Predicting Insulin Sensitivity: A Clamp Study
Predicting Insulin Sensitivity: A Clamp Study
Type 2 diabetes mellitus (T2DM) and obesity, which are both associated with insulin resistance, are increasingly common worldwide, especially in developing countries including sub-Saharan African (SSA). Furthermore, the highest relative increases in diabetes (by 90%) prevalence by 2030 is projected to occur in SSA. The experienced increasing trends of T2DM and obesity over the last two decades in SSA have revealed new challenges for diagnosis, prevention and treatment, as well as uncovering context specific causes and promoters of the conditions. Given the central role of insulin resistance in the pathogenesis of T2DM and obesity, measures of insulin sensitivity are very important diagnostic and research tools. The gold standard for assessing insulin sensitivity is the hyperinsulinemic-euglycemic clamp, which measures the in vivo rate of insulin-stimulated glucose uptake. However, this method is invasive, costly, logistically challenging, technically demanding, and time consuming. Consequently, it is impractical and not applicable in large-scale epidemiological and intervention studies, especially in resource-poor settings of SSA. Surrogate indices of insulin sensitivity that can be used in large-scale studies have been developed, and validated in several populations, mainly Caucasians. However, there are suggestions that ethnicity may influence the performance of available surrogate indices of insulin sensitivity, particularly among populations with high prevalence of insulin resistance such as Africans. This issue however, remains largely under-investigated and little is known on the diagnostic utility of common insulin sensitivity indices, and whether they even do better than non-laboratory-based determinants of insulin sensitivity, in SSA populations. We therefore assessed the performance of common fasting indices of insulin sensitivity and clinical surrogates of insulin resistance, against hyperinsulinemic-euglycemic clamp-measured insulin sensitivity, among non-diabetic Cameroonians adults with a wide range of insulin sensitivity/resistance profile.
Background
Type 2 diabetes mellitus (T2DM) and obesity, which are both associated with insulin resistance, are increasingly common worldwide, especially in developing countries including sub-Saharan African (SSA). Furthermore, the highest relative increases in diabetes (by 90%) prevalence by 2030 is projected to occur in SSA. The experienced increasing trends of T2DM and obesity over the last two decades in SSA have revealed new challenges for diagnosis, prevention and treatment, as well as uncovering context specific causes and promoters of the conditions. Given the central role of insulin resistance in the pathogenesis of T2DM and obesity, measures of insulin sensitivity are very important diagnostic and research tools. The gold standard for assessing insulin sensitivity is the hyperinsulinemic-euglycemic clamp, which measures the in vivo rate of insulin-stimulated glucose uptake. However, this method is invasive, costly, logistically challenging, technically demanding, and time consuming. Consequently, it is impractical and not applicable in large-scale epidemiological and intervention studies, especially in resource-poor settings of SSA. Surrogate indices of insulin sensitivity that can be used in large-scale studies have been developed, and validated in several populations, mainly Caucasians. However, there are suggestions that ethnicity may influence the performance of available surrogate indices of insulin sensitivity, particularly among populations with high prevalence of insulin resistance such as Africans. This issue however, remains largely under-investigated and little is known on the diagnostic utility of common insulin sensitivity indices, and whether they even do better than non-laboratory-based determinants of insulin sensitivity, in SSA populations. We therefore assessed the performance of common fasting indices of insulin sensitivity and clinical surrogates of insulin resistance, against hyperinsulinemic-euglycemic clamp-measured insulin sensitivity, among non-diabetic Cameroonians adults with a wide range of insulin sensitivity/resistance profile.
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