Measurement Of Insulin Resistance

Several methods have been used to assess insulin resistance, but most are not readily available or practical for use in clinical practice. The easiest approach is to measure fasting plasma glucose and insulin concentrations or the glucose and insulin responses during an OGTT or test meal. The higher the insulin concentration in relation to the glucose level, the more insulin resistant the subject. One can also obtain similar information by measuring the C-peptide concentration in the fasting and stimulated states. Various methods have been developed to analyze glucose and insulin data, one of the most widely used being the homeostasis model (HOMA) that is most effectively used in large-population studies to assess insulin resistance and beta-cell function (44,45). A major drawback for using plasma insulin concentrations from individual patients is the wide range of normal values and lack of standardization of insulin assays used by clinical laboratories, both of which make interpretation of data difficult.

In a clinical research setting, insulin resistance is most commonly measured using the hyperinsulinemic glucose clamp technique (46) or the frequently sampled intravenous glucose tolerance test (FSIGT) using the minimal model method of Bergman (47-49). Both of these methods provide adequate measurements of g insulin sensitivity in individual subjects, but they are both time consuming and difficult to perform and are not practical for routine clinical use. In the final analysis, the best way to identify patients with insulin resistance syndrome is to do so on the basis of the clinical features (i.e., the constellation of obesity,

& u hypertension, dyslipidemia, IGT, or type 2 diabetes and accelerated atherosclerosis and cardiovascular disease).

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