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Modified Quantitative Insulin Sensitivity Check Index Is Better Correlated to Hyperinsulinemic Glucose Clamp than Other Fasting-Based Index of Insulin Sensitivity in Different Insulin-Resistant States

Human Nutrition Research Centre of Lyon (R.R.-L., P.-H.D., F.A., F.G., J.B., C.L.-P., C.M., J.P., J.C., M.L.), Hôpital Edouard-Herriot, Lyon 69003, France; Institut National de la Santé et de la Recherche Médicale (INSERM) U449 (R.R.-L., H.V., M.L.), Laennec Faculty of Medicine, Université Claude Bernard, Lyon 69372, France; Centre de Recherche (R.R.-L.), Centre Hospitalier de l’Université de Montréal Hôtel-Dieu, Montréal, Québec, Canada H2W 1T7; Department of Biochemistry and Hormonology (V.J.), Hôpital Tenon, Paris 75970 Cedex 20, France; and INSERM U402 (J.-P.B.), Saint-Antoine Faculty of Medicine, Université Pierre et Marie Curie, Paris 75571 Cedex 12, France

Address all correspondence and requests for reprints to: Rémi Rabasa-Lhoret, M.D., Ph.D., Division of Endocrinology Research Centre, Centre Hospitalier de l’Université de Montréal Hôtel-Dieu 3850, Saint-Urbain St. Montréal, Québec, Canada H2W 1T7. E-mail: remi.rabasa-lhoret{at}umontreal.ca.

Fasting-based index estimates of insulin sensitivity were compared with euglycemic hyperinsulinemic clamp (IS clamp) measurements in 148 subjects: normal controls (n = 46), and obese (n = 12), polycystic ovary syndrome (n = 16), first-degree relatives of type 2 diabetic (n = 17), impaired glucose tolerance (n = 28), and type 2 diabetic (n = 29) patients. The fasting-based indexes tested included log homeostasis model assessment (HOMA), the quantitative insulin sensitivity check index (QUICKI), the revised QUICKI, and a new revised QUICKI using fasting plasma glycerol.

In the population studied, at 40 mU/m²·min (n = 30) revised QUICKI (r = 0.86; P < 0.0001) and QUICKI-glycerol (r = 0.87; P < 0.0001) gave higher correlations with the IS clamp than QUICKI and log HOMA (r = 0.78 and r = -0.78; P < 0.001). For subjects tested at 75 mU/m²·min (n = 118), comparable correlations were found for all indexes (r > 0.80; P < 0.0001). When studied in subgroups, revised QUICKI and QUICKI-glycerol give significantly higher correlations with the IS clamp than other indexes for lean control subjects studied at 40mU/m²·min and impaired glucose tolerance subjects.

We confirmed, in a large patient population with a wide range of insulin sensitivities, that no single test is superior in all groups of patients. However, QUICKI and revised QUICKI are good indexes that offer correlations similar to or higher than values obtained with log HOMA. Such indexes are simple tools to estimate insulin sensitivity appropriate for epidemiological studies.

This work was supported by a postdoctoral fellowship from the French Diabetes Association (ALFEDIAM-Servier grant; to R.R.-L.) and a postdoctoral award from the Information, Educational and Research Centre in Nutrition (CERIN, Paris, France; to R.R.-L.).

Abbreviations: BMI, Body mass index; FFA, free fatty acid(s); GIR, glucose infusion rate; HOMA, homeostasis model assessment; IGT, impaired glucose tolerance; IS clamp, euglycemic hyperinsulinemic clamp; PCOS, polycystic ovary syndrome; QUICKI, quantitative insulin sensitivity check index.

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