[How to measure insulin sensitivity in clinical practice?]

Area of Science:

• Endocrinology and Metabolism
• Clinical Diagnostics

Context:

• Insulin resistance is prevalent and associated with metabolic syndrome components like hyperglycemia, dyslipidemia, and hypertension.
• The insulin-resistant phenotype is crucial for assessing cardiovascular risk and treatment response in type 2 diabetes mellitus.
• Current gold standard methods for measuring insulin resistance, such as the euglycemic hyperinsulinemic clamp, are not clinically feasible.

Purpose:

• To highlight the need for accurate, reproducible, and simple in vivo methods for measuring insulin resistance.
• To discuss the limitations of various proposed indices for estimating insulin resistance from routine glucose and insulin measurements.
• To guide the selection of appropriate insulin resistance assessment methods based on clinical objectives and available resources.

Summary:

• The euglycemic hyperinsulinemic clamp is the gold standard for insulin resistance measurement but is impractical for clinical settings.
• Numerous simplified indices exist for estimating insulin resistance from fasting or post-load oral glucose tolerance tests (OGTT), but they have limitations.
• The choice of method depends on the application: clamp for clinical research, validated models like HOMA for epidemiological studies, and clinical context with validated indices for type 2 diabetes patients.

Impact:

• Facilitates informed selection of insulin resistance assessment tools tailored to specific research or clinical needs.
• Promotes better understanding and management of cardiovascular risk associated with insulin resistance.
• Supports the clinical practice for type 2 diabetes by providing guidance on evaluating insulin resistance and its contributing factors.