Skip to main content

Advertisement

SpringerLink
Log in

Comparison of Estimates of Insulin Sensitivity in Pre- and Postmenopausal V/omen Using the Insulin Tolerance Test and the Frequently Sampled Intravenous Glucose Tolerance Test

  • Published:
The Journal of the Society for Gynecologic Investigation: JSGI Aims and scope Submit manuscript

Abstract

Objective

We assessed insulin sensitivity in women comparing the insulin tolerance test (ITT) with the intravenous glucose tolerance test with frequent sampling and computer modeling (FSIVGTT) and evaluated the effects ofhormonal therapy in postmenopausal women using both methods.

Methods

This prospective study tested 18 premenopausal women and ten postmenopausal women randomized to receive either estrogen alone or estrogen with a sequential progestin for 6 months at a menopause research clinic. All subjects received an ITT and an FSIVGTT within 48–72 hours of each other in random sequence. Postmenopausal women were then randomized to receive either 0.625 mg conjugated equine estrogen for 6 months or 0.625 mg conjugated equine estrogen with medroxyprogesterone acetate, 10 mg, for 10 days each month for 6 months. Both the ITT and the FSIVGTT were repeated following hormonal therapy at 2 and 6 months. Plasma insulin and glucose were measured; insulin sensitivity was calculated after the ITT (Kitt) and the FSIVGTT (Si) at each visit in each group.

Results

A close correlation was found between Kitt and Si values at initial testing in both pre- and postmenopausal women and following both types of hormonal therapy (r = 0.76 for all tests, P <.001). A reduction in insulin sensitivity was observed in postmenopausal compared to premenopausal women; this occurred in five of ten postmenopausal women using the Kitt measurement and in four often women using Si. Estrogen replacement had a beneficial effect on insulin sensitivity. While Kitt increased by 24.2 ± 9.6% (P <.05), the increase in Si (6.7 ± 18%) was not significant because of the variability with this measurement. An attenuation in insulin sensitivity was seen with added progestin. Kitt values decreased by 17.7 ± 7.7% and Si values by 31.9 ± 12%. Similar findings were noted at 2 and 6 months.

Conclusions

The ITT and FSIVG TT provide quantitatively similar information regarding insulin sensitivity in healthy women. A mild degree of insulin resistance appears to be present in some healthy postmenopausal women. Estrogen appears to improve insulin sensitivity, while added progestin may attenuate this beneficial effect.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Stampfer MJ, Willett WC, Colditz GA, Rosner B, Speizer FE, Hennekens CH. A prospective study of postmenopausal estrogen therapy and coronary heart disease. N Engl J Med 1985;313:1044–9.

    Article  CAS  Google Scholar 

  2. Henderson BE, Paginini-Hill A, Ross RK. Decreased mortality in users of estrogen replacement therapy. Arch Intern Med 1991;151:75–8.

    Article  CAS  Google Scholar 

  3. Lobo RA. Clinical review 27. Effects of hormonal replacement on lipids and lipoproteins in postmenopausal women. J Clin Endocrinol Metab 1991;73:925–30.

    Article  CAS  Google Scholar 

  4. Bush TL. Noncontraceptive estrogen use and risk of cardiovascular disease: An overview and critique of the literature. Proceedings of the Symposium on the Menopause, sponsored by Serono Symposia, USA, March 5–8, 1989, Napa, CA. (1990 Serono Symposia, USA, 100 Longwater Circle, Norwell, MA 02061.)

    Google Scholar 

  5. Garcia MJ, McNamara PM, Gordon T, Kannel WB. Morbidity and mortality in diabetics in the Framingham population: Sixteen year follow-up study. Diabetes 1974;23:105- 11.

    Article  CAS  Google Scholar 

  6. Pyorala K. Diabetes and coronary heart disease. Acta Endocrinol 1985;110(suppl 272):11–9.

    Article  Google Scholar 

  7. Spellacy WN, Buhi WC, Birk SA. The effect of two years of mestranol treatment on carbohydrate metabolism. Metabolism 1982;31:1006–8.

    Article  CAS  Google Scholar 

  8. Ballejo G, Saleem TH, Khan-Dawood FS, Tsibris JCM, Spellacy WN. The effect of sex steroids on insulin binding by target tissues in the rat. Contraception 1983;28:413–22.

    Article  CAS  Google Scholar 

  9. Barrett-Connor E, Laakso M. Ischemic heart disease risk in postmenopausal women. Effects of estrogen use on glucose and insulin levels. Arteriosclerosis 1990;10:531–4.

    Article  CAS  Google Scholar 

  10. Lindheim SR, Presser SC, Ditkoff EC, Vijod MA, Stanczyk FZ, Lobo RA. A possible bimodal effect of estrogen on insulin sensitivity in postmenopausal women and the attenuating effect of added progestin. Fertil Steril 1993;60: 664–7.

