title: Monte Carlo analysis of a new model-based method for insulin sensitivity testing.
abstract: Insulin resistance (IR), or low insulin sensitivity, is a major risk factor in the pathogenesis of type 2 diabetes and cardiovascular disease. A simple, high resolution assessment of IR would enable earlier diagnosis and more accurate monitoring of intervention effects. Current assessments are either too intensive for clinical settings (Euglycaemic Clamp, IVGTT) or have too low resolution (HOMA, fasting glucose/insulin). Based on high correlation of a model-based measure of insulin sensitivity and the clamp, a novel, clinically useful test protocol is designed with: physiological dosing, short duration (<1 h), simple protocol, low cost and high repeatability. Accuracy and repeatability are assessed with Monte Carlo analysis on a virtual clamp cohort (N=146). Insulin sensitivity as measured by this test has a coefficient of variation (CV) of CV(SI)=4.5% (90% CI: 3.8-5.7%), slightly higher than clamp ISI (CV(ISI)=3.3% (90% CI: 3.0-4.0%)) and significantly lower than HOMA (CV(HOMA)=10.0% (90% CI: 9.1-10.8%)). Correlation to glucose and unit normalised ISI is r=0.98 (90% CI: 0.97-0.98). The proposed protocol is simple, cost effective, repeatable and highly correlated to the gold-standard clamp.
authors.affiliation: Centre for Bioengineering, Department of Mechanical Engineering, University of Canterbury, Christchurch, New Zealand. tlo16@student.canterbury.ac.nz
authors.forename: Thomas F
authors.initials: TF
authors.lastname: Lotz
authors.forename: J Geoffrey
authors.initials: JG
authors.lastname: Chase
authors.forename: Kirsten A
authors.initials: KA
authors.lastname: McAuley
authors.forename: Geoffrey M
authors.initials: GM
authors.lastname: Shaw
authors.forename: Xing-Wei
authors.initials: XW
authors.lastname: Wong
authors.forename: Jessica
authors.initials: J
authors.lastname: Lin
authors.forename: Aaron
authors.initials: A
authors.lastname: Lecompte
authors.forename: Christopher E
authors.initials: CE
authors.lastname: Hann
authors.forename: Jim I
authors.initials: JI
authors.lastname: Mann
mesh_terms: D000328:Adult; D000368:Aged; D003924:Diabetes Mellitus, Type 2 / Q000503:physiopathology*; D005260:Female; D006801:Humans; D007328:Insulin / Q000378:metabolism*; D007333:Insulin Resistance; D000078790:Insulin Secretion; D008297:Male; D008403:Mass Screening; D008875:Middle Aged; D015233:Models, Statistical; D009010:Monte Carlo Method; D012307:Risk Factors
chemical_list: D007328:Insulin