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Identification of Individuals With Insulin Resistance Using Routine Clinical Measurements
Open accessAbstract
Insulin resistance is a treatable precursor of diabetes and potentially of cardiovascular disease as well. To identify insulin-resistant patients, we developed decision rules from measurements of obesity, fasting glucose, insulin, lipids, and blood pressure and family history in 2,321 (2,138 nondiabetic) individuals studied with the euglycemic insulin clamp technique at 17 European sites; San Antonio, Texas; and the Pima Indian reservation. The distribution of whole-body glucose disposal appeared to be bimodal, with an optimal insulin resistance cutoff of <28 μmol/min · kg lean body mass. Using recursive partitioning, we developed three types of classification tree models: the first, based on clinical measurements and all available laboratory determinations, had an area under the receiver operator characteristic curve (aROC) of 90.0% and generated a simple decision rule: diagnose insulin resistance if any of the following conditions are met: BMI >28.9 kg/m2, homeostasis model assessment of insulin resistance (HOMA-IR) >4.65, or BMI >27.5 kg/m2 and HOMA-IR >3.60. The fasting serum insulin concentrations corresponding to these HOMA-IR cut points were 20.7 and 16.3 μU/ml, respectively. This rule had a sensitivity and specificity of 84.9 and 78.7%, respectively. The second model, which included clinical measurements but no laboratory determinations, had an aROC of 85.0% and generated a decision rule that had a sensitivity and specificity of 78.7 and 79.6%, respectively. The third model, which included clinical measurements and lipid measurements but not insulin (and thus excluded HOMA-IR as well), had a similar aROC (85.1%), sensitivity (81.3%), and specificity (76.3%). Thus, insulin-resistant individuals can be identified using simple decision rules that can be tailored to specific needs.
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“Because the study was designed to recruit a sample at risk for diabetes, adolescents were highly insulin resistant, on average, as indicated by a mean HOMA-IR value exceeding 5 (Stern et al., 2005).”
From Relationship of Mindfulness to Distress and Cortisol Response in Adolescent Girls At-Risk for Type 2 Diabetes. (2018) · cites this paper as Stern et al., 2005
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Kahn, R., Buse, J. B., Ferrannini, E., & Stern, M. P. (2005) · Diabetes Care · doi:10.2337/diacare.28.9.2289 · Cited by 2,400
Self-citationNonalcoholic fatty liver disease and nonalcoholic steatohepatitis
Vuppalanchi, R., & Chalasani, N. (2008) · Hepatology · doi:10.1002/hep.22603 · Cited by 568
Defining insulin resistance from hyperinsulinemic-euglycemic clamps
Tam, C. S., Xie, W., Johnson, W. D., Cefalu, W. T., Redman, L. M., & Ravussin, E. (2012) · Diabetes Care · doi:10.2337/dc11-2339 · Cited by 364
The metabolic syndrome: time for a critical appraisal
Kahn, R., Buse, J. B., Ferrannini, E., & Stern, M. P. (2005) · Diabetologia · doi:10.1007/s00125-005-1876-2 · Cited by 384
Self-citationPhysical activity and diabetes prevention
LaMonte, M. J., Blair, S. N., & Church, T. S. (2005) · Journal of Applied Physiology · doi:10.1152/japplphysiol.00193.2005 · Cited by 340
Metadata
- Authors
- Stern, S. E., Williams, K., Ferrannini, E., DeFronzo, R. A., Bogardus, C., & Stern, M. P.
- Affiliations
- Australian National University (AU)
- The University of Texas at San Antonio Health Science Center (US)
- Istituto di Fisiologia Clinica (IT)
- National Institutes of Health (US)
- Division of Clinical Epidemiology, Department of Medicine, University of Texas Health Science Center at San Antonio, San Antonio, Texas
- Venue
- Diabetes
- Publisher
- American Diabetes Association
- Published
- 2005-02-01
- Volume
- 54
- Issue
- 2
- Pages
- 333-339
- ISSN
- 0012-1797 (ISSN-L)
- 1939-327X
- OpenAlex
- W2151716502
- Semantic Scholar
- 4e8c3e8e3b4db413e21a0acf7ac1a349884ba391
- Cited by
- 384
- References
- 30
- Citations by year
- 2026: 2 · 2025: 9 · 2024: 19 · 2023: 7 · 2022: 19 · 2021: 10 · 2020: 18 · 2019: 14 · 2018: 27 · 2017: 19 · 2016: 21 · 2015: 29 · 2014: 21 · 2013: 19 · 2012: 22
- FWCI
- 13.45
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Diabetes (publishedVersion)
- PubMed (publishedVersion)
- CINECA IRIS Institutial research information system (University of Pisa) (submittedVersion)
- ANU Open Research (Australian National University) (submittedVersion)
- Funders
- American Diabetes Association
- Topics
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes, Cardiovascular Risks, and Lipoproteins
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Adipokines, Inflammation, and Metabolic Diseases
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Pancreatic function and diabetes
- Keywords
- insulin resistance, diabetes prevention, cardiovascular risk, HOMA-IR, decision rules, classification trees, obesity, body mass index, fasting insulin, glucose disposal, hyperinsulinemic-euglycemic clamp, sensitivity and specificity, Pima Indians
- MeSH terms
- Blood Glucose, Homeostasis, Humans, Hyperinsulinism, Insulin, Insulin Resistance, Glucose Clamp Technique
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