Measures of Insulin Sensitivity

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37 Scopus citations

Abstract

Many approaches may be taken in the assessment of insulin sensitivity in humans, including the glucose clamp technique, measurement of steady-state plasma glucose, the frequently sampled IV or oral glucose tolerance test analyzed using the minimal model, and fasting insulin-based calculations as well as semiquantitative approaches no longer used, such as the insulin tolerance and insulin suppression tests. All are noninvasive, and all, to varying degrees, represent the physiologic process of glucose lowering by insulin and correlate with one another [77]. The glucose clamp is considered the gold standard, with the similar but more readily performed steady-state plasma glucose also giving reliable information. The plasma insulin level is, unfortunately, limited in its ability to give direct information pertaining to insulin sensitivity in a given individual because of the great intraindividual variability in insulin secretion and in basal glucose production rates. Readily obtained clinical measures, in particular BMI and fasting plasma triglyceride level, offer useful additional information and it is possible that clinically useful equations may be developed using BMI and plasma insulin and triglyceride to give reliable information for a given individual's degree of insulin sensitivity. New, innovative approaches include indices based on glucose and insulin measurements during standard oral glucose tolerance tests, and clinically defined characterization based on standard examination and laboratory measures. Some approaches, such as the use of the fasting triglyceride level in determination of insulin sensitivity, appear particularly useful in developing new ways of characterizing persons with insulin sensitivity. In addition, several isotopic approaches now being developed offer the potential to characterize whole-body glucose metabolism in fashion that may eventually allow routine clinical testing of insulin sensitivity, with the potential to greatly expand our armamentarium in addressing the large number of conditions associated with insulin resistance.

Original languageEnglish
Pages (from-to)611-633
Number of pages23
JournalClinics in Laboratory Medicine
Volume26
Issue number3
DOIs
StatePublished - Sep 2006

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