Determining a diagnostic algorithm for hyperinsulinaemia

Journal of Insulin Resistance

Field Value
Title Determining a diagnostic algorithm for hyperinsulinaemia
Creator Crofts, Catherine A.P. Schofield, Grant Wheldon, Mark C. Zinn, Caryn Kraft, Joseph R.
Subject — type 2 diabetes; insulin resistance; hyperinsulinaemia; Kraft patterns; insulin response patterns; diagnosis
Description Background: Ascertaining Kraft dynamic insulin response patterns following a 3-h 100 g oral glucose tolerance test seems to be the most reliable method for diagnosing hyperinsulinaemia. However, this test may be too resource-intensive for standard clinical use.Aim: This study aims to see if Kraft patterns can be accurately predicted using fewer blood samples with sensitivity and specificity analyses.Setting: St Joseph Hospital, Chicago, Illinois, United States and Human Potential Centre, Auckland University of technology, Auckland, New Zealand.Method: We analysed the results of 4185 men and women with a normal glucose tolerance, who had a 100 g oral glucose tolerance test with Kraft pattern analysis. Participants were dichotomised into normal–low insulin tolerance (Kraft I or V patterns) or hyperinsulinaemia (Kraft IIA–IV patterns). Sensitivity and specificity analysis was applied to available variables (including age, body mass index, fasting insulin or glucose) both individually and in combination.Results: Out of a maximal combined sensitivity and specificity score of 2.0, 2-h insulin level 45 µU/mL attained the highest score (1.80). Two-hour insulin also attained the highest sensitivity ( 30 µU/mL, 0.98) and the highest specificity ( 50 µU/mL, 0.99) scores. Combining the 2-h insulin with other variables reduced the sensitivity and/or specificity. Dynamic measures had a better combined sensitivity and specificity compared to fasting or anthropological measures.Conclusion: People with a 2-h plasma insulin level 30 µU/mL are unlikely to be hyperinsulinaemic. Given that first-line treatment is lifestyle modification, we recommend that a 2-h plasma insulin level 30 µU/mL following a 100 g oral glucose tolerance test be used to identify the hyperinsulinaemic individual.
Publisher AOSIS
Contributor Heart Foundation (NZ) AUT
Date 2019-06-26
Type info:eu-repo/semantics/article info:eu-repo/semantics/publishedVersion — Cross-sectional study
Format text/html application/epub+zip application/xml application/pdf
Identifier 10.4102/jir.v4i1.49
Source Journal of Insulin Resistance; Vol 4, No 1 (2019); 7 pages 2519-7533 2412-2785
Language eng
Coverage Global — —
Rights Copyright (c) 2019 Catherine A.P. Crofts, Grant Schofield, Mark C. Wheldon, Caryn Zinn, Joseph R. Kraft