Preview

Rational Pharmacotherapy in Cardiology

Advanced search

NEW METABOLIC INDEX USE POTENTIALITIES IN EVALUATION OF INSULIN RESISTANCE IN CLINICAL PRACTICE

https://doi.org/10.20996/1819-6446-2014-10-3-264-274

Full Text:

Abstract

Early diagnostics of insulin resistance (IR) is one of the methods of primary prevention of cardio-vascular diseases and type 2 diabetes mellitus. The HOMA-IR index and ratio of plasma triglyceride to high-density lipoprotein cholesterol concentration are the most frequently used indices in clinical and epidemiological scientific research. Prognostic value and efficacy of these tests as a screening method are not high. What method of IR detection should be used in clinical practice and how to interpret received values of the indices is still a matter of dispute.

Aim. To evaluate informative value, sensitivity and specificity of a new metabolic index (MI) for IR estimation in comparison with the calculated HOMA-IR index.

Material and methods. A total of 845 patients (298 men, 547 women) were enrolled into the further study after an outpatient regular medical check-up of 2,615 persons. Mean age of the patients was 45.77±12.18 years, body mass index – 28.95±1.44 kg/m2. To evaluate lipid and carbohydrate metabolism blood chemistry parameters were assessed. IR was determined by the Homeostasis Model Assessment (HOMA-IR) and an oblique calculated index based on lipid metabolism parameters. In accordance with the developed screening method of IR detection (invention patent № 2493566) MI considering carbohydrate and lipid changes was proposed.

Results. Calculation of MI and its threshold level was performed by analysis of a characteristic curve. Graphical dependence between sensitivity and specificity of the proposed index was demonstrated: sensitivity of the test was 75.7%, specificity – 89.1%. Probability of IR at MI value >7.0 was 63.5% (positive predictive value), probability of IR absence at the index value ≤7.0 was 93.6% (negative predictive value). The general accuracy of the test, which is characterized by the area under the characteristic curve, was 0.881 with 95%-confidence interval within 0.854-0.905.

Conclusion. The importance of negative result – absence of IR at normal values of MI and use of routine blood chemistry parameters for its calculation allows to recommend MI for IR screening in clinical practice. Distinction of the proposed method of IR diagnostics from the other known oblique laboratory methods is in easy calculation based on the routine biochemistry parameters detected in venous blood on one occasion. Use of the proposed MI allows to economically and efficiently estimate indirectly sensitivity to insulin without additional assessment of laboratory indices.

About the Authors

G. E. Roytberg
Pirogov Russian National Research Medical University
Russian Federation

MD, PhD, Professor, Member of the Russian Academy of Sciences, Head of the Chair of Therapy and Family Medicine, Faculty of Postgraduate education

Ostrovitianova ul. 1, Moscow, 117997 Russia


J. V. Dorosh
Pirogov Russian National Research Medical University
Russian Federation

MD, PhD, Asssistant Professor of the same Chair

Ostrovitianova ul. 1, Moscow, 117997 Russia


O. O. Sharkhun
Pirogov Russian National Research Medical University
Russian Federation

MD, PhD, Asssistant Professor of the same Chair

Ostrovitianova ul. 1, Moscow, 117997 Russia


T. I. Ushakova
“Medicina” JSC
Russian Federation

PhD (Biology), Coordinator of the Scientific Projects

Vtoroy Tverskoi-Yamskoi per. 10, Moscow, 125047 Russia


E. A. Trubino
“Medicina” JSC
Russian Federation

MD, Doctor of the Diagnostic Unit

Vtoroy Tverskoi-Yamskoi per. 10, Moscow, 125047 Russia



References

1. Roytberg G.E., Metabolic syndrome. M.: MED press inform; 2007. Russian. (Ройтберг Г.Е., редактор. Метаболический синдром. М.: МЕД пресс информ; 2007).

2. Perova N.V., Metelskaya V.A., Oganov R.G. Metabolic syndrome: pathogenic interrelations and ways of correction. Cardiologia 2001;(3): 4-9. Russian. (Перова Н.В., Метельская В.А., Оганов Р.Г. Метаболический синдром: патогенетические взаимосвязи и направления коррекции. Кардиология 2001; (3): 4-9).

3. Roytberg G.E., Ushakova T.I., Dorosh J.V. Role of insulin resistance in diagnostics of metabolic syndrome. Cardiologia 2004; (3): 94-101. Russian. (Ройтберг Г.Е., Ушакова Т.И., Дорош Ж.В. Роль инсулинорезистентности в диагностике метаболического синдрома. Кардиология 2004; (3): 94-101).

4. Reaven GM. Role of insulin resistance in human disease. Diabetes 1988; 37:1595-607.

5. Roytberg G.E., Ushakova T.I., Sharhun O.O., Dorosh J.V. Integral approach to diagnostics of metabolic syndrome in clinical practice. Cardiologia 2012;(10): 45-50. Russian. (Ройтберг Г.Е., Ушакова Т.И., Шархун О.О., Дорош Ж.В. Интегральный подход к диагностике метаболического синдрома в клинической практике. Кардиология 2012; (10): 45-50).

6. Sheen A, Paquot N, Lefebore P. How to measure insulin action in vivo. Diab Met Rev 1994; (10): 151-88.

7. Alisheva E.K., Krasilnikova E.I., Shliahto E.V. Methods of insulin resistance diagnostics. Arterialnaya Hypertensia 2002; (1): 29-34. Russian. (Алишева Е.К., Красильникова Е.И., Шляхто Е.В. Методы диагностики инсулинорезистентности. Артериальная Гипертензия 2002; (1): 29-34).

8. Bergman R, Finegood D, Ader M. Assessment of insulin sensitivity in vivo. Endocrine Rev 1985; (6): 45-86.

9. Mari A. Assessment of insulin sensitivity with minimal model: role of model assumptions. Am J Physiol 1997; 272: 925-34.

10. Borona E, Moghetti P, Zancanaro C, et al. Estimates of in vivo insulin action in man: comparison of insulin tolerance tests with euglycemic and hyperglycemic clamp studies . J Clin Endocrinol Metab 1989; 68: 374-8.

11. Alberti KG, Zimmet PZ. Definition, diagnosis and classification of diabetes mellitus and its complications. Part 1: diagnosis and classification of diabetes mellitus provisional report of a WHO consultation. Diabet Med 1998; 15: 539-53.

12. Matthews D, Hosker J, Rudenski A. Homeostatis model assessment: insulin resistance and b-cell function from fasting plasma glucose and insulin concentrations in man. Diabetologia 1985; 28: 412-9.

13. Tripathy D, Carlsson M, Almgren P, et al. Insulin secretion and insulin sensitivity in relation to glucose tolerance: lessons from the Botnia study. Diabetes 2000; 49(6): 975-80.

14. McLaughlin T, Reaven G, Abbasi F, et al. Is there a simple way to identify insulin-resistant individuals at increased risk of cardiovascular disease? Am J Cardiol 2005; 96(3): 399-404.


For citation:


Roytberg G.E., Dorosh J.V., Sharkhun O.O., Ushakova T.I., Trubino E.A. NEW METABOLIC INDEX USE POTENTIALITIES IN EVALUATION OF INSULIN RESISTANCE IN CLINICAL PRACTICE. Rational Pharmacotherapy in Cardiology. 2014;10(3):264-274. (In Russ.) https://doi.org/10.20996/1819-6446-2014-10-3-264-274

Views: 374


Creative Commons License
This work is licensed under a Creative Commons Attribution 4.0 License.


ISSN 1819-6446 (Print)
ISSN 2225-3653 (Online)