title: Accuracy and precision of commonly used methods for quantifying surgery-induced insulin resistance: Prospective observational study.
abstract: BACKGROUND
  Insulin resistance develops in the perioperative setting and has an adverse influence on postoperative recovery and well-being.
  
  
  OBJECTIVE
  To evaluate the effectiveness of commonly used methods for quantifying surgery-induced insulin resistance.
  
  
  METHODS
  Prospective observational study.
  
  
  METHODS
  Surgery department and orthopaedic ward at two regional hospitals.
  
  
  METHODS
  Twenty-two patients (mean age 68 years) scheduled for elective hip replacement.
  
  
  METHODS
  A short seven-sample intravenous glucose tolerance test (IVGTT) followed by a euglycaemic hyperinsulinaemic glucose clamp 1 day before and 2 days after the surgery.
  
  
  METHODS
  Insulin resistance shown by dynamic tests (the IVGTT and the glucose clamp) were compared to static tests [the quantitative insulin sensitivity check index (QUICKI) and the homeostatic model assessment-insulin resistance (HOMA-IR)], which use only the plasma glucose and insulin concentrations at baseline.
  
  
  RESULTS
  The linear correlation coefficients for the relationship between insulin resistance as obtained with the glucose clamp and the other methods before or after surgery were 0.76 (IVGTT), 0.58 (QUICKI) and -0.65 (HOMA). The prediction errors (precision) averaged 18, 29 and 31%, respectively. Surgery-induced insulin resistance amounted to 45% (glucose clamp), 26% (IVGTT), 4% (QUICKI) and 3% (HOMA).
  
  
  CONCLUSIONS
  Despite reasonably good linear correlations, the static tests grossly underestimated the degree of insulin resistance that developed in response to surgery.
authors.affiliation: From the Research Unit, Södertälje Hospital, Södertälje (SL, RGH), Section of Internal Medicine, Department of Clinical Science and Education, Karolinska Institutet, Södersjukhuset, Stockholm (SL, TN) and Department of Anesthesia, Linköping University, Linköping (RGH), Sweden.
authors.forename: Stefan
authors.initials: S
authors.lastname: Ljunggren
authors.forename: Thomas
authors.initials: T
authors.lastname: Nyström
authors.forename: Robert G
authors.initials: RG
authors.lastname: Hahn
mesh_terms: D000368:Aged; D019644:Arthroplasty, Replacement, Hip / Q000379:methods; D001786:Blood Glucose / Q000032:analysis; D005260:Female; D015309:Glucose Clamp Technique / Q000592:standards*; D005951:Glucose Tolerance Test / Q000592:standards*; D006706:Homeostasis; D006801:Humans; D007328:Insulin / Q000097:blood; D007333:Insulin Resistance; D008099:Liver / Q000378:metabolism; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D015203:Reproducibility of Results; D013514:Surgical Procedures, Operative / Q000009:adverse effects*; D013997:Time Factors
chemical_list: D001786:Blood Glucose; D007328:Insulin