title: Clinical validation of the quick dynamic insulin sensitivity test.
abstract: The quick dynamic insulin sensitivity test (DISTq) can yield an insulin sensitivity result immediately after a 30-min clinical protocol. The test uses intravenous boluses of 10 g glucose and 1 U insulin at t = 1 and 11 min, respectively, and measures glucose levels in samples taken at t = 0, 10, 20, and 30 min. The low clinical cost of the protocol is enabled via robust model formulation and a series of population-derived relationships that estimate insulin pharmacokinetics as a function of insulin sensitivity (SI). Fifty individuals underwent the gold standard euglycaemic clamp (EIC) and DISTq within an eight-day period. SI values from the EIC and two DISTq variants (four-sample DISTq and two-sample DISTq30) were compared with correlation, Bland-Altman and receiver operator curve analyses. DISTq and DISTq30 correlated well with the EIC [R = 0.76 and 0.75, and receiver operator curve c-index = 0.84 and 0.85, respectively]. The median differences between EIC and DISTq/DISTq30 SI values were 13% and 22%, respectively. The DISTq estimation method predicted individual insulin responses without specific insulin assays with relative accuracy and thus high equivalence to EIC SI values was achieved. DISTq produced very inexpensive, relatively accurate immediate results, and can thus enable a number of applications that are impossible with established SI tests.
authors.affiliation: Centre for Bioengineering, University of Canterbury, Christchurch 8140, New Zealand. paul.docherty@canterbury.ac.nz
authors.forename: Paul D
authors.initials: PD
authors.lastname: Docherty
authors.forename: Juliet E
authors.initials: JE
authors.lastname: Berkeley
authors.forename: Thomas F
authors.initials: TF
authors.lastname: Lotz
authors.forename: Lisa
authors.initials: L
authors.lastname: Te Morenga
authors.forename: Liam M
authors.initials: LM
authors.lastname: Fisk
authors.forename: Geoffrey M
authors.initials: GM
authors.lastname: Shaw
authors.forename: Kirsten A
authors.initials: KA
authors.lastname: McAuley
authors.forename: Jim I
authors.initials: JI
authors.lastname: Mann
authors.forename: J Geoffrey
authors.initials: JG
authors.lastname: Chase
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D005947:Glucose / Q000008:administration & dosage / Q000378:metabolism; D015309:Glucose Clamp Technique / Q000379:methods*; D005951:Glucose Tolerance Test / Q000379:methods*; D006801:Humans; D007328:Insulin / Q000378:metabolism; D007333:Insulin Resistance / Q000502:physiology*; D019344:Lactic Acid; D008297:Male; D008875:Middle Aged; D008954:Models, Biological; D012372:ROC Curve
chemical_list: D007328:Insulin; D019344:Lactic Acid; D005947:Glucose