossRefPubMed

74.

Belfiore F, Iannello S, Volpicelli G: Insulin sensitivity indices calculated from basal and OGTT-induced insulin, glucose, and FFA levels. Mol Genet Metab. 1998, 63 (2): 134-141.CrossRefPubMed

The pre-publication history for this paper can be accessed here:http://www.biomedcentral.com/1471-2288/11/158/prepub

Title: Selection of the appropriate method for the assessment of insulin resistance
Authors: Anwar Borai
Callum Livingstone
Ibrahim Kaddam
Gordon Ferns
Publication date: 01-12-2011
Publisher: BioMed Central
Published in: BMC Medical Research Methodology / Issue 1/2011
Electronic ISSN: 1471-2288
DOI: https://doi.org/10.1186/1471-2288-11-158

At a glance: The STEP trials

Springer Medicine

Selection of the appropriate method for the assessment of insulin resistance

Abstract

At a glance: The STEP trials

Springer Medicine

Abstract

Please log in to get access to this content

Other articles of this Issue 1/2011

A multidisciplinary systematic review of the use of diagrams as a means of collecting data from research subjects: application, benefits and recommendations

Pitfalls in the statistical examination and interpretation of the correspondence between physician and patient satisfaction ratings and their relevance for shared decision making research

Effort, reward and self-reported mental health: a simulation study on negative affectivity bias

Shared component modelling as an alternative to assess geographical variations in medical practice: gender inequalities in hospital admissions for chronic diseases

A randomised trial and economic evaluation of the effect of response mode on response rate, response bias, and item non-response in a survey of doctors

Parametric methods outperformed non-parametric methods in comparisons of discrete numerical variables