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      Assessment of preferred methods to measure insulin resistance in Asian patients with hypertension

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          Abstract

          Insulin resistance (IR), a metabolic risk factor, is linked to the pathogenetic mechanism of primary hypertension. Detecting IR in the patients with hypertension will help to predict and stratify the added cardiovascular risk, institute appropriate IR management, and manage hypertension optimally. There are many methods for assessing IR, each with distinct advantages and disadvantages. The euglycemic insulin clamp and intravenous glucose tolerance test, gold standards for measuring IR, are used in research but not in clinical practice. Homeostatic model assessment (HOMA‐IR), a method for assessing β‐cell function and IR, is frequently applied presently, particularly in Asia. Besides, the triglyceride–glucose index (TyG) first published by South American authors showed a good correlation with the insulin clamp technique and HOMA‐IR index. This simple, convenient, and low‐cost TyG index is of research interest in many countries in Asia and can be used to screen for IR in the Asian hypertensive community.

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          The product of triglycerides and glucose, a simple measure of insulin sensitivity. Comparison with the euglycemic-hyperinsulinemic clamp.

          To meet the worldwide challenge of emerging diabetes, accessible and inexpensive tests to identify insulin resistance are needed. To evaluate the sensitivity and specificity of the product of fasting, we compared the triglycerides and glucose (TyG) index, a simple measure of insulin resistance, with the euglycemic-hyperinsulinemic clamp test. We conducted a cross-sectional study of the general population and outpatients of the Internal Medicine Department at the Medical Unit of High Specialty of the Specialty Hospital at the West National Medical Center in Guadalajara, Mexico. Eleven nonobese healthy subjects, 34 obese normal glucose tolerance individuals, 22 subjects with prediabetes, and 32 diabetic patients participated in the study. We performed a euglycemic-hyperinsulinemic clamp test. Sensitivity and specificity of the TyG index [Ln(fasting triglycerides) (mg/dl) x fasting glucose (mg/dl)/2] were measured, as well as the area under the curve of the receiver operating characteristic scatter plot and the correlation between the TyG index and the total glucose metabolism (M) rates. Pearson's correlation coefficient between the TyG index and M rates was -0.681 (P < 0.005). Correlation between the TyG index and M rates was similar between men (-0.740) and women (-0.730), nonobese (-0.705) and obese (-0.710), and nondiabetic (-0.670) and diabetic (-0.690) individuals. The best value of the TyG index for diagnosis of insulin resistance was 4.68, which showed the highest sensitivity (96.5%) and specificity (85.0%; area under the curve + 0.858). The TyG index has high sensitivity and specificity, suggesting that it could be useful for identification of subjects with decreased insulin sensitivity.
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            The product of fasting glucose and triglycerides as surrogate for identifying insulin resistance in apparently healthy subjects.

            Because the insulin test is expensive and is not available in most laboratories in the cities of undeveloped countries, we tested whether the product of fasting triglycerides and glucose levels (TyG) is a surrogate for estimating insulin resistance compared with the homeostasis model assessment of insulin resistance (HOMA-IR) index. We performed a population-based cross-sectional study. Sampling strategy was based on a randomized two-stage cluster sampling procedure. Only apparently healthy subjects, men and nonpregnant women aged 18-65 years, with newly diagnosed impaired fasting glucose (IFG), impaired glucose tolerance (IGT), or IFG + IGT were enrolled. Renal disease, malignancy, and diabetes were exclusion criteria. Sensitivity, specificity, predictive values, and the probability of disease given a positive test were calculated. The optimal TyG index for estimating insulin resistance was established using a receiver operating characteristic scatter plot analysis. A total of 748 apparently healthy subjects aged 41.4 +/- 11.2 years were enrolled. Insulin resistance was identified in 241 (32.2%) subjects (HOMA-IR index 4.4 +/- 1.6). New diagnoses of IFG, IGT, and IFG + IGT were established in 145 (19.4%), 54 (7.2%), and 75 (10.0%) individuals. respectively. The best TyG index for diagnosis of insulin resistance was Ln 4.65, which showed the highest sensitivity (84.0%) and specificity (45.0%) values. The positive and negative predictive values were 81.1% and 84.8%, and the probability of disease, given a positive test, was 60.5%. The TyG index could be useful as surrogate to identify insulin resistance in apparently healthy subjects.
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              Current approaches for assessing insulin sensitivity and resistance in vivo: advantages, limitations, and appropriate usage.

