Prediction of clamp-derived insulin sensitivity from the oral glucose insulin sensitivity index
The euglycaemic–hyperinsulinaemic clamp is the gold-standard method for measuring insulin sensitivity, but is less suitable for large clinical trials. Thus, several indices have been developed for evaluating insulin sensitivity from the oral glucose tolerance test (OGTT). However, most of them yield values different from those obtained by the clamp method. The aim of this study was to develop a new index to predict clamp-derived insulin sensitivity (M value) from the OGTT-derived oral glucose insulin sensitivity index (OGIS).
We analysed datasets of people that underwent both a clamp and an OGTT or meal test, thereby allowing calculation of both the M value and OGIS. The population was divided into a training and a validation cohort (n = 359 and n = 154, respectively). After a stepwise selection approach, the best model for M value prediction was applied to the validation cohort. This cohort was also divided into subgroups according to glucose tolerance, obesity category and age.
The new index, called PREDIcted M (PREDIM), was based on OGIS, BMI, 2 h glucose during OGTT and fasting insulin. Bland–Altman analysis revealed a good relationship between the M value and PREDIM in the validation dataset (only 9 of 154 observations outside limits of agreement). Also, no significant differences were found between the M value and PREDIM (equivalence test: p < 0.0063). Subgroup stratification showed that measured M value and PREDIM have a similar ability to detect intergroup differences (p < 0.02, both M value and PREDIM).
The new index PREDIM provides excellent prediction of M values from OGTT or meal data, thereby allowing comparison of insulin sensitivity between studies using different tests.
KeywordsGlucose clamp Glucose tolerance Insulin resistance Oral glucose tolerance test Prediction model Validation
Akaike’s information criterion
Glucose infusion rates
Impaired fasting glucose
Impaired glucose tolerance
Normal glucose tolerance
Oral glucose insulin sensitivity index
The authors wish to thank G. Kacerovsky-Bielesz and A. Brehm (Hanusch-Krankenhaus, Vienna, Austria) and A. Schmid, M. Chmelik and M. Fritsch (Medical University of Vienna, Vienna, Austria) for their help in clarifying some aspects of the data.
AT analysed the data, developed the model, and wrote the manuscript; GC and CG contributed to the analyses of the data and model development, and drafted the manuscript; JS, KF, JV, EF collected or contributed to collect the data, contributed to the interpretation of the results, and drafted the manuscript; GP contributed to the design of the study, to data analyses and results interpretation, and revised the manuscript critically; MR designed the study, contributed to data analyses and results interpretation, and revised the manuscript critically. All authors approved the final version. MR is the guarantor of this work.
Duality of interest
The authors declare that there is no duality of interest associated with this manuscript.
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