Hostname: page-component-cd9895bd7-gxg78 Total loading time: 0 Render date: 2024-12-26T21:56:56.412Z Has data issue: false hasContentIssue false
  • English
  • Français

Correlation of calculated indices of insulin resistance (QUICKI and HOMA) with the euglycaemic hyperinsulinaemic clamp technique for evaluating insulin resistance in critically ill patients

Published online by Cambridge University Press:  01 November 2007

U. Holzinger ,
R. Kitzberger ,
V. Fuhrmann ,
G.-C. Funk ,
C. Madl  and
K. Ratheiser
U. Holzinger*
Affiliation:
Medical University of Vienna, Intensive Care Unit, Department of Internal Medicine IV, Waehringer Guertel, Vienna, Austria
R. Kitzberger
Affiliation:
Medical University of Vienna, Intensive Care Unit, Department of Internal Medicine IV, Waehringer Guertel, Vienna, Austria
V. Fuhrmann
Affiliation:
Medical University of Vienna, Intensive Care Unit, Department of Internal Medicine IV, Waehringer Guertel, Vienna, Austria
G.-C. Funk
Affiliation:
Medical University of Vienna, Intensive Care Unit, Department of Internal Medicine IV, Waehringer Guertel, Vienna, Austria
C. Madl
Affiliation:
Medical University of Vienna, Intensive Care Unit, Department of Internal Medicine IV, Waehringer Guertel, Vienna, Austria
K. Ratheiser
Affiliation:
Medical University of Vienna, Intensive Care Unit, Department of Internal Medicine IV, Waehringer Guertel, Vienna, Austria
*
Correspondence to: Ulrike Holzinger, Department of Internal Medicine IV, ICU, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria. E-mail: [email protected]; Tel: +43 1 40400 4767; Fax: +43 1 40400 4797
Get access

Summary

Background and objective

Insulin resistance is frequently observed in critical illness. It can be quantified by the expensive and time-consuming euglycaemic hyperinsulinaemic clamp technique (M-value) and calculated indices of insulin resistance (Quantitative Insulin Sensitivity Check Index; QUICKI and Homeostasis Model Assessment; HOMA) with lower costs and efforts. We performed an observational study to assess the reliability of QUICKI and HOMA to evaluate insulin resistance in critically ill patients compared with the current gold standard method, the euglycaemic hyperinsulinaemic clamp technique.

Methods

Insulin resistance was measured in 30 critically ill medical patients by the euglycaemic hyperinsulinaemic clamp technique (M-value) as well as calculated using QUICKI and HOMA. Correlations between the M-values as well as QUICKI and HOMA were assessed by means of the Pearson’s correlation coefficient.

Results

M-value, QUICKI and HOMA indicated insulin resistance in all 30 patients. However, both indices QUICKI and HOMA did not correlate with the M-values in our patients (r2 = 0.008 and 0.0005, respectively). A significant negative correlation was found between the M-value and the severity of illness assessed by the APACHE (Acute Physiology and Chronic Health Evaluation) III score (r2 = 0.16; P < 0.05). In contrast, neither HOMA nor QUICKI correlated with the APACHE III score (r2 = 0.034 and 0.033, respectively).

Conclusions

Although QUICKI and HOMA indicated insulin resistance in the critically ill medical patients, both indices did not correlate with the M-value. Therefore, the euglycaemic hyperinsulinaemic clamp technique remains the gold standard for estimating insulin resistance in critically ill patients.

Keywords

CRITICAL CAREINSULIN RESISTANCEMETABOLISM, response to stressGLUCOSE CLAMP TECHNIQUE
Type
Original Article
Information
European Journal of Anaesthesiology , Volume 24 , Issue 11 , November 2007 , pp. 966 - 970
Copyright
Copyright © European Society of Anaesthesiology 2007

