Clinically Useful Estimates of Insulin Sensitivity During Pregnancy
- 1 September 2001
- journal article
- research article
- Published by American Diabetes Association in Diabetes Care
- Vol. 24 (9), 1602-1607
- https://doi.org/10.2337/diacare.24.9.1602
Abstract
OBJECTIVE—We examined whether selected indexes of insulin sensitivity derived from an oral glucose tolerance test (ISOGTT) or fasting glucose/insulin levels (ISQUICKI and ISHOMA) can be used to predict insulin sensitivity in women before and during pregnancy. RESEARCH DESIGN AND METHODS—A 2-h euglycemic-hyperinsulinemic clamp (5 mmol/l glucose, 40 mU · m−2 · min−1 insulin) and a 120-min oral glucose tolerance test (75 g load pregravid, 100 g pregnant) were repeated on 15 women (10 with normal glucose tolerance [NGT] and 5 with gestational diabetes mellitus [GDM]) pregravid and during both early (12–14 weeks) and late (34–36 weeks) pregnancy. An index of insulin sensitivity derived from the clamp (ISCLAMP) was obtained from glucose infusion rates adjusted for change in fat-free mass and endogenous glucose production measured using [6,6-2H2]glucose. RESULTS—Univariate analysis using combined groups and periods of pregnancy resulted in significant correlations between ISCLAMP and ISOGTT (r2 = 0.74, P < 0.0001), ISQUICKI (r2 = 0.64, P < 0.0001), and ISHOMA (r2 = 0.53, P < 0.0001). The ISOGTT provided a significantly better correlation (P < 0.0001) than either ISQUICKI or ISHOMA. Multivariate analysis showed a significant group effect (P < 0.0003) on the prediction model, and separate equations were developed for the NGT (r2 = 0.64, P < 0.0001) and GDM (r2 = 0.85, P < 0.0001) groups. When subdivided by period of pregnancy, the correlation between ISCLAMP and ISOGTT pregravid was r2 = 0.63 (P = 0.0002), during early pregnancy was r2 = 0.80 (P < 0.0001), and during late pregnancy was r2 = 0.64 (P = 0.0002). CONCLUSIONS—Estimates of insulin sensitivity from the ISOGTT during pregnancy were significantly better than from fasting glucose and insulin values. However, separate prediction equations are necessary for pregnant women with NGT and women with GDM.Keywords
This publication has 21 references indexed in Scilit:
- Quantitative Insulin Sensitivity Check Index: A Simple, Accurate Method for Assessing Insulin Sensitivity In HumansJournal of Clinical Endocrinology & Metabolism, 2000
- Homeostasis model assessment closely mirrors the glucose clamp technique in the assessment of insulin sensitivity: studies in subjects with various degrees of glucose tolerance and insulin sensitivity.Diabetes Care, 2000
- Glucose turnover and gluconeogenesis in human pregnancy.JCI Insight, 1997
- Understanding Oral Glucose Tolerance: Comparison of Glucose or Insulin Measurements During the Oral Glucose Tolerance Test with Specific Measurements of Insulin Resistance and Insulin SecretionDiabetic Medicine, 1994
- Type 2 (non-insulin-dependent) diabetes mellitus: the thrifty phenotype hypothesisDiabetologia, 1992
- Insulin sensitivity and B-cell responsiveness to glucose during late pregnancy in lean and moderately obese women with normal glucose tolerance or mild gestational diabetesAmerican Journal of Obstetrics and Gynecology, 1990
- Abnormal Patterns of Insulin Secretion in Non-Insulin-Dependent Diabetes MellitusNew England Journal of Medicine, 1988
- Homeostasis model assessment: insulin resistance and ?-cell function from fasting plasma glucose and insulin concentrations in manDiabetologia, 1985
- Classification and Diagnosis of Diabetes Mellitus and Other Categories of Glucose IntoleranceDiabetes, 1979
- Insulin deficiency and insulin resistance interaction in diabetes: Estimation of their relative contribution by feedback analysis from basal plasma insulin and glucose concentrationsMetabolism, 1979