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Diabetes Care 27:1249, 2004
© 2004 by the American Diabetes Association, Inc.

Letters: Comments and Responses

Diagnosing Insulin Resistance by Simple Quantitative Methods in Subjects With Normal Glucose Metabolism

Response to Karne, Chen, and Quon

Juan F. Ascaso, MD, Susana Pardo, MD, José T. Real, MD, Rosario I. Lorente, MD, Antonia Priego, MD and Rafael Carmena, MD

From the Department of Medicine, University of Valencia, Valencia, Spain

Address correspondence to Juan F. Ascasco, MD, University of Valencia, Dept. of Medicine, Blasco Ibanez 15, Valencia 46010, Spain. E-mail: ascaso{at}uv.es or juan.f.ascaso{at}uv.es

We thank Karne et al. for their comments (1) on our article (2). The ideal method to evaluate insulin resistance and insulin sensitivity, outside of the euglycemic-hyperinsulinemic clamp, has not yet been fully established. However, the minimal model, extensively used during the past decades, is considered a valuable surrogate of the clamp (3–5). The genetic factors involved in insulin sensitivity are better determined with the minimal model approach than with indirect methods based on fasting glucose and insulin values (6). Thus, the minimal model, as used in our study, provides more complete information on both, insulin resistance and insulin sensitivity than that given by indirect indexes (7–9). Although, as stated by Karne et al., the minimal model is not a direct measure of insulin sensitivity, the evidence in the literature supports its use as a valid surrogate of the clamp.

Minimal model results have been compared with those obtained by indirect indexes, establishing a good correlation. However, indexes based solely on fasting blood glucose and insulin could not always reliably estimate insulin resistance, since it is possible to have insulin resistance without hyperinsulinemia and conversely hyperinsulinemia without insulin resistance (10). A modified version of QUICKI recently published (11) provides a significantly better correlation with minimal model results than that obtained with QUICKI and homeostasis model assessment for insulin resistance. Interestingly, as observed by us, the values obtained with these latter two indexes were similar.

Karne’s comments on hypertensive subjects and estimation of insulin resistance with minimal model are not substantiated by the results published by other authors (11).

We consider that the minimal model provides reliable data on insulin sensitivity and insulin resistance. Indirect methods, such as those included in our study, are useful in the study of large number of subjects. It is possible that the predictive value of indirect indexes bears relationship with the evolutionary moment of the insulin resistance syndrome and the onset of metabolic abnormalities. In our study, all indexes correlated significantly with the minimal model results. The McAuley index and the clinical parameters of the metabolic syndrome were the best indicators of insulin resistance. The best indirect method is still to be defined. It is possible that the new modified version of QUICKI will provide some advantage.

References

  1. Karne RJ, Chen H, Quon MJ: Diagnosing insulin resistance by simple quantitative methods in subjects with normal glucose metabolism (Letter). Diabetes Care 27:1247–1248, 2004[Free Full Text]
  2. 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 26:3320–3325, 2003[Abstract/Free Full Text]
  3. Finegood DT, Hramiac IM, Dupre J: Modified protocol for estimation of insulin sensitivity with the minimal model of glucose kinetics in patients with insulin dependent diabetes mellitus. J Clin Endocrinol Metab 70:1538–1549, 1990[Abstract]
  4. 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 43:1114–1121, 1994[Abstract]
  5. Bonora E, Targher G, Alberiche M, Bonadonna RC, Saggiani F, Zenere MA, 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 23:57–63, 2000[Abstract]
  6. Bergman RN, Zaccaro DJ, Watanabe RM, Haffner SM, Saad MF, Norris JM, Wagenknecht LE, Hokanson JE, Rotter JI, Rich SS: Minimal model–based insulin sensitivity has greater heritability and a different genetic basis than homeostasis model assessment or fasting insulin. Diabetes 52:2168–2174, 2003[Abstract/Free Full Text]
  7. Garcia-Estevez DA, Araujo-Vilar D, Fiestras-Janeiro G, Saavedra-Gonzalez A, Cabezas-Cerrato J: Comparison of several insulin sensitivity indices derived from basal plasma insulin and glucose levels with minimal model indices. Horm Metab Res 35:13–17, 2003[Medline]
  8. Godsland IF: The minimal model: an evolving methodology. Clin Sci (Lond) 105:531–532, 2003[Medline]
  9. Agbaje OF, Luzio SD, Albarrak AI, Lunn DJ, Owens DR, Hovorka R: Bayesian hierarchical approach to estimate insulin sensitivity by minimal model. Clin Sci (Lond) 105:551–560, 2003[Medline]
  10. Ferrannini E, Balkau B: Insulin: in search of a syndrome. Diabet Med 19:724–729, 2000
  11. Rabasa-Lhoret R, Bastard JP, Jan V, Ducluzeau PH, Andreelli F, Guebre F, Bruzeau J, Louche-Pellissier C, MaItrepierre C, Peyrat J, Chagne J, Vidal H, Laville M: Modified quantitative insulin sensitivity check index is better correlated to hyperinsulinemic glucose glamp than other fasting-based index of insulin sensitivity in different insulin-resistant states. J Clin Endocrinol Metab 88:4917–4923, 2003[Abstract/Free Full Text]
  12. Goff DC Jr, Zaccaro DJ, Haffner SM, Saad MF: Insulin sensitivity and the risk of incident hypertension: insights from the Insulin Resistance Atherosclerosis Study. Diabetes Care 26:805–809, 2003[Abstract/Free Full Text]

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