Hettihewa L M, Weerarathna T P
Departments of Pharmacology, Faculty of Medicine, University of Ruhuna, Sri Lanka.
J Pharmacol Pharmacother. 2011 Jul;2(3):165-9. doi: 10.4103/0976-500X.83280.
To estimate the prevalence of insulin resistant syndrome (IRS) among newly diagnosed patients with type 2 diabetes and to test their validity against two indices of insulin resistance (IR).
Prevalence of IRS was estimated according to the criteria used by ATP III in newly diagnosed type 2 diabetic patients. Sensitivity and specificity of the ACE criteria were calculated against two indices of IR namely fasting insulin (FI) level > 12 mU/l and McAuley index (McA) < 5.8. [McA= exp [2.63--0.28 ln(insulin in mU/l) -- 0.31 ln(triglycerides in mmol/l)].
35.7% of patients had IRS by ATP III criteria. 64.3% of patients were insulin resistant by FI and McA in each index. In patients who had IRS with ATP criteria, 80% and 86.6% were found to have McA and FI in the insulin resistant range. Out of the patients who were resistant by McA, only 40.6% had IR by ACE criteria and 93% had shown IR by FI. Out of all patients who did not fulfill the ATP III for IR, 74% and 59% were detected as having IR by fasting insulin and McA respectively. Sensitivity of the ACE criteria when tested against the FI and McA were 37.5% and 40.6%, specificity were 70% and 80%, respectively.
IRS was common among the newly diagnosed patients with type 2 diabetes. ACE criteria showed an acceptable specificity but lack adequate sensitivity when compared with the two Indices of insulin resistance. More valid and clinically useful criteria should be available for the accurate diagnosis of IRS in clinical practice.
评估新诊断的2型糖尿病患者中胰岛素抵抗综合征（IRS）的患病率，并根据两种胰岛素抵抗（IR）指标检验其有效性。
根据ATP III使用的标准评估新诊断的2型糖尿病患者中IRS的患病率。针对两种IR指标，即空腹胰岛素（FI）水平>12 mU/l和麦考利指数（McA）<5.8，计算ACE标准的敏感性和特异性。[McA = exp [2.63 - 0.28 ln（胰岛素，单位为mU/l）- 0.31 ln（甘油三酯，单位为mmol/l）]。
根据ATP III标准，35.7%的患者患有IRS。在每个指标中，64.3%的患者通过FI和McA存在胰岛素抵抗。在符合ATP标准的IRS患者中，80%和86.6%的患者McA和FI处于胰岛素抵抗范围内。在通过McA存在抵抗的患者中，只有40.6%根据ACE标准存在IR，而93%根据FI显示存在IR。在所有未达到ATP III IR标准的患者中，分别有74%和59%通过空腹胰岛素和McA检测出存在IR。ACE标准针对FI和McA检验时的敏感性分别为37.5%和40.6%，特异性分别为70%和80%。
IRS在新诊断的2型糖尿病患者中很常见。与两种胰岛素抵抗指标相比，ACE标准显示出可接受的特异性，但缺乏足够敏感性。在临床实践中，应具备更有效且临床有用的标准以准确诊断IRS。
