Insulin Resistance: Detection By Fasting Insulin In North Indian Obese Adults.

Background&objectives:Several studies have shown that obesity is closely related to Insulin resistance(IR). Insulin resistance has been suggested as a primary cause for metabolic syndrome. Identifying such individuals would help to prevent progression of comorbidities associated with IR. Hence present study was planned to assess the importance of Fasting Insulin(FI) as a measure of IR and to analyze its correlation with other indirect methods for the assessment of IR . Methods: Study was conducted in fifty obese and overweight subjects.Body Mass Index of all subjects was calculated . Blood glucose, and FI were assayed after twelve hours of fasting. Homeostasis model assessment (HOMA) and Quantitative insulin sensitivity check indices (QUICKI) were calculated. Results: Present study showed that 90% of subjects had IR by HOMA and QUICKI.Correlation of FI with HOMA and QUICKI was statistically significant (P < 0.05). FI test had significant sensitivity and specificity when compared with HOMA and QUICKI indices. Validity of FI was further analyzed by Cohen’s kappa test and had good agreement (κ =0.67). Conclusion: FI was sensitive and also specific as HOMA and QUICKI in assessment of IR in obese. Thus, FI can be used as a simple test and feasable tool to detect IR in obese subjects. [AnshuKhatri NJIRM 2016; 7(5):1-4]

Efecto del consumo de bebidas dietéticas sobre los niveles de glucosa e insulina plasmática en jóvenes estudiantes de la Universidad del Norte / Effect of the consumption of diet sodas in plasmatic levels of glucose and insulin in young students at Universidad del Norte

Objetivo: Determinar el efecto de las bebidas dietéticas en los niveles de glucosa e insulina en jóvenes estudiantes de medicina de la Universidad del Norte. Materiales y métodos: Se realizó un estudio experimental aleatorizado con una muestra de 16 estudiantes de sexo femenino de tercer semestre del programa de Medicina de la Universidad del Norte. Su participación fue voluntaria, previa firma del consentimiento informado. Se determinaron las variables antropométricas: peso, talla e índice cintura/ cadera. Se extrajo muestras para la determinación de la glucosa e insulina en ayunas. Posteriormente se distribuyeron aleatoriamente en dos grupos. Al grupo control se le suministró una gaseosa normal de 600cc y al grupo experimental, una gaseosa dietética de igual volumen. Al término de 2 horas se extrajeron nuevas muestras para determinar niveles de glucosa e insulina postprandiales. Se recolectaron los datos y se realizó el análisis estadístico utilizando el software IBM SPSS v22.0. Resultados: Se encontró una relación lineal positiva estadísticamente significativa entre los niveles de insulina (r = 0,908; p=0,002) y entre los índices HOMA (r= 0,913; p=0,002), HOMAR (r= 0,920;p=0,001), HOMA beta (r= 0,838;p=0,009)y OUICKI (r= 0,996;p=0,001) pre- y postprandial en el grupo que recibió la bebida dietética. Conclusiones: Los datos demuestran que los niveles de glucosa, insulina y el índice HOMA se comportan de forma lineal según el tipo de gaseosa consumido. No obstante se necesitan más estudios para determinar la interrelación entre dichas variables.

Objective: To determine the effect of diet sodas in glucose and insulin levels in young medical students from the Universidad del Norte. Materials and methods: A randomized experimental study with a sample of 16 female students with an average age of 18 years, belonging to the third semester of Medicine pro-gram at Universidad del Norte. The subject's participation was voluntary prior signature of informed consent. We assed the following anthropometric variables: weight, height, waist / hip ratio. Blood samples were obtainedfor determination of fasting glucose. We randomly divided the sample into two groups. The control group was provided a 600 cc of a regular soda, and the group experimental, an equal volume of diet soda. After 2 hours, new blood samples were taken in order to determine postprandial glucose and insulin levels. Data was collected and statistical analysis was performed using SPSS v22.0 software. Results: A statistically significant positive linear relationship between the levels of basal and postprandial insulin (r = 0.908; p = 0.002) and between pre and post-prandial HOMA index (r = 0.913;p = 0.002), HOMAR (r= 0,920;p=0,001), HOMA beta (r= 0,838;p=0,009), y OUICKI (r= 0,996; p=0,001) was found in the group receiving dietary drink. Conclusions: Data from this study show that the levels of glucose, insulin and HOMA index behave in lineal ways according to the type of soda consumed, however further studies are needed to determine the inter-relationship between these variables.

