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      A simple way to identify insulin resistance in non-diabetic acute coronary syndrome patients with impaired fasting glucose

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          Abstract

          Background and Objective:

          The incidence of coronary artery disease (CAD) is increasing in India. Recent data suggesting insulin resistance can predict cardiovascular disease independently of the other risk factors, such as hypertension, visceral obesity, or dyslipidemia, so a focus on the relation between acute coronary syndrome (ACS) and insulin resistance is relevant. Several studies addressing serum lipoprotein ratios as surrogates for insulin resistance have found promising results. We analyzed the association of lipoprotein ratios with the homeostatic model assessment of insulin resistance (HOMA-IR).

          Methods:

          One hundred non-diabetic patients with impaired fasting glucose admitted with a diagnosis of ACS were included in the study. Admission fasting glucose and insulin concentrations were measured. The HOMA-IR was used to calculate insulin resistance. The fasting serum total cholesterol (TC), triglycerides (TG), and high-density lipoprotein (HDL-C) levels are used to calculate following lipid ratios: TC/HDL-C and TG/HDL-C. The areas under the curves (AUC) of the receiver operating characteristic curves (ROC) were used to compare the power of these serum lipoprotein ratio markers.

          Results:

          Lipoprotein ratios were significantly higher in patients with HOMA Index >2 as compared to patients with Index <2. TG/HDL-C ratio and TC/HDL-C ratio were significantly correlated with HOMA-IR ( P < 0.05) as obtained by Pearson's correlation analysis ( r = 0.4459, P = 0.0012; r = 0.4815, P = 0.0004; r = 0.3993; P = 0.0041, respectively). The area under the ROC curve of the TG/HDL-C and TC/HDL-C ratios for predicting insulin resistance was 0.80 (95% CI, 0.67-0.93), 0.78 (95% CI, 0.65-0.91), respectively.

          Conclusion:

          A plasma TG/HDL-C ratio and TC/HDL-C ratio provide a simple means of identifying insulin resistant and can be used as the markers of insulin resistance and cardiovascular diseases risk in adult non-diabetic patients.

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          Most cited references3

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          Should triglycerides and the triglycerides to high-density lipoprotein cholesterol ratio be used as surrogates for insulin resistance?

          The aims of the present study were to examine whether triglycerides (TG) and the triglyceride to high-density lipoprotein cholesterol ratio (TG/HDL-C) could predict insulin resistance in healthy African Americans and whites. This cross-sectional study included 99 African American and 50 white men and women between 18 and 45 years of age with body mass indexes between 18.5 and 38.0 kg/m(2). Anthropometric measures were obtained; and overnight fasting blood was collected for TG, HDL-C, glucose, and insulin. Insulin resistance was defined by fasting insulin concentration of at least 13.13 microU/mL and homeostasis model assessment of insulin resistance (HOMA-IR) of at least 2.5. Receiver operating characteristic curves were used to analyze the data. African Americans and whites had comparable demographic and anthropometric measures. Fasting insulin was higher in African Americans (12.4 +/- 7.8 microU/mL) than whites (10.2 +/- 7.5 microU/mL), but HOMA-IR did not differ significantly (African Americans, 2.9 +/- 2.0; whites, 2.4 +/- 1.9). Triglycerides and TG/HDL-C were significantly lower in African Americans (TG, 68.2 +/- 43.3 mg/dL; TG/HDL-C, 1.8 +/- 2.1) compared with whites (TG, 105.4 +/- 55.2 mg/dL; TG/HDL-C, 2.8 +/- 1.8). Area under the receiver operating characteristic curves revealed that both TG and TG/HDL-C were acceptable markers of insulin resistance, as defined by fasting insulin concentration, in whites, 0.770 and 0.765, respectively, but poor predictors in African Americans, 0.633 and 0.651, respectively. Similarly, TG and TG/HDL-C were acceptable in predicting insulin resistance, as measured by HOMA-IR, in whites, 0.763 and 0.770, respectively, but poor in predicting HOMA-IR in African Americans, with areas of 0.625 and 0.639, respectively. In conclusion, the relationship between TG and TG/HDL-C with insulin resistance differs by ethnicity; and using TG and TG/HDL-C to predict insulin resistance in African Americans would not be appropriate. Copyright 2010 Elsevier Inc. All rights reserved.
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            Insulin sensitivity indices: a proposal of cut-off points for simple identification of insulin-resistant subjects.

