Plasma Adiponectin as a Marker of Insulin Receptor Dysfunction: Clinical Utility in Severe Insulin Resistance
- Robert K. Semple, MB, PhD (rks16{at}cam.ac.uk)1,
- 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 CB2 0QQ, UK
- 2Clinical Endocrinology Branch, National Institute of Diabetes, Digestive and Kidney Diseases, Bethesda, Maryland 20892
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 precludes formal diagnosis. Our previous observation of paradoxical hyperadiponectinemia in insulin receptoropathy provides a possible basis for a simpler and cheaper screening test.
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 SHBG and IGFBP-1.
Results: Adiponectin above 7 mg/l in severe insulin resistance had a 97% positive predictive value (PPV) for insulin receptoropathy, and below 5 mg/l a 97% negative predictive value (NPV). IGFBP-1 and SHBG had lesser, though still significant, utility.
Conclusion: Use of these markers is likely to have significant value in accelerating the diagnosis of insulin receptoropathies.
Footnotes
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- Received November 18, 2007.
- Accepted February 13, 2008.
- Copyright © American Diabetes Association