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1.Biolo, G, Toigo, G, Ciocchi, B et al. . Metabolic response to injury and sepsis: changes in protein metabolism. Nutrition 1997; 13 (Suppl. 9): 52S–57S.CrossRefGoogle ScholarPubMed
2.Chiolero, R, Revelly, JP, Tappy, L. Energy metabolism in sepsis and injury. Nutrition 1997; 13 (Suppl. 9): 45S–51S.CrossRefGoogle ScholarPubMed
3.Samra, JS, Summers, LK, Frayn, KN. Sepsis and fat metabolism. Br J Surg 1996; 83: 1186–1196.Google ScholarPubMed
4.Mizock, BA. Alterations in carbohydrate metabolism during stress: a review of literature. Am J Med 1998; 98: 75–84.CrossRefGoogle Scholar
5.Ferrannini, E, Mari, A. How to measure insulin sensitivity. J Hypertens 1998; 16: 895–905.CrossRefGoogle ScholarPubMed
6.DeFronzo, RA, Tobin, JD, Andres, R. Glucose clamp technique: a method for quantifying insulin secretion and resistance. Am J Physiol 1979; 237: 214–233.Google ScholarPubMed
7.Katz, A, Nambi, S, Mather, K et al. . Quantitative insulin sensitivity check index: a simple, accurate method for assessing insulin sensitivity in humans. J Clin Endocrinol Metab 2000; 85: 2402–2410.CrossRefGoogle ScholarPubMed
8.Matthews, DR, Hosker, JP, Rudenski, AS, Naylor, BA, Treacher, DF, Turner, RC. Homeostasis model assessment: insulin resistance and beta-cell function from fasting plasma glucose and insulin concentrations in man. Diabetologia 1985; 28: 412–419.CrossRefGoogle ScholarPubMed
9.Mather, KJ, Hunt, AE, Steinberg, HO et al. . Repeatability characteristics of simple indices of insulin resistance; implications for research applications. J Clin Endocrinol Metab 2001; 86: 5457–5464.CrossRefGoogle ScholarPubMed
10.Chen, H, Sullivan, G, Yue, LQ, Katz, A, Quon, MJ. QUICKI is a useful index of insulin sensitivity in subjects with hypertension. Am J Physiol Endocrinol Metab 2003; 284: 804–812.CrossRefGoogle ScholarPubMed
11.Lansang, MC, Williams, GH, Carroll, JS. Correlation between the glucose clamp technique and homeostasis model assessment in hypertension. Am J Hypertens 2001; 14: 51–53.CrossRefGoogle ScholarPubMed
12.Kirwan, JP, Huston-Presley, L, Kalhan, SC, Catalano, PM. Clinically useful estimates of insulin sensitivity during pregnancy: validation studies in women with normal glucose tolerance and gestational diabetes mellitus. Diabetes Care 2001; 24: 1602–1607.CrossRefGoogle ScholarPubMed
13.Basi, S, Pupim, LB, Simmons, EM et al. . Insulin resistance in critically ill patients with acute renal failure. Am J Physiol Renal Physiol 2005; 289: 259–264.CrossRefGoogle ScholarPubMed
14.Knaus, WA, Wagner, DP, Draper, EA et al. . The APACHE III prognostic system. Risk prediction of hospital mortality for critically ill hospitalized adults. Chest 1991; 100: 1619–1636.CrossRefGoogle ScholarPubMed
15.Van den Berghe, G, Wouters, P, Weekers, F et al. . Intensive insulin therapy in critically ill patients. N Engl J Med 2001; 345: 1359–1367.CrossRefGoogle ScholarPubMed
16.Marik, PE, Raghavan, M. Stress-hyperglycemia, insulin and immunomodulation in sepsis. Intensive Care Med 2004; 30: 748–756.CrossRefGoogle ScholarPubMed
17.Virkamäki, A, Puhakainen, I, Koivisto, VA, Vuorinen-Markkola, H, Yki-Jarvinen, H. Mechanisms of hepatic and peripheral insulin resistance during acute infections in humans. J Clin Endocrinol Metab 1992; 74: 673–679.Google ScholarPubMed
18.Thorell, A, Rooyackers, O, Myrenfors, P, Soop, M, Nygren, J, Ljungqvist, OH. Intensive insulin treatment in critically ill trauma patients normalizes glucose by reducing endogenous glucose production. J Clin Endocrinol Metab 2004; 89: 5382–5386.CrossRefGoogle ScholarPubMed
19.Wallace, TM, Matthews, DR. The assessment of insulin resistance in man. Diabet Med 2002; 19: 527–534.CrossRefGoogle ScholarPubMed
20.Bonora, E, Targher, G, Alberiche, M et al. . Homeostasis model assessment closely mirrors the glucose clamp technique in the assessment of insulin sensitivity. Diabetes Care 2000; 23: 57–63.CrossRefGoogle ScholarPubMed
21.Chambrier, C, Laville, M, Rhzioual Berrada, K, Odeon, M, Bouletreau, P, Beylot, M. Insulin sensitivity of glucose and fat metabolism in severe sepsis. Clin Sci 2000; 99: 321–328.Google ScholarPubMed