Simple fasting methods to assess insulin sensitivity in childhood

The 'gold standard' techniques used to measure insulin sensitivity in children are the hyperinsulinaemic-euglycaemic clamp and Bergman's minimal model. Although precise, these techniques are complex, invasive and time consuming. Alternative indirect measures of insulin sensitivity have been developed that utilize fasting glucose and insulin data in algorithms or computer programs. These methods include homeostatic model assessment (HOMA), the quantitative insulin sensitivity check index (QUICKI) and the glucose to insulin ratio (G:I). Each of these three fasting techniques has been developed and validated in adults, with little or no validation in children. Increasingly, HOMA and QUICKI are being used in childhood studies to assess insulin sensitivity. In a group of 79 pre-pubertal children, we found that the correlation between the minimal model and RHOMA (r = -0.4) was no better than that between the minimal model and fasting insulin (r = 0.4), with an even weaker correlation between the minimal model and QUICKI (r = 0.2). In addition, neither HOMA nor QUICKI were able to detect a reduction in insulin sensitivity with obesity or during growth hormone therapy, unlike the minimal model. In children with normal glucose levels, neither HOMA nor QUICKI was superior to fasting insulin. Validation of the derivation formulae for these methods in children is needed before they are more widely used. The potential benefits of these simple fasting techniques is that they are useful in large field studies. However, if the study groups are small or longitudinal changes in insulin sensitivity are sought, more precise techniques such as the clamp or minimal model should be used.