Estimation of insulin resistance in type 2 diabetes
Från Diabetes 2000;49:626-632.

Easily identifiable clinical risk factors can be used to identify type 1 diabetics with insulin resistance syndrome (IRS), according to the results of a Pennsylvania-based study.

    While insulin resistance in type 2 diabetics has been linked to an increased risk of cardiovascular disease, intensive study of this association has been limited by the use of the costly and complicated euglycemic clamp technique, the only available measure of insulin resistance in this population, according to Dr. Trevor J. Orchard, of the University of Pittsburgh in Pennsylvania, and multicenter colleagues. - Few studies have examined the association between clinical IRS risk factors and insulin resistance in this population, Dr. Orchard adds in a statement from the university. In the April issue of Diabetes, the researchers report on their development of a simple inexpensive "proxy measure" of insulin resistance.

    Dr. Orchard and colleagues developed an IRS scoring tool using a series of clinical risk factors in adults with early-onset type 2 diabetes mellitus. The risk factors included hypertension, waist-to-hip ratio, triglyceride level, high-density lipoprotein cholesterol level, family history of type 2 diabetes, and glycemic control. Subjects were categorized as low, moderate or high risk based on their IRS scores, and insulin clamp studies were conducted in eight patients from each risk category to validate the IRS tool.

    The team found that the best predictor of insulin resistance as measured by the insulin clamp was the combination of hypertension, high waist-to-hip ratio, and poor glycemic control. Individually, these factors plus a family history of diabetes were the best clinical predictors of insulin resistance. The glucose disposal rate differed significantly by IRS risk group.

    Due to the small sample size, the investigators warn that their findings should be "carefully interpreted." Even so, they write, the data suggest that "interventions such as exercise, weight loss, improved glycemic control and potentially insulin-sensitizing medications can be considered to improve insulin resistance."

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