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Low Insulin Sensitivity Measured by Both Quantitative Insulin Sensitivity Check Index and Homeostasis Model Assessment Method as a Risk Factor of Increased Intima-Media Thickness of the Carotid Artery

Departments of Public Health Science and General Practice (U.R., M.L., S.K.-K.) and Diagnostic Radiology (M.P., O.P., I.S.), University of Oulu; and Unit of General Practice (M.L., S.K.-K.), Oulu University Hospital, 90220 Oulu, Finland

Address all correspondence and requests for reprints to: Ulla Rajala, M.D., Ph.D., Department of Public Health Science and General Practice, University of Oulu, Aapistie 1, 90220 Oulu, Finland. E-mail: urajala{at}cc.oulu.fi.

Abstract

The present study evaluated the association of ultrasonographic manifestations of carotid atherosclerosis with glucose status, various components of the insulin resistance syndrome, and insulin sensitivity measured by a novel quantitative insulin sensitivity check index (QUICKI = 1/[log(I0) + log (G0)]). Carotid ultrasonographic measurements were performed on 54 diabetic subjects, 97 subjects with impaired glucose tolerance and 57 normoglycemic subjects. QUICKI and insulin resistance measured by a HOMA (homeostasis model assessment) method had a high negative correlation (r = -0.995, P < 0.001). QUICKI was lower in diabetic subjects (0.319 ± 0.022) than in subjects with impaired glucose tolerance (0.334 ± 0.027) or normoglycemia (0.335 ± 0.022, P = 0.002). There was an increasing trend in the mean and maximal intima-media thickness (IMT) of the common carotid artery (CCA) with worsening of glucose status. The maximal IMT of the CCA correlated inversely with QUICKI (r = -0.158, P = 0.027). The prevalence of severe CCA atherosclerosis (maximal IMT of the CCA 1.2 mm) was 41% in men and 16% in women (P < 0.001). It was also associated with a long (26 yr) smoking history. The prevalence of severe CCA atherosclerosis was 11% in the highest QUICKI tertile, 36% in the middle tertile, and 33% in the lowest tertile (P = 0.002). Systolic blood pressure was higher and high-density lipoprotein cholesterol lower in subjects with severe CCA atherosclerosis, compared with those without it. In multiple regression analysis, the adjusted odds ratio for severe CCA atherosclerosis was 5.7 (95% confidence interval, 2.2–15.1) in subjects in the two lowest tertiles of QUICKI, compared with those in the highest tertile.

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