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- Title
Evaluation of Indirect Measures of Insulin Resistance in HIV-Positive Patients.
- Authors
Goebel-Hoffman, Shannon; Reeds, Dominic N.; Mondy, Kristin; Lassa-Claxton, Sherry; Yarasheski, Kevin E.; Cade, William T.
- Abstract
Several indices have been used to quantify insulin resistance in individuals with HIV, however none has been validated against the "gold standard" hyperinsulinemic-euglycemic clamp. The purpose of this investigation was to determine if simple surrogate indices of insulin resistance are predictive of glucose disposal rate (R[sub d]) quantified during the clamp procedure in HIV-positive subjects. In 37 HIV-positive men and women with varying levels of insulin resistance, we measured glucose and insulin levels after an overnight fast and during a 2-hr oral glucose tolerance test (OGTT), and glucose R[sub d] during a 2-stage hyperinsulinemic (20 & 40 mU/m²/min)-euglycemic clamp. Univariate relationships among glucose R[sub d] during the clamp and several surrogate measures of insulin sensitivity [homeostasis model assessment for insulin resistance (HOMA-IR), log HOMA-IR, quantitative insulin sensitivity check index (QUICKI), fasting glucose concentration, fasting insulin concentration, glucose area under the curve (GAUC), insulin area under the curve (IAUC), glucose concentration at 120 min, and insulin concentration at 120 min] were examined. Indices that significantly correlated with stage 1 and stage 2 glucose R[sub d] included HOMA-IR (logarithmically transformed) (r=0.65 and r=0.63; p<0.05) and the QUICKI (r=0.64 and r=0.61; p<0.05). Multivariate linear regression analyses indicated that log HOMA-IR and GAUC modestly improved the prediction of clamp glucose R[sub d] (r=0.71 and r=0.66 p<0.05). The predictive indices only accounted for ≤50% of the variability associated with the measurement of glucose R[sub d]. In people with HIV, the best predictors of glucose R[sub d] and insulin sensitivity were HOMA-IR, QUICKI, or the HOMA-IR plus GAUC during a 2hr OGTT, but these were suboptimal. Supported by the NIH.
- Subjects
INSULIN resistance; HIV-positive persons; GLUCOSE; INSULIN; GLUCOSE tolerance tests
- Publication
Diabetes, 2007, Vol 56, pA681
- ISSN
0012-1797
- Publication type
Article