Methods for quantifying insulin resistance in human immunodeficiency virus-positive patients.
Various indirect indices have been used in human immunodeficiency virus (HIV)-infected individuals to assess insulin resistance, but the validity of these measures has not been rigorously assessed by comparison with physiologic methods of quantifying insulin-mediated glucose uptake (IMGU). We directly measured IMGU in 50 nondiabetic HIV-positive subjects by determining the steady-state plasma glucose (SSPG) concentration in response to a 3-hour continuous infusion of insulin, glucose, and somatostatin. Because steady-state plasma insulin concentrations were similar (approximately 60 microU/mL) in all subjects, the SSPG concentrations provided direct assessments of insulin action. Relationships between SSPG levels and various surrogate measures of IMGU derived from the 75-g oral glucose tolerance test (OGTT) were determined. The indirect measure of IMGU most closely related to SSPG concentrations was the total integrated insulin response to a 75-g glucose load (r=0.78, P<.01), accounting for approximately two thirds of the variability in SSPG (r2=0.61). Other indirect measures of IMGU, including the homeostasis assessment for insulin resistance (HOMA-IR), were also significantly related to SSPG values, but had lower magnitudes of correlation (r=0.43 to 0.61), thereby possessing limited ability to predict SSPG variability (r2=0.18 to 0.37). In conclusion, indirect measures of IMGU need to be applied with caution when evaluating insulin action in HIV-infected patients.
Chu
James W
JW
Department of Medicine, Stanford University School of Medicine, CA, USA.
Abbasi
Fahim
F
Beatty
George W
GW
Khalili
Mandana
M
Koch
Johannes
J
Rosen
Alan
A
Schmidt
Jamey M
JM
Stansell
John D
JD
Reaven
Gerald M
GM
D000328:Adult; D001786:Blood Glucose / Q000032:analysis / Q000378:metabolism; D005215:Fasting; D005230:Fatty Acids, Nonesterified / Q000097:blood; D005260:Female; D005951:Glucose Tolerance Test; D015658:HIV Infections / Q000097:blood / Q000150:complications* / Q000188:drug therapy; D017320:HIV Protease Inhibitors / Q000627:therapeutic use; D006801:Humans; D007328:Insulin / Q000494:pharmacology; D007333:Insulin Resistance; D008297:Male; D008875:Middle Aged
D001786:Blood Glucose; D005230:Fatty Acids, Nonesterified; D017320:HIV Protease Inhibitors; D007328:Insulin