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This version published online on December 14, 2004
Journal of Clinical Endocrinology & Metabolism, doi:10.1210/jc.2004-0410
A more recent version of this article appeared on March 1, 2005
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*Menopause

Submitted on March 1, 2004
Accepted on December 2, 2004

ASSESSMENT OF INSULIN SENSITIVITY FROM MEASUREMENTS IN THE FASTING STATE AND DURING AN ORAL GLUCOSE TOLERANCE TEST IN POLYCYSTIC OVARY SYNDROME AND MENOPAUSAL PATIENTS

Mario Ciampelli M.D., Fulvio Leoni M.D., Francesco Cucinelli M.D., Salvatore Mancuso M.D., Simona Panunzi, Andrea De Gaetano, and Antonio Lanzone M.D.*

Department of Obstetrics and Gynecology, Università Cattolica del Sacro Cuore, Roma, Italy; Laboratorio di Biomatematica, CNR IASI, Roma, Italia, OASI Institute for Research, Troina (EN), Italy

* To whom correspondence should be addressed. E-mail: alanzone{at}rm.unicatt.it.

Background: Polycystic ovary syndrome (PCOS) and menopausal subjects are characterized by an increased cardiovascular (CVD) and type 2 diabetes mellitus risk, at least partially related to insulin disturbances. The evaluation of insulin resistance in these patients could be useful as primary prevention. The aim of the study was to verify the validity of several indexes of insulin sensitivity in polycystic ovary syndrome (PCOS) and menopausal subjects by comparing the data obtained by these indexes to those of euglycemic-hyperinsulinemic clamp studies.

Methods: one hundred PCOS and 110 menopausal subjects were analyzed; all subjects underwent oral glucose tolerance test (OGTT, 75 g) and euglycemic-hyperinsulinemic clamp study. Seven PCOS patients and 13 menopausal subjects had impaired glucose tolerance or type 2 diabetes mellitus and were excluded from the study. After the analysis of correlation coefficients between the evaluated indices and the clamp studies, the sensitivity and specificity of different cut-off values for each parameter were analyzed by ROC curves.

Results: the best correlation coefficients with clamp studies were obtained with the SiM (Rs= 0.7812) in PCOS and the Matsuda and De Fronzo index (Rs= 0.6178) in menopausal patients.

The best predictive index of insulin resistance in PCOS resulted to be the Sib B ≤ 62 (78% sensitivity, 95% specificity) and the insulin AUC ≥ 7000 µUI/ml (≥ 50225 pmol/L) x 120' (83% sensitivity, 90% specificity). In the menopausal population the best predictive performance was obtained by an insulin-AUC ≥10000 µIU/ml (≥71750 pmol/L) x 240' (70% sensitivity, 88% specificity).

Conclusions: the presence of high correlation coefficients does not directly mean that the indices of insulin resistance have an optimal predictive performance; this is probably due to the presence of many border-line values. The simple evaluation of insulin-AUC seems to effectively replace the euglycemic-hyperinsulinemic clamp in the routine clinical practice, allowing results superimposable to those obtained by minimal model analysis.
Key words: insulin resistance • polycystic ovary syndrome • menopause • HOMA • OGTT




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