Evaluation of Simple Indices of Insulin Sensitivity and Insulin Secretion for Use in Epidemioiogic Studies

Abstract

The metabolic characteristics of type 2 diabetes, insulin resistance, and diminished insulin secretion are costly to measure directly. To evaluate the utility of several simple indices derived from insulin and glucose measurements, the indices were examined from 1982 to 1997 with respect to correlation with more sophisticated measures of insulin sensitivity and secretion in Pima Indians in the Gila River Indian Community of Arizona. Ability to predict the incidence of diabetes in 1, 731 persons was also examined. Indices were calculated from fasting and 2-hour glucose (G₀, G₁₂₀) and insulin (I₀, I₁₂₀) concentrations obtained during an oral glucose tolerance test. Fasting serum insulin concentration and the insulin sensitivity index (10⁴/(I₀ × G₀)) each showed a moderate correlation with the estimate of insulin sensitivity derived from the hyperinsulinemiceuglycemic clamp (|r| ≈ 0.60). They also strongly predicted the incidence of diabetes (incidence rate ratio comparing the most and least insulin-resistant tertile groups ≈ 3.0). Corrected insulin response (I₁₂₀/(G₁₂₀ × (G₁₂₀ − 70))) was modestly correlated with insulin secretion as measured by an intravenous glucose tolerance test (r = 0.35). Impaired insulin secretion assessed by this index predicted incidence of diabetes, particularly after control for insulin sensitivity index (incidence rate ratio = 1.6). Thus, simple indices of insulin sensitivity and secretion may be responsible surrogates for more sophisticated measures in epidemiologic studies. Am J Epidemiol 2000; 151:190-8.