    Article  CAS  Google Scholar 

  11. Bonora E, Moghetti P, Zancanaro C, et al. Estimates of in vivo insulin action in man: Comparison of insulin tolerance tests with euglycemic and hyperglycemic glucose clamp studies. J Clin Endocrinol Metab 1989;68:374–8.

    Article  CAS  Google Scholar 

  12. Bergman RN, Phillips LS, Cobelli C. Physiologic evaluation of factors controlling glucose tolerance in man. Measurement of insulin sensitivity and β-cell glucose sensitivity from the response to intravenous glucose. J Clin Invest 1981;68:1456–67.

    Article  CAS  Google Scholar 

  13. Beard JC, Bergman RN, Ward K, Porte D Jr. The insulin sensitivity index in man: Correlation between clampderived and IVGTT-derived values. Diabetes 1986;35: 362–9.

    Article  CAS  Google Scholar 

  14. Bergman RN, Prager R, Volund A, Olefsky JM. Equivalence of the insulin sensitivity index in man derived by the minimal model method and euglycemic clamp. J Clin Invest 1987;79:790–900.

    Article  CAS  Google Scholar 

  15. Trinder P. Determination of blood glucose using 4-amino nazone as oxygen acceptor. J Clin Pathol 1969;22:246.

    Article  CAS  Google Scholar 

  16. Cassidenti DL, Pike MC, Vijod AG, Stanczyk FZ, Lobo RA. A reevaluation of estrogen status in postmenopausal women who smoke. Am J Obstet Gynecol 1992;166: 1444–8.

    Article  CAS  Google Scholar 

  17. Pyorala K, Savolainen E, Kaukola S, Haapakoski J. Plasma insulin as coronary heart disease risk factor: Relationship to other risk factors and predictive value during 9.5-year follow- up of the Helsinki Policemen Study population. Acta Med Scand Suppl 1985;701:38–52.

    CAS  PubMed  Google Scholar 

  18. Eschwege E, Richard JL, Thibult N, et al. Coronary heart disease mortality in relation with diabetes, blood glucose and plasma insulin levels. The Paris Prospective Study, ten years later. Horm Metab Res 1985;(suppl)15:41–6.

    CAS  Google Scholar 

  19. Lindheim SR, Duffy DM, Kojima T, Vijod MA, Stanczyk FX, Lobo RA. The route of administration influences the effect of estrogen on insulin sensitivity in postmenopausal women. Fertil Steril (in press).

  20. Godsland IF, Gangar K, Walton C, et al. Insulin resistance, secretion, and elimination in postmenopausal women receiving oral or transdermal hormone replacement therapy. Metabolism 1993;42:846–53.

    Article  CAS  Google Scholar 

  21. Tsibris JC, Hunt LT, Ballejo G, Barker W, Toney LJ, Spellacy WN. Selective inhibition of protein disulfide isomerase by estrogens. J Biol Chem 1989;264:13967–70.

    CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Women’s Hospital, 1240 North Mission Road, Room 1M2, Los Angeles, CA, 90033, USA

    Steven R. Lindheim MD, Thomas A. Buchanan MD, Daniel M. Duffy MD, Marcela A. Vijod BS, Tetsuya Kojima MD, Frank Z. Stanczyk PhD & Rogerio A. Lobo MD

  2. Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, University of Southern California School of Medicine, Los Angeles, California, USA

    Steven R. Lindheim MD, Thomas A. Buchanan MD, Daniel M. Duffy MD, Marcela A. Vijod BS, Tetsuya Kojima MD, Frank Z. Stanczyk PhD & Rogerio A. Lobo MD

Authors
  1. Steven R. Lindheim MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Thomas A. Buchanan MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Daniel M. Duffy MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Marcela A. Vijod BS
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Tetsuya Kojima MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Frank Z. Stanczyk PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Rogerio A. Lobo MD
    View author publications

    You can also search for this author in PubMed Google Scholar

Additional information

Supported in part by National Institutes of Health, National Center for Research Resources of the General Research Center Grant MO1 RR-43 (NCRR GCRC Grant MO1RR43).

Rights and permissions

Reprints and permissions

About this article

Cite this article

Lindheim, S.R., Buchanan, T.A., Duffy, D.M. et al. Comparison of Estimates of Insulin Sensitivity in Pre- and Postmenopausal V/omen Using the Insulin Tolerance Test and the Frequently Sampled Intravenous Glucose Tolerance Test. Reprod. Sci. 1, 150–154 (1994). https://doi.org/10.1177/107155769400100210

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1177/107155769400100210

Key words

Search

Navigation