Puntos de corte del perímetro de la cintura para identificar sujetos con resistencia a la insulina en una población colombiana / Cut points of waist circumference to identify subjects with insulin resistance in a colombian population

Resumen Introducción: el síndrome metabólico (SM) es una condición clínica que aumenta el riesgo de enfermedad cardiovascular y se relaciona con resistencia a la insulina (RI). Aunque los consensos establecen la necesidad de puntos de corte específicos del perímetro de la cintura (PC) para cada país, con el fin de identificar sujetos con SM, en Colombia no han sido definidos. Objetivo: definir los puntos de corte del PC en hombres y en mujeres que mejor discriminan la presencia de RI, establecer la prevalencia de SM y verificar la relación entre el PC y RI. Material y métodos: en el contexto del estudio Diagnóstico del Riesgo Cardiovascular Global, Medellín 2007-2008, se realizó una evaluación clínica, antropométrica y de laboratorio. Con el índice de resistencia a la insulina HOMA (IR-HOMA) se definió la presencia de RI a partir del percentil 75. Se construyeron curvas de las características operativas del receptor (COR), se obtuvo el área bajo la curva (AUC) para cada sexo y se usó el índice de Youden para establecer el PC que mejor discriminaba la presencia de RI. Resultados: se incluyeron 800 sujetos, de los cuales 44.8% fueron hombres, con un promedio de edad de 50.3±12.1 e índice de masa corporal (IMC) de 26.1±4.7. Los sujetos con RI tuvieron mayor PC, triglicéridos y presión arterial, además, menor colesterol HDL que aquellos sin RI. Los valores que mejor discriminan la presencia de RI fueron 92 cm en hombres (sensibilidad 82.28%; especificidad 70.14%) y 84 cm en mujeres (sensibilidad 78.15%; especificidad 73.98%) (índice de Youden de 0.52 en ambos sexos). Para los hombres y mujeres el AUC fue 0.828 (IC 95% 0.780-0.876) y 0.815 (IC 95% 0.770-0.859), respectivamente, valor de p< 0.001. Se encontró correlación entre el PC e IR-HOMA (ρ=0.65 en los hombres y ρ=0.62 en las mujeres) y una prevalencia del SM del 44.9%. Conclusión: los valores de PC que mejor discriminaron la presencia de RI son 92 cm para hombres y 84 cm para mujeres. Este criterio podría ser utilizado para identificar sujetos con SM a nivel poblacional. (Acta Med Colomb 2013; 38: 118-126).

Abstract Introduction: the metabolic syndrome (MS) is a clinical condition that increases the risk of cardiovascular disease and is associated with insulin resistance (IR). Although consensus establish the need of specific cut points of waist circumference (WC) for each country in order to identify subjects with MS, these have not been defined in Colombia. Objective: to define the WC cut points in men and women that best discriminate the presence of IR, to establish the prevalence of MS and verify the relation between WC and IR. Material and methods: in the context of the Diagnosis of the Global Cardiovascular Risk study, Medellin 2007-2008, we conducted an anthropometric and laboratory clinical evaluation. With the HOMA insulin resistance (HOMA-IR) index, we defined the presence of IR starting from the 75th percentile. Curves of the receiver operating characteristics (ROC) were made and the area under the curve (AUC) for each sex was obtained and the Youden index was used to establish the WC that best discriminated the presence of IR. Results: 800 subjects were included, of whom 44.8% were male, with a mean age of 50.3 ± 12.1 years and body mass index (BMI) of 26.1 ± 4.7. Subjects with IR had higher WC, triglycerides and blood pressure and also lower HDL cholesterol than those without IR. The values that best discriminate the presence of IR were 92 cm in men (sensitivity 82.28%, specificity 70.14%) and 84 cm in women (sensitivity 78.15%, specificity 73.98%) (Youden index of 0, 52 in both sexes). For men and women, the AUC was 0.828 (95% CI 0.780-0.876) and 0.815 (95% CI 0.770 to 0.859), respectively, p <0.001. A correlation between the WC and IR-HOMA ( ρ= 0.65 in men and ρ= 0.62 in women) as well as MS prevalence of 44.9% was found. Conclusion: WC values that best discriminated the presence of IR are 92 cm for men and 84 cm for women. This criterion could be used to identify subjects with MS at the population level. (ActaMed Colomb 2013; 38: 118-126).

