Plasma Adiponectin as a Marker of Insulin Receptor Dysfunction
Clinical utility in severe insulin resistance
- Robert K. Semple, MB, PHD1,
- Elaine K. Cochran, MSN, CRNP2,
- Maria A. Soos, PHD1,
- Keith A. Burling, MPHIL1,
- David B. Savage, MD1,
- Phillip Gorden, MD2 and
- Stephen O'Rahilly, MD1
- 1Institute of Metabolic Science, University of Cambridge, Addenbrooke's Hospital, Cambridge, U.K.
- 2Clinical Endocrinology Branch, Digestive and Kidney Diseases, National Institute of Diabetes, Bethesda, Maryland
- Corresponding author: Dr. R. Semple, Institute of Metabolic Science, Addenbrooke's Hospital, Cambridge, CB2 0QQ, U.K. E-mail: rks16{at}cam.ac.uk
Abstract
OBJECTIVE—Severe insulin resistance is associated with high morbidity. Identification of severely insulin-resistant patients who have genetic or acquired insulin receptor dysfunction may aid therapeutic decision making; however, onerous diagnostic tests allied to a low frequency of insulin receptor dysfunction often preclude formal diagnosis. Our previous observation of paradoxical hyperadiponectinemia in insulin receptoropathy provides a possible basis for a simpler and cheaper screening test.
RESEARCH DESIGN AND METHODS—Receiver operating characteristics analysis was used to determine diagnostic thresholds for insulin receptoropathy in severe insulin resistance for adiponectin and for the insulin-regulated hepatic proteins sex hormone–binding globulin (SHBG) and IGF binding protein-1 (IGFBP-1).
RESULTS—Adiponectin >7 mg/l in severe insulin resistance had a 97% positive predictive value for insulin receptoropathy and <5 mg/l a 97% negative predictive value. IGFBP-1 and SHBG had lesser, though still significant, utility.
CONCLUSIONS—Use of these markers is likely to have significant value in accelerating the diagnosis of insulin receptoropathies.
- IGFBP-1, IGF binding protein-1
- NPV, negative predictive value
- PPV, positive predictive value
- SHBG, sex hormone–binding globulin
Footnotes
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Published ahead of print at http://care.diabetesjournals.org on 25 February 2008. DOI: 10.2337/dc07-2194.
Additional information for this article can be found in an online appendix at http://dx.doi.org/10.2337/dc07-2194.
The costs of publication of this article were defrayed in part by the payment of page charges. This article must therefore be hereby marked “advertisement” in accordance with 18 U.S.C. Section 1734 solely to indicate this fact.
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- Accepted February 13, 2008.
- Received November 18, 2007.
- DIABETES CARE
