Hernández YJA, Tuero IA, Vargas GD

Language: Spanish
References: 17
Page: 69-77
PDF size: 57.06 Kb.

ABSTRACT

Introduction: HOMA-IR index is a simple and not much invasive procedure allowing by a validated and well established formula to specify exactly a value expression of insulin resistance. To estimate the HOMA-IR index with an only numerical value of insulinemia could to present a greater variability, something that could be solved with at least the mean of three insulinemias, according to original formula. En some studies it is habitual to perform it with a single insulinemia determination. Thus, we conducted a study in patients presenting type 2 diabetes and to compare the results as regards the sensitivity and specificity with a single blood determination for insulinemia and glycemia.
Objectives: to assess the sensitivity and specificity of each of insulinemia determinations performed each 5 min versus the mean of these determinations during the application of formula for HOMA-IR index.
Methods: sixty patients diagnosed with type 2 diabetes attended in the Center for Diabetic Care of La Habana were studied. They had a diabetes course time lower than 5 years as average with predominance of body excess weight recruited during 6 months in a consecutive way and the carrying out of fasting insulinemias and glycemias determinations by trocar and venous blood extraction at 0,5 and 10 min for a calculation of Mathews's hemostatic model known as HOMA-IR.
Results: a 88,3 % had a HOMA-IR greater than 3,2. The sensitivity of a single sample of insulinemia, although high to confirm the insulin resistance diagnosis, it is variable and specificity of one of samples was low with a 14%. There is an appropriate concordance among the positive predictor values with sensitivity and the negative predictive values with the test specificity.
Conclusions: a single insulinemia determination to study HOMA-IR is useful in daily practice, although it is necessary much accuracy to apply the original formula for a better reproducibility.

REFERENCES

1. Benozzi S, Ordoñez F, Polini N, Alvarez C, Selles J, Coniglio RI. Insulino resistencia y síndrome metabólico en pacientes con enfermedad coronaria definida por angiografía. Medicina (Buenos Aires). 2009;69:225-8.

2. De Fronzo RA. Insulin resistance. A multifactorial síndrome. Diabetes Care. 1991;36:429-51.

3. Haffner S.M, Miettinen H, Stern MP. The homeostasis model in the San Antonio Heart Study. Diabetes Care. 1997;20:1087-92.

4. Haffner SM, Meittinen H, Gaskill PP. Decreased insulin action and insulin secretion predict the development of impaired glucose tolerance. Diabetologia. 1996;39:1201- 7.

5. Garcia-Estevez DA, Araujo-Vilar D, Fiestras-Janeiro G, Saavedra-González A. Cabezas-Cerrato J. Comparison of several insulin sensitivity índices derived from basal plasma insulin and glucose levels with minimal model índices. Horm Metab Res. 2003;35:13-7.

6. Javier Taverna M. Homeostatic model assessment (HOMA). Rev Asociación Latinoamericana de Diabetes. 2002;10(1):8-17.

7. Haffner SM, Gonzalez C, Meittinen H, Kennedy E, Dtem M. A prospective analysis of the HOMA model. Diabetes Care. 1996;19:138-41.

8. Hernández Yero JA, Vargas González D. Utilidad de Diamel en pacientes con diabetes mellitus tipo 2 en tratamiento combinado con glibenclamida. Av Diabetologia. 2007;23(1):284-90.

9. Matthews DR, Hosker JP, Rudenski AS, Nayor BA, Treacher DF, Turner RL. Homeostatic model assessment: insulin resistance and beta-cell function from fasting plasma glucose and insulin concentrations in man. Diabetologia. 1985;28:412-9.

10. Trinder D. Determination of glucose in blood using glucose oxidase with an alternative oxygen acceptor. Ann Clin Biochem. 1969;6:24-7.

11. Arranz C, González RM. Utilización de un método rápido para la separación de la hormona libre y unida en el radioinmunoensayo de insulina. Rev Cubana Invest Biomed. 1988;7:150-6.

12. Bonora E, Targher G, Alberichie M, Bonadonna RC, Saggianni F, Zenere MB, et al. Homeostasis model assessment as a clinical index of insulin resistance in type 2 diabetic patients treated with sulfonylureas. Diabetes Care. 2000;23:57-63.

13. Wallace TM, Levy JC, Matthews DR. Use and abuse of HOMA modeling. Diabetes Care. 2004;27:1487-95.

14. Buccini GS, Wolfthal DL. Valores de corte para índices de insulinorresistencia, insulinosensibilidad e insulinosecreción derivados de la fórmula HOMA y del programa HOMA-2. Rev Argentina Endocrinología y Metabolismo. 2008;1:3-21.

15. Urdaneta Machado J, Vera Cabana J, Garcia Ildefonso J, Babel Zambrano N, Contreras Benitez A. Insulino resistencia en mujeres infértiles. Rev Chil Obstet Ginecol. 2010;75(3):153-61.

16. Park K, Steffers M, Lee DH, Himes AH, Jacobs DR. Association of inflammation with worsening HOMA insulin resistance. Diabetologia. 2009;52(1):2337-44.

17. Arranz C, González RM, Álvarez A, Rodríguez B, Reyes A. Reference criteria for insulin secretion indicators and of the lipid parameters in a hospital mixed population. Rev Cubana Endocrinol. 2010;21:1-12.