Analysis of metabolic syndrome among obese children in clinics / 上海交通大学学报（医学版）

Objective To investigate the incidence of metabolic syndrome among obese children in clinics. Methods One hundred and thirteen obese children aged 7 to 14 years were selected from clinics of nutrition(case group),and another 366 healthy students aged 7 to 14 years were served as controls.Height,body weight,waist circumference,hip circumference,blood pressure and liver ultrasound were measured,related biochemical parameters such as fasting blood glucose,fasting insulin,serum total cholesterol,triglyceride(TG),hiSh density lipoprotein and low density lipoprotein were detected,and the incidences of metabolic syndrome were obtained in two groups.Insulin resistance(IR)was evaluated by homeostasis model assessment(HOMA). Results There was no significant difference in age and gender between case group and control group(P>0.05).Body weight,body mass index(BMI),waist circumference,hip circumference,waist to hip ratio,systolic blood pressure,diastolic blood pressure,fasting blood glucose,fasting insulin,HOMA index and TG in case group were significantly higher than those in control group(P<0.01).The 75th percentile of HOMA index in control group was 3.28,and IR subgroup and non-IR subgroup were divided according to this cutpoint.In case group,body weight,BMI,waist circumference and TG in non-IR subgroup were significantly higher than those in IR subgroup (P< 0.05).Metabolic syndrome occurred in 51 cases(45.1%) in case group.The incidence of metabolic syndrome was higher in IR subgroup than that in non-IR group(50.0% vs 21.1%)(P<0.05). Conclusion The prevalence of metabolic syndrome is higher in overweight and obese children.IR has a close relationship with metabolic syndrome.

Análise crítica do uso dos índices do Homeostasis Model Assessment (HOMA) na avaliação da resistência à insulina e capacidade funcional das células-beta pancreáticas: [revisão] / Critical analysis on the use of the homeostasis hodel assessment (HOMA) indexes in the evaluation of the insulin resistance and the pancreatic beta cells functional capacity: [review]

A disfunção das células-beta e a resistência insulínica são anormalidades metabólicas inter-relacionadas na etiologia do diabetes tipo 2. Em diversos países, tem sido observado o aumento da prevalência de obesidade e diabetes em associação com a presença da resistência insulínica. Nesse contexto, é útil a mensuração da resistência insulínica e da capacidade funcional das células-beta nos indivíduos. Os índices Homeostasis Model Assessment (HOMA) têm sido amplamente utilizados, representando uma das alternativas para avaliação desses parâmetros, principalmente por figurarem um método rápido, de fácil aplicação e de menor custo. Esta revisão discute sobre a origem e a evolução dos índices HOMA, bem como as particularidades do método, abordando aspectos relacionados à sua validação e aos pontos de corte existentes para sua interpretação.

Beta-cell dysfunction and insulin resistance are interrelated metabolic abnormalities in the aetiology of Type 2 Diabetes. In several countries, increases in the prevalence of obesity and diabetes have been observed in association with the presence of insulin resistance. In this context, measurement of insulin resistance and beta-cell function is useful. The HOMA indexes (Homeostasis Model Assessment) have been widely used, representing an alternative for the evaluation of these parameters, particularly as a fast, easy and cheap method. This review discusses the origin and evolution of the HOMA index, as well as details of the method, analyzing features related to its validation and the cutoff limits for its interpretation.

Study on the Insulin Resistance According to Obesity in the Patients with Polycystic Ovarian Syndrome / 대한산부인과학회잡지

OBJECTIVE: Polycystic ovarian syndrome (PCOS) is a heterogenous dysfunctional endocrinologic disorder with unknown etiology, clinically characterized by obesity, chronic anovulation, masculinization and infertility. Recently, the association between polycystic ovarian syndrome and insulin resistance have been brought up and insulin resistance is one of the most important factor related to the development of obesity. However, not all polycystic ovarian syndrome patients are obese, it would give a clue to understanding pathophysiology of obesity and PCOS if insulin resistance could be classified according to the degree of obesity in PCOS. Thus, we performed this prospective study to know the relationship between insulin resistance and obesity in the patients with PCOS. METHODS: Fourty eight polycystic ovary patients were included at Samsung Cheil Hospital from April to October 2002. These patients were grouped according to obeseness. HOMA index was used to evaluate insulin resistance calculated by using fasting blood sugar and serum insulin level. RESULTS: Twenty patients (41%) were classified as obese group, twenty eight patients (59%) had normal body mass index. Increased insulin resistance was observed in the patients with polycystic ovarian syndrome. And it was significantly higher in the obese patients compared to the patients with normal body mass index (6.8+/-2.8 vs. 2.7+/-0.9, t-test, p<0.01). CONCLUSION: For increased insulin resistance, immediate management would be needed in the patients of polycystic ovarian syndrome, especially combined with obesity.