Diabetes Care
HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS
QUICK SEARCH:   [advanced]


     

Published online June 26, 2007
Diabetes Care 30:2374-2380, 2007
DOI: 10.2337/dc07-0422
© 2007 by the American Diabetes Association
This Article
Right arrow Full Text
Right arrow Full Text (PDF)
Right arrow Online-Only Appendix
Right arrow All Versions of this Article:
dc07-0422v1
30/9/2374    most recent
Right arrow Purchase Article
Right arrow View Shopping Cart
Right arrow Alert me when this article is cited
Right arrow Alert me if a correction is posted
Services
Right arrow Email this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Download to citation manager
Right arrow Request Permissions
Citing Articles
Right arrow Citing Articles via HighWire
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Anderwald, C.
Right arrow Articles by Krebs, M.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Anderwald, C.
Right arrow Articles by Krebs, M.
Social Bookmarking
Add to CiteULike   Add to Del.icio.us   Add to Digg   Add to Reddit   Add to Technorati  
What's this?

Cardiovascular and Metabolic Risk
Original Article

The Clamp-Like Index

A novel and highly sensitive insulin sensitivity index to calculate hyperinsulinemic clamp glucose infusion rates from oral glucose tolerance tests in nondiabetic subjects

Christian Anderwald, MD, MPHARM1,2, Marietta Anderwald-Stadler, MD3,4, Miriam Promintzer, MD1, Gerhard Prager, MD5, Martina Mandl, MD1, Peter Nowotny1, Martin G. Bischof, MD1, Michael Wolzt, MD1,2, Bernhard Ludvik, MD1, Thomas Kästenbauer, DSC3,4, Giovanni Pacini, DSC6, Anton Luger, MD1 and Michael Krebs, MD1

1 Division of Endocrinology and Metabolism, Department of Internal Medicine III, Medical University of Vienna, Austria
2 Department of Clinical Pharmacology, Medical University of Vienna, Vienna, Austria
3 Third Medical Department of Metabolic Diseases and Nephrology, Hietzing Hospital, Vienna, Austria
4 Karl Landsteiner Institute of Metabolic Diseases and Nephrology, Hietzing Hospital, Vienna, Vienna, Austria
5 Department of Surgery, Medical University of Vienna, Vienna, Austria
6 Metabolic Unit, Institute of Biomedical Engineering, National Research Council, Padova, Italy

Address correspondence and reprint requests to Christian Anderwald, MD, MPharm, Division of Endocrinology and Metabolism, Department of Internal Medicine III, Medical University of Vienna, Waehringer Guertel 18-20, A-1090 Vienna, Austria. E-mail: christian-heinz.anderwald{at}meduniwien.ac.at

OBJECTIVE—Insulin resistance, the underlying pathophysiological mechanism of the metabolic syndrome, can not only predict type 2 diabetes development but also cardiovascular disease. Thus, precise insulin resistance measurement in individuals at risk for metabolic diseases would support clinical risk stratification. However, the gold standard for measuring insulin resistance, the hyperinsulinemic clamp test, is too labor intensive to be performed in large clinical studies/settings.

RESEARCH DESIGN AND METHODS—Using plasma glucose and C-peptide concentrations from oral glucose tolerance tests (OGTTs), we developed the novel "clamp-like index" (CLIX) for insulin sensitivity calculation and compared CLIX to clamp glucose infusion rates (GIR) (100–120 min). We evaluated CLIX in 89 nondiabetic subjects (58 female and 31 male, aged 45 ± 1 years, BMI 27.5 ± 0.8 kg/m2) who underwent frequently sampled 3-h 75-g OGTTs and 2-h hyperinsulinemic-isoglycemic clamp (40 mU/min per m2) tests.

RESULTS—CLIX, calculated as serum creatinine (x0.85 if male)/(mean AUCglucose x mean AUCC-peptide) x 6,600, was highly correlated (r = 0.670, P < 10–12) with and comparable to clamp GIRs100–120 min. In subgroup analyses, GIRs100–120 min were lower (P < 0.005) in type 2 diabetic offspring (6.2 ± 0.7 mg · min–1 · kg–1) than in sex-, age-, and BMI-matched subjects without a family history of type 2 diabetes (8.6 ± 0.5 mg · min–1 · kg–1), which was also reflected by CLIX (insulin-resistant offspring 6.4 ± 0.6 vs. those without a family history of type 2 diabetes 9.0 ± 0.5; P < 0.002). When compared with normal-weight subjects (GIR 8.8 ± 0.4 mg · min–1 · kg–1; CLIX 9.0 ± 0.5), both GIRs100–120 min and CLIX of obese (5.2 ± 0.9 mg · min –1 · kg–1; 5.7 ± 0.9) and morbidly obese (2.4 ± 0.4 mg · min –1 · kg–1; 3.3 ± 0.5) humans were lower (each P < 0.02).

CONCLUSIONS—CLIX, a novel index obtained from plasma OGTT glucose and C-peptide levels and serum creatinine, without inclusion of anthropometrical measures to calculate insulin sensitivity in nondiabetic humans, highly correlates with clamp GIRs and reveals even slight insulin sensitivity alterations over a broad BMI range and is as sensitive as the hyperinsulinemic clamp test.

Abbreviations: AUC, area under the curve • CLIX, clamp-like index • GFR, glomerular filtration rate • GIR, glucose infusion rate • HOMA, homeostasis model assessment • MCRest, estimated metabolic clearance rate • OGSI, oral glucose insulin sensitivity index • OGTT, oral glucose tolerance test • QUICKI, quantitative insulin sensitivity check index


Add to CiteULike CiteULike   Add to Del.icio.us Del.icio.us   Add to Digg Digg   Add to Reddit Reddit   Add to Technorati Technorati    What's this?


This article has been cited by other articles:


Home page
 Am. J. Physiol. Endocrinol. Metab.Home page
M. Anderwald-Stadler, M. Krebs, M. Promintzer, M. Mandl, M. G. Bischof, P. Nowotny, T. Kastenbauer, A. Luger, R. Prager, and C. Anderwald
Plasma obestatin is lower at fasting and not suppressed by insulin in insulin-resistant humans
Am J Physiol Endocrinol Metab, November 1, 2007; 293(5): E1393 - E1398.
[Abstract] [Full Text] [PDF]


HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS
Diabetes Diabetes Care Clinical Diabetes Diabetes Spectrum
Copyright © 2007 by the American Diabetes Association.