Design and clinical pilot testing of the model-based dynamic insulin sensitivity and secretion test (DISST).
BACKGROUND
Insulin resistance is a significant risk factor in the pathogenesis of type 2 diabetes. This article presents pilot study results of the dynamic insulin sensitivity and secretion test (DISST), a high-resolution, low-intensity test to diagnose insulin sensitivity (IS) and characterize pancreatic insulin secretion in response to a (small) glucose challenge. This pilot study examines the effect of glucose and insulin dose on the DISST, and tests its repeatability.


METHODS
DISST tests were performed on 16 subjects randomly allocated to low (5 g glucose, 0.5 U insulin), medium (10 g glucose, 1 U insulin) and high dose (20 g glucose, 2 U insulin) protocols. Two or three tests were performed on each subject a few days apart.


RESULTS
Average variability in IS between low and medium dose was 10.3% (p=.50) and between medium and high dose 6.0% (p=.87). Geometric mean variability between tests was 6.0% (multiplicative standard deviation (MSD) 4.9%). Geometric mean variability in first phase endogenous insulin response was 6.8% (MSD 2.2%). Results were most consistent in subjects with low IS.


CONCLUSIONS
These findings suggest that DISST may be an easily performed dynamic test to quantify IS with high resolution, especially among those with reduced IS.
Centre for Bioengineering, University of Canterbury, and Department of Intensive Medicine, Christchurch Hospital, Christchurch, New Zealand.
Thomas F
TF
Lotz
J Geoffrey
JG
Chase
Kirsten A
KA
McAuley
Geoffrey M
GM
Shaw
Paul D
PD
Docherty
Juliet E
JE
Berkeley
Sheila M
SM
Williams
Christopher E
CE
Hann
Jim I
JI
Mann
D000328:Adult; D015415:Biomarkers / Q000097:blood; D001786:Blood Glucose / Q000378:metabolism*; D002096:C-Peptide / Q000097:blood; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000175:diagnosis* / Q000503:physiopathology; D005240:Feasibility Studies; D005260:Female; D005947:Glucose; D005951:Glucose Tolerance Test; D006801:Humans; D007328:Insulin / Q000097:blood; D007333:Insulin Resistance; D008297:Male; D008875:Middle Aged; D009520:New Zealand; D010179:Pancreas / Q000378:metabolism*; D010865:Pilot Projects; D011237:Predictive Value of Tests; D015203:Reproducibility of Results; D012107:Research Design; D013997:Time Factors; D055815:Young Adult
D015415:Biomarkers; D001786:Blood Glucose; D002096:C-Peptide; D007328:Insulin; D005947:Glucose