            Demanding measurement of insulin sensitivity using clamp methods does not simplify the identification of insulin resistant subjects in the general population. Other approaches such as fasting- or oral glucose tolerance test-derived insulin sensitivity indices were proposed and validated with the euglycemic clamp. Nevertheless, a lack of reference values for these indices prevents their wider use in epidemiological studies and clinical practice. The aim of our study was therefore to define the cut-off points of insulin resistance indices as well as the ranges of the most frequently obtained values for selected indices. A standard 75 g oral glucose tolerance test was carried out in 1156 subjects from a Caucasian rural population with no previous evidence of diabetes or other dysglycemias. Insulin resistance/sensitivity indices (HOMA-IR, HOMA-IR2, ISI Cederholm, and ISI Matsuda) were calculated. The 75th percentile value as the cut-off point to define IR corresponded with a HOMA-IR of 2.29, a HOMA-IR2 of 1.21, a 25th percentile for ISI Cederholm, and ISI Matsuda of 57 and 5.0, respectively. For the first time, the cut-off points for selected indices and their most frequently obtained values were established for groups of subjects as defined by glucose homeostasis and BMI. Thus, insulin-resistant subjects can be identified using this simple approach.
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              Association of serum lipoprotein ratios with insulin resistance in type 2 diabetes mellitus.

              The fasting serum total cholesterol (TC), triglycerides (TG), high density lipoprotein (HDL-C) and low density lipoprotein (LDL-C) levels are used to calculate following lipid ratios: TC/ HDL-C, TG/HDL-C, and LDL-C/HDL-C. Cholesterol retention fraction (CRF), non-HDL-C, LDL-C, TG and waist circumference (WC) one considered as markers for the identification of individuals with an increased risk for cardiovascular diseases (CVD). These individuals frequently show insulin resistance as well. We analyzed the association of lipoprotein ratios with the homeostasis model assessment of insulin resistance (HOMA-IR). Type 2 diabetes mellitus (T2D) patients (92) and 40 age match healthy controls were randomized from the Tapho Primary Health Care Unit and the area in the same district. The HOMA-IR was used to calculate for insulin resistance. The areas under the curves (AUC) of the receiver operating characteristic curves (ROC) were used to compare the power of these serum lipoprotein ratios markers. All lipoprotein ratios, lipid profile, blood pressure, and WC were significantly higher in T2D patients as compared to healthy controls (P<0.05). TC/HDL-C ratio, TG/HDL-C ratio, non-HDL-C, WC, TG, and TC were significantly correlated with HOMA-IR (P<0.05) as obtained by Spearman correlation analysis. The largest AUC of the ROC curve was obtained with the TC/HDL-C ratio as one parameter. TC/HDL-C ratio, TG/HDL-C, ratio, Non-HDL-C, WC, TG, and TC can be used as the markers of insulin resistance and CVD risk in T2D patients.
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                Author and article information

                Journal
                Indian J Endocrinol Metab
                Indian J Endocrinol Metab
                Indian Journal of Endocrinology and Metabolism
                Indian Journal of Endocrinology and Metabolism
                Medknow Publications & Media Pvt Ltd (India )
                2230-8210
                2230-9500
                December 2012
                : 16
                : Suppl 2
                : S460-S464
                Affiliations
                [1] Department of Medicine, Medical College and Hospital, Kolkata, India
                [1 ] Department of Cardiology, Medical College and Hospital, Kolkata, India
                [2 ] Department of Biochemistry, Medical College and Hospital, Kolkata, India
                [3 ] Department of Endocrinology, Medical College and Hospital, Kolkata, India
                Author notes
                Corresponding Author: Dr. Anirban Sinha, Department of Cardiology, Medical College and Hospital, Kolkata, West Bengal, India. E-mail: anirban.doc@ 123456gmail.com
                Article
                IJEM-16-460
                10.4103/2230-8210.104132
                3603115
                23565467
                8cb39a4e-d47e-46fd-a208-5e1000485dda
                Copyright: © Indian Journal of Endocrinology and Metabolism

                This is an open-access article distributed under the terms of the Creative Commons Attribution-Noncommercial-Share Alike 3.0 Unported, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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                Brief Communication

                Endocrinology & Diabetes
                acute coronary syndrome,homeostatic model assessment of insulin resistance,insulin resistance,lipoprotein ratios

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