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Colegio de Medicina Interna de México.

2009, Number 6

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Med Int Mex 2009; 25 (6)

Utilidad de los criterios clínicos del NCEP y la FID del síndrome metabólico para detectar resistencia a la insulina mediante el HOMA

Rosendo BN, Franco SO, Carranza MJ

Language: Spanish
References: 13
Page: 429-431
PDF size: 180.73 Kb.


ABSTRACT

Background: Metabolic syndrome is a public health problem that increases the risk of cardiovascular events and diabetes mellitus. There are several clinical approaches to detect metabolic syndrome as indicators of insulin resistance. In our means these approaches have not been contrasted with measurements of insulin resistance, so its true utility is unknown.
Objective: Determine the utility of clinical approaches of metabolic syndrome in order to detect insulin resistance using the Homeostasis Method Assesment (HOMA) in two cut points.
Method: Patients were diagnosed with metabolic syndrome according to NCEP and FID criteria, where HOMA was calculated = Fasting glucose(mmol/l) x Fasting Insulin (mU/dl)/22.5. HOMA ≥2.5 was considered a predictor insulin resistance level of cardiovascular events and HOMA ≥3.5 was considered an increased risk of metabolic syndrome. Sensibility (S) was calculated upon the formula: S=VP/(VP+FP); the specificity (SP) with the formula: SP=VN/(VN+FN); the positive predictive value: VPP=VP/(VP+VN), the negative predictive value: VPN=FN/(FP+FN); accuracy (A) was calculated upon the formula: A=(VP+FN)/(VP+VN+FP+FN). Patients with HOMA ≥3.5 or ≥2.5 were considered positive for metabolic syndrome and for the reference test.
Results: For HOMA ≥3.5, S: 60.8% NCEP, 62.6% FID; SP: 21.1% NCEP, 20.3% FID; VPP: 50.6% NCEP, 49.4% FID; VPN: 28.9% NCEP, 30.5% FID; A: 43.8% NCEP and FID. For HOMA ≥2.5, S: 71.7% NCEP, 72.3% FID; SP: 46.3% NCEP, 47.7% FID; VPP: 71.7% NCEP, 70.5% FID; VPN: 46.3% NCEP, 50% FID; A: 71.9% NCEP, 72.5% FID.
Conclusions: There are no differences between NCEP and FID criteria. These criteria value is superior when cutting at level 2.5. The sensibility, the VPP and the accuracy are superior to the specificity and the VPN. It is necessary to carry out the calculation of HOMA, especially when the clinical approaches are negative, since this does not discard insulin resistance in patients.


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