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 Presentation

"Measuring Insulin in Clinical Practice"

Prof. David R. Matthews (biography)
English - 2005-06-10 - 36 minutes
(46 slides)

Summary :
In this presentation Prof. Matthews discusses some philosophical aspects about insulin resistance and ways in which it can be measured.

In the clinical setting, assessment of insulin resistance can be made without measurement, for example by looking at factors such as a person's weight or BMI, among others. There is a tendency to assume that insulin resistance is a defect or a problem, but since it is a normally-distributed variable, this is unlikely to be true, says Prof. Matthews.

Measurement of insulin resistance is carried out to observe the response for any given insulin concentration, and Prof. Matthews talks about different methods that can be used e.g., the euglycaemic clamp, the pancreatic suppression test, minimal models, the HOMA model, and other ratios and approximations.

The “gold standard” for insulin resistance would be a measure insulin's effect, but not only in terms of glucose; the insulin concentration would be physiological, but not only in one compartment, and the dose-response curve would be characterised with at least 3 concentrations of insulin. The coefficient of variation would also be robust, and this in turn depends on factors affecting insulin resistance.

Prof. Matthews discusses the pros and cons of different insulin resistance measures, and information gleaned from epidemiological studies looking at insulin resistance and beta cell function. The euglycaemic clamp and the HOMA model have also been used to assess changes in insulin resistance in response to thiazolidinediones.

Copyright © 2005 MULTIWEBCAST "State-of-the-Art Webcast Services"

Learning objectives :
After viewing this presentation the participant will be able to discuss:

- Measuring insulin resistance in clinical practice
- Concepts of IR
- Infusion methods clamps and steady state infusions
- Minimal models
- HOMA
- CVs
- Philosophy of IR as a physiological state not a pathological one

Bibliographic references :
R N Bergman, L S Phillips, and C Cobelli. Physiologic evaluation of factors controlling glucose tolerance in man: measurement of insulin sensitivity and beta-cell glucose sensitivity from the response to intravenous glucose. J Clin Invest. 1981 December; 68(6): 1456–1467.

DeFronzo RA.Pathogenesis of glucose intolerance in uremia.Metabolism. 1978 Dec;27(12 Suppl 2):1866-80.

DC Shen, SM Shieh, MM Fuh, DA Wu, YD Chen and GM Reaven. Resistance to insulin-stimulated-glucose uptake in patients with hypertension JCEM.1988;66:580-583.

Turner RC, Holman RR, Matthews D, Hockaday TD, Peto J. Insulin deficiency and insulin resistance interaction in diabetes: estimation of their relative contribution by feedback analysis from basal plasma insulin and glucose concentrations. Metabolism. 1979 Nov;28(11):1086-96.

Tara M. Wallace, MD, Jonathan C. Levy, MD and David R. Matthews,
MD. Use and Abuse of HOMA Modeling Diabetes Care 27:1487-1495, 2004.

   


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