Endukuru Chiranjeevi Kumar, Gaur Girwar Singh, Yerrabelli Dhanalakshmi, Sahoo Jayaprakash, Vairappan Balasubramaniyan
Department of 1Physiology, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India.
Department of Endocrinology, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India.
J Obes Metab Syndr. 2020 Dec 30;29(4):281-291. doi: 10.7570/jomes20071.
Insulin resistance (IR) is a collective clinical entity that exacerbates metabolic syndrome (MetS). As the gold-standard test to quantify IR involves intravenous insulin loading and repeated blood glucose monitoring, many indices have been developed for IR assessment for convenience. This study tested the ideal cut-off values and clinical utility of IR indices in identifying MetS.
We recruited 150 subjects, 75 MetS patients and 75 healthy controls, then obtained written informed consent to participate in this study. We collected fasting blood samples for glucose and lipid profiles and calculated nineteen indices of IR and insulin secretion using validated formulae. We determined the precision of these IR indices using the area under the curve (AUC) in a receiver operating characteristic analysis.
Subjects with MetS have significantly higher IR coupled with lower insulin sensitivity and beta-cell function than controls. Among the surrogate markers of IR tested, the homeostatic model assessment of insulin resistance (HOMA-IR), HOMA-adiponectin (HOMA-AD), triglyceride-glucose (TyG) index, HOMA-1%S (insulin sensitivity), quantitative insulin sensitivity check index (QUICKI), McAuley index, single-point insulin sensitivity estimator (SPISE), and HOMA-2%B (beta-cell function) showed the highest AUC values for detecting MetS.
Our study results suggest that the ideal cut-off and AUC values identified for HOMA-IR, HOMA-AD, the TyG index, HOMA-1%S, QUICKI, the McAuley index, SPISE, and HOMA-2%B offer a clinical approach to the early detection and risk stratification for MetS among people in southern India.
胰岛素抵抗（IR）是一种会加重代谢综合征（MetS）的临床综合征。由于量化IR的金标准检测涉及静脉注射胰岛素负荷和反复监测血糖，为方便起见，已开发出许多用于IR评估的指标。本研究测试了IR指标在识别MetS中的理想临界值和临床效用。
我们招募了150名受试者，其中75名MetS患者和75名健康对照者，然后获得了参与本研究的书面知情同意书。我们采集空腹血样以检测血糖和血脂谱，并使用经过验证的公式计算了19项IR和胰岛素分泌指标。我们在受试者工作特征分析中使用曲线下面积（AUC）确定了这些IR指标的准确性。
与对照组相比，MetS患者的IR显著更高，同时胰岛素敏感性和β细胞功能更低。在所测试的IR替代标志物中，胰岛素抵抗稳态模型评估（HOMA-IR）、HOMA-脂联素（HOMA-AD）、甘油三酯-葡萄糖（TyG）指数、HOMA-1%S（胰岛素敏感性）、定量胰岛素敏感性检查指数（QUICKI）、麦考利指数、单点胰岛素敏感性估计器（SPISE）和HOMA-2%B（β细胞功能）在检测MetS时显示出最高的AUC值。
我们的研究结果表明，为HOMA-IR、HOMA-AD、TyG指数、HOMA-1%S、QUICKI、麦考利指数、SPISE和HOMA-2%B确定的理想临界值和AUC值为印度南部人群中MetS的早期检测和风险分层提供了一种临床方法。
