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Lee: Methods for the Assessment of Insulin Resistance
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J Korean Diabetes 2014;15(1):7-11.

Published online: 10 January 2014

DOI: https://doi.org/10.4093/jkd.2014.15.1.7

Methods for the Assessment of Insulin Resistance

Hyejin Lee

Division of Endocrinology and Metabolism, Department of Internal Medicine, Ewha Womans University School of Medicine, Seoul, Korea

Copyright © 2014 Korean Diabetes Association

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Insulin resistance is one of the major aggravating factors for metabolic disease. There are many methods available for estimation of insulin resistance which range from complex techniques down to simple indices. For all methods of assessing insulin resistance, it is essential that their validity and reliability be established before using them in clinical investigations. The reference techniques of hyperinsulinemic euglycemic clamp and its alternative, the frequently sampled intravenous glucose tolerance test, are the most reliable methods available for estimating insulin resistance. However, there are many simple methods from which indices can be derived that have been assessed and validated, which include homeostasis model assessment (HOMA) and the quantitative insulin sensitivity check index (QUICKI). Given the increasing number of simple indices of insulin resistance, it may be difficult for clinicians and researchers to select the most appropriate index for their studies. In planning studies on insulin resistance and selecting a suitable index, a number of important factors need to be considered by investigators, the principle one being the nature of the study to be undertaken.

Keywords: Insulin resistance, Glucose clamp technique

References

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Table 1.
Techniques used in the assessment of insulin resistance
Dynamic tests Biochemical markers on a single specimen
1) Clamp techniques 1) Homeostasis model assessment (HOMA)
– Hyperinsulinemic euglycemic clamp – Insulin resistance (HOMA-IR)
– Hyperglycemic clamp – β-cell function (HOMA-β)
2) Insulin tolerance test (ITT) 2) Quantitative insulin sensitivity check index (QUICKI)
3) Frequently sampled intravenous glucose tolerance test (FSIVGTT) and minimal model analysis 3) Serum insulin
– FSIVGTT (standard) 4) Sex hormone binding globulin (SHBG)
– FSIVGTT (tolbutamide) 5) Insulin-like growth factor binding protein-1 (IGFBP-1)
– FSIVGT (insulin modified)  
– FSIVGTT (reduced sampling protocol)  
4) Glucose tolerance test (GTT)  
5) Insulin sensitivity index (ISI-gly)  
6) Continuous infusion of glucose with model assessment (CIGMA)  
7) Stable isotopes  
Table 2.
Oral glucose tolerance test (OGTT)-derived indices
Index Formula
ISI Avignon[10] {(0.137 × [10 8 / (fasting insulinμIU/mL × fasting glucosemg/dL × VD)]) × [10 8 / (120 min insulinμIU/mL × 120 min glucosemg/dL × VD)]} / 2
ISI Belfiore 2 / [(INSPμIU/mL) × (GLYPmg/dL) + 1], where INSP = AUC of insulin(μIU/mL) during OGTT divided by mean values of nondiabetic subjects as a unit, and GLYP = AUC of glucose(mg/dL) during OGTT divided by mean values of nondiabetic subjects as a unit
ISI Cederholm[11] [75,000 × (fasting glucose-120 min glucosemmol/L) × 1.15 × 180 × 0.19 × body weightkg] / [120 × (log mean insulinμIU/mL) × mean glucosemmol/L]
ISI Gutt[12] [{75,000 × [(fasting glucose – 120 min glucosemg/dL) × 0.19 × body weightkg]} / 120} / [(fasting glucose + 2hrglucosemg/dL) / 2] / log[(fasting insulin + 120 min insulinμIU/mL) / 2]
ISI Matsuda [13] 10 4 / (fasting glucosemg/dL × fasting insulinμIU/mL × mean glucose OGTTmg/dL × mean insulin OGTTμIU/mL) 0.5
ISI Stumvoll[14] 0.226 – 0.032 × BMIkg/m2 – 0.0000645 × 120 min insulinpmol/L – 0.00375 × 90 min glucosemmol/L
OGIS [15] For this calculation, go to: http://webmet.pd.cnr.it/ogis/index.php
SIisOGTT[16] 1 / {log [∑ glucose0+30+90+120 min(mmol/L)] + log [∑ insulin0+30+90+120 min (μIU/mL)]}

ISI, insulin sensitivity index;VD, volume of distribution [150 (mL/kg) × body weight (kg)]; AUC, area under the curve; BMI body mass index; OGIS, oral glucose insulin sensitivity.

Table 3.
Simple indices of insulin resistance derived from fasting specimens
Index Formula
HOMA-IR Fasting glucose (mmol/L) × fasting insulin (mU/L) / 22.5
HOMA2-S HOMA2 calculator version 2.2
FGIR Fasting glucose (mg/dL)/ fasting insulin (mU/L)
Raynaud 40 / fasting insulin (mU/L)
Reciprocal insulin 1 / fasting insulin (mU/L)
QUICKI 1 / [log fasting insulin (mU/L) + log fasting glucose (mg/dL)]

HOMA-IR, homeostasis model assessment insulin resistance; FGIR, fasting glucose insulin resistance; QUICKI, quantitative insulin sensitivity check index; FGIF, fasting glucose insulin ratio. Adapted from Borai et al. BMC Med Res Methodol 2011;11:158[2].

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