              Insulin resistance contributes to the pathophysiology of diabetes and is a hallmark of obesity, metabolic syndrome, and many cardiovascular diseases. Therefore, quantifying insulin sensitivity/resistance in humans and animal models is of great importance for epidemiological studies, clinical and basic science investigations, and eventual use in clinical practice. Direct and indirect methods of varying complexity are currently employed for these purposes. Some methods rely on steady-state analysis of glucose and insulin, whereas others rely on dynamic testing. Each of these methods has distinct advantages and limitations. Thus, optimal choice and employment of a specific method depends on the nature of the studies being performed. Established direct methods for measuring insulin sensitivity in vivo are relatively complex. The hyperinsulinemic euglycemic glucose clamp and the insulin suppression test directly assess insulin-mediated glucose utilization under steady-state conditions that are both labor and time intensive. A slightly less complex indirect method relies on minimal model analysis of a frequently sampled intravenous glucose tolerance test. Finally, simple surrogate indexes for insulin sensitivity/resistance are available (e.g., QUICKI, HOMA, 1/insulin, Matusda index) that are derived from blood insulin and glucose concentrations under fasting conditions (steady state) or after an oral glucose load (dynamic). In particular, the quantitative insulin sensitivity check index (QUICKI) has been validated extensively against the reference standard glucose clamp method. QUICKI is a simple, robust, accurate, reproducible method that appropriately predicts changes in insulin sensitivity after therapeutic interventions as well as the onset of diabetes. In this Frontiers article, we highlight merits, limitations, and appropriate use of current in vivo measures of insulin sensitivity/resistance.
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                Author and article information

                Contributors
                hvminhdr@yahoo.com , hvminh@hueuni.edu.vn , hvminh@huemed-univ.edu.vn
                Journal
                J Clin Hypertens (Greenwich)
                J Clin Hypertens (Greenwich)
                10.1111/(ISSN)1751-7176
                JCH
                The Journal of Clinical Hypertension
                John Wiley and Sons Inc. (Hoboken )
                1524-6175
                1751-7176
                07 January 2021
                March 2021
                : 23
                : 3 , Hypertension in Asia: From national guidelines to Asian consensus ( doiID: 10.1111/jch.v23.3 )
                : 529-537
                Affiliations
                [ 1 ] Department of Internal Medicine University of Medicine and Pharmacy Hue University Hue Vietnam
                [ 2 ] Departement of Internal Medicine University of Medicine Vinh University Vinh Vietnam
                [ 3 ] Departement of Cardiology Hue Central Hospital Hue Vietnam
                [ 4 ] Institute of Public Health and Community Medicine Research Center National Yang‐Ming University School of Medicine Taipei Taiwan
                [ 5 ] Division of Cardiology Department of Medicine Taipei Veterans General Hospital Taipei Taiwan
                [ 6 ] Faculty of Medicine National Yang‐Ming University School of Medicine Taipei Taiwan
                [ 7 ] Department of General Medicine Tan Tock Seng Hospital Singapore City Singapore
                [ 8 ] Punjab Medical Center Lahore Pakistan
                [ 9 ] Cardiovascular Center and Division of Cardiology Department of Internal Medicine National Taiwan University Hospital Taipei City Taiwan
                [ 10 ] Division of Hospital Medicine Department of Internal Medicine National Taiwan University Hospital Taipei City Taiwan
                [ 11 ] MIOT International Hospital Chennai India
                [ 12 ] College of Medical Sciences Kathmandu University Bharatpur Nepal
                [ 13 ] Department of Primary Care Medicine Faculty of Medicine University of Malaya Kuala Lumpur Malaysia
                [ 14 ] Department of Medical Sciences School of Healthcare and Medical Sciences Sunway University Bandar Sunway Malaysia
                [ 15 ] Division of Cardiovascular Medicine Department of Medicine Jichi Medical University School of Medicine Tochigi Japan
                Author notes
                [*] [* ] Correspondence

                Huynh Van Minh, University Hospital, University of Medicine and Pharmacy, Hue University, 41 Nguyen Hue Street, Hue City 52000, Vietnam.

                Emails: hvminhdr@ 123456yahoo.com ; hvminh@ 123456hueuni.edu.vn ; hvminh@ 123456huemed-univ.edu.vn

                Author information
                https://orcid.org/0000-0003-4273-4187
                https://orcid.org/0000-0002-9262-0287
                https://orcid.org/0000-0001-7657-4383
                https://orcid.org/0000-0003-1294-0430
                https://orcid.org/0000-0002-7180-3607
                https://orcid.org/0000-0002-1410-9328
                https://orcid.org/0000-0003-1995-0359
                https://orcid.org/0000-0002-8251-4480
                Article
                JCH14155
                10.1111/jch.14155
                8029536
                33415834
                9aa87881-578c-499c-b116-0848dbf5e4e9
                © 2021 The Authors. The Journal of Clinical Hypertension published by Wiley Periodicals LLC.

                This is an open access article under the terms of the http://creativecommons.org/licenses/by-nc/4.0/ License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited and is not used for commercial purposes.

                History
                : 14 December 2020
                : 12 October 2020
                : 15 December 2020
                Page count
                Figures: 0, Tables: 3, Pages: 0, Words: 6232
                Categories
                Review Paper
                Hypertension and Clinical Outcomes
                Custom metadata
                2.0
                March 2021
                Converter:WILEY_ML3GV2_TO_JATSPMC version:6.0.1 mode:remove_FC converted:06.04.2021

                asia patients,hypertension,insulin resistance
                asia patients, hypertension, insulin resistance

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