New measure of insulin sensitivity predicts cardiovascular disease better than HOMA estimated insulin resistance

• Published in: PloS one 2013-09, Vol.8 (9), p.e74410-e74410
• Main Authors: Venkataraman, Kavita, Khoo, Chin Meng, Leow, Melvin K S, Khoo, Eric Y H, Isaac, Anburaj V, Zagorodnov, Vitali, Sadananthan, Suresh A, Velan, Sendhil S, Chong, Yap Seng, Gluckman, Peter, Lee, Jeannette, Salim, Agus, Tai, E Shyong, Lee, Yung Seng
• Format: Article
• Language: English
• Subjects: Adult; Anthropometry; Anthropometry - methods; Body mass; Body mass index; Body measurements; Body size; Cardiovascular diseases; Cardiovascular Diseases - epidemiology; Cohort Studies; Diabetes mellitus; Epidemiology; Fasting; Glucose; Glucose Clamp Technique; Health care facilities; Health risk assessment; Health risks; Hip; Humans; Insulin; Insulin resistance; Insulin Resistance - physiology; Linear Models; Longitudinal Studies; Male; Metabolic syndrome; NMR; Nuclear magnetic resonance; Predictions; Risk; Risk Assessment - methods; ROC Curve; Science; Sensitivity; Sensitivity analysis; Triglycerides
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0074410

Accurate assessment of insulin sensitivity may better identify individuals at increased risk of cardio-metabolic diseases. To examine whether a combination of anthropometric, biochemical and imaging measures can better estimate insulin sensitivity index (ISI) and provide improved prediction of cardio-metabolic risk, in comparison to HOMA-IR. Healthy male volunteers (96 Chinese, 80 Malay, 77 Indian), 21 to 40 years, body mass index 18-30 kg/m(2). Predicted ISI (ISI-cal) was generated using 45 randomly selected Chinese through stepwise multiple linear regression, and validated in the rest using non-parametric correlation (Kendall's tau τ). In an independent longitudinal cohort, ISI-cal and HOMA-IR were compared for prediction of diabetes and cardiovascular disease (CVD), using ROC curves. The study was conducted in a university academic medical centre. ISI measured by hyperinsulinemic euglycemic glucose clamp, along with anthropometric measurements, biochemical assessment and imaging; incident diabetes and CVD. A combination of fasting insulin, serum triglycerides and waist-to-hip ratio (WHR) provided the best estimate of clamp-derived ISI (adjusted R(2) 0.58 versus 0.32 HOMA-IR). In an independent cohort, ROC areas under the curve were 0.77±0.02 ISI-cal versus 0.76±0.02 HOMA-IR (p>0.05) for incident diabetes, and 0.74±0.03 ISI-cal versus 0.61±0.03 HOMA-IR (p