ABSTRACT
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Insulin is the principal hormone of glucose metabolic regulation. Reduced glucose responses to insulin constitute an underlying feature of type 2 diabetes. In addition, insulin resistance is a common condition related with the metabolic syndrome and strongly associated with an increased risk of cardiovascular disease. The importance of the insulin-resistant phenotype for the assessment of cardiovascular risk and response to intervention is increasingly being recognized. Therefore, there is a need for an accurate and reproducible method for measuring insulin resistance in vivo. The euglycemic hyperinsulinemic clamp (EHC) is currently the gold standard method available for the determination of whole glucose uptake in response to insulin, from which several derived indices of insulin sensitivity are obtained. The clamp technique is both expensive and complex to undertake and has prompted the use of surrogate methods, notably the insulin tolerance test and frequently sampled intravenous glucose tolerance test. Indices may be derived from these methods and correlate well with those derived from clamp studies. However, important limitations of these procedures are that not only does insulin sensitivity change in pathological situations, but also in normal physiology. Variations also occur in timedepending on the physiological state of the individual or following diurnal rhythms. In conclusion, the quantitative assessment of insulin sensitivity with EHC is not used for routine clinical purposes, but the emerging importance of insulin resistance has led to its wider application to research studies that have examined its pathogenesis, etiology and consequences (AU)
