title: The dynamic insulin sensitivity and secretion test--a novel measure of insulin sensitivity.
abstract: The objective was to validate the methodology for the dynamic insulin sensitivity and secretion test (DISST) and to demonstrate its potential in clinical and research settings. One hundred twenty-three men and women had routine clinical and biochemical measurements, an oral glucose tolerance test, and a DISST. For the DISST, participants were cannulated for blood sampling and bolus administration. Blood samples were drawn at t = 0, 10, 15, 25, and 35 minutes for measurement of glucose, insulin, and C-peptide. A 10-g bolus of intravenous glucose at t = 5 minutes and 1 U of intravenous insulin immediately after the t = 15 minute sample were given. Fifty participants also had a hyperinsulinemic-euglycemic clamp. Relationships between DISST insulin sensitivity (SI) and the clamp, and both DISST SI and secretion and other metabolic variables were measured. A Bland-Altman plot showed little bias in the comparison of DISST with the clamp, with DISST underestimating the glucose clamp by 0.1·10(-2)·mg·L·kg(-1)·min(-1)·pmol(-1) (90% confidence interval, -0.2 to 0). The correlation between SI as measured by DISST and the clamp was 0.82; the c unit for the receiver operating characteristic curve analysis for the 2 tests was 0.96. Metabolic variables showed significant correlations with DISST SI and the second phase of insulin release. The DISST also appears able to distinguish different insulin secretion patterns in individuals with identical SI values. The DISST is a simple, dynamic test that compares favorably with the clamp in assessing SI and allows simultaneous assessment of insulin secretion. The DISST has the potential to provide even more information about the pathophysiology of diabetes than more complicated tests.
authors.affiliation: Edgar National Centre for Diabetes and Obesity Research, University of Otago, Dunedin 9054, New Zealand. kirsten.mcauley@otago.ac.nz
authors.forename: Kirsten A
authors.initials: KA
authors.lastname: McAuley
authors.forename: Juliet E
authors.initials: JE
authors.lastname: Berkeley
authors.forename: Paul D
authors.initials: PD
authors.lastname: Docherty
authors.forename: Thomas F
authors.initials: TF
authors.lastname: Lotz
authors.forename: Lisa A
authors.initials: LA
authors.lastname: Te Morenga
authors.forename: Geoff M
authors.initials: GM
authors.lastname: Shaw
authors.forename: Sheila M
authors.initials: SM
authors.lastname: Williams
authors.forename: J Geoffrey
authors.initials: JG
authors.lastname: Chase
authors.forename: Jim I
authors.initials: JI
authors.lastname: Mann
mesh_terms: D000328:Adult; D000368:Aged; D001786:Blood Glucose / Q000378:metabolism*; D003920:Diabetes Mellitus / Q000097:blood / Q000175:diagnosis*; D005260:Female; D005947:Glucose / Q000008:administration & dosage; D015309:Glucose Clamp Technique; D006801:Humans; D007328:Insulin / Q000097:blood / Q000378:metabolism*; D007333:Insulin Resistance; D000078790:Insulin Secretion; D008297:Male; D008875:Middle Aged
chemical_list: D001786:Blood Glucose; D007328:Insulin; D005947:Glucose