Insulin Resistance Study in Diabetes Mellitus Type II and Its Correlation with Obesity
Background: The earliest detectable abnormality in diabetes mellitus type II (DM II) is the impairment of body’s ability to respond to insulin, necessitating extra insulin secretion in an attempt to stimulate the desensitized cells. Obesity is considered as the single most important, reversible, causative environmental factor for insulin resistance (IR) aggravating the metabolic disturbance in DM II. Objectives: We aimed the study to evaluate the association of IR with DM II (its major outcome) and obesity (its main causative factor) in Pakistani diaspora. We measured IR in insulin resistance syndrome (IRS), DM II and obesity by using parameters namely fasting insulin level (FIL), homeostatic model assessment for insulin resistance (HOMA-IR), and quick insulin sensitivity check index (QUICKI), and evaluated their credibility. Materials and Methods: The study included 156 subjects (76 males and 80 females), out of which 101 were diabetics (with 59 on insulin, and 42 on oral hypoglycemics) with different duration of time in years, and 55 were non-diabetics. The data was analyzed after further subdividing the diabetics and non-diabetics into those having body mass index (BMI)<25, and those with BMI≥25. 101 had BMI≥25 (overweight/obese) [57 with BMI=25-29.9 (overweight), and 44 with BMI≥30 (obese)] and 55 had BMI= 18- 24.9 (normal weight). The individuals were then classified as those having insulin resistance syndrome (IRS) and those not having it. On the basis of NCEP criteria the associations between DM II, IRS, and obesity were evaluated. The credibility of three IR measuring parameters, namely, fasting insulin level (FIL), homeostatic model assessment (HOMA) and quick insulin sensitivity check index (QUICKI) was then assessed. Results: It was found that IRS prevailed up to 85% in diabetics and 76% in subjects with BMI≥25 out of which 84% IRS cases existed among obese (with BMI≥30). Similarly, 82% IRS cases were found diabetic and 72.4% with BMI≥25. FIL and HOMA showed significantly raised insulin and QUICKI showed significantly lower in IRS cases. But unlike FIL and HOMA, QUICKI did not show any significance when different subgroups of IRS cases were inter-compared. FIL and HOMA were also significantly raised in overweight/ obese individuals. QUICKI however showed significant but weak correlations with BMI. HOMA and QUICKI were significant in diabetics but FIL did not show significant difference. Conclusion: The results revealed strong correlation of obesity, IRS and DM II. HOMA was found better and sensitive index for evaluating IR in diabetes, IRS and obesity, than FIL alone or with QUICKI
Saghir Ahmad Jafri,
Insulin Resistance Study in Diabetes Mellitus Type II and Its Correlation with Obesity, American Journal of Life Sciences.
Vol. 2, No. 2,
2014, pp. 96-102.
T. Santoso, “Prevention of cardiovascular disease in diabetes mellitus: by stressing the CARD study,” Acta Med Indones, vol. 32, pp.97-102, 2006.
M. Verma ,S. Paneri, P. Badi, and P. G. Raman, “ Effect of increasing duration of diabetes mellitus type 2 on glycated hemoglobin and insulin sensitivity,”Ind J Clin Biochem, vol. 21, pp.142-146, January 2006.
S. Inchiostro, “Measurements of insulin sensitivity in type-2 diabetes mellitus: Comparison between KITT and HOMA indices and evaluation of their relationship with the components of the insulin resistance syndrome,” Diabetes UK Diabetic Med, vol. 22, pp. 39-44, 2004.
G.M. Reaven, and B.B. Hoffman, “A role for insulin in the etiology and course of hypertension,” Lancet, vol. 2, pp.435-437, 1987.
B. Kim, “Blood sugar and insulin: The essentials,”2005. Retrieved from: http://drbenkim.com/articles-blood sugar .html , on 9th March 2010.
S. Schrinner, W.A. Scherbaum S.R. Bornstein, and Al Barthe, “Molecular mechanism of insulin resistance,” Diabetes UK Diabetic Med, vol.22, pp.674-682, 2005.
M. Laakso,”Insulin resistance and its impact on the approach to therapy of type-2 diabetes mellitus,” Int J Clin Pract Suppl, vol.121, pp.8-12, 2001.
R. A. Defronzo, R. C. Bonadonna, and E. Ferrannini, “Pathogenesis of NIDDM: A balanced overview,” Diabetes Care, vol. 15, pp.318-368, March 1992.
M. B. Davidson, “Clinical implications of insulin resistance syndrome,” Am J Med, vol.99, pp.420-426, 1995.
O. E. Odeleye, M. De Courten, D. J. Pettitt, and E. Ravussin, “Fasting hyperinsulinemia is a predictor of increased body weight gain and obesity in Pima Indian children,” Diabetes, vol. 46, pp.1341-1345, 1997.
E. J. Boyko, D. L. Leonetti, R. W. Bergstrom, L. M. Newell, and W.Y. Fujimoto, “Low insulin secretion and high fasting insulin and C-peptide levels predict increased visceral adiposity,” Diabetes, vol. 45, pp.1010-1015, 1996.
N. Ali, N. Afzal, S. Shahjahan, M. Z. Ahmed, and A. Baseer, “A study of insulin resistance in obese and non-obese healthy FDRs of T2DMpatients,” Pak Postgrad Med J, vol. 15, pp.81-92, February 2004.
N. Shah, Amanullah, and S. Ataullah, “Prevalence of insulin resistance in type-2 diabetic patients,” J Postgrad Med Inst, vol. 22, pp. 52-56, January 2008.
N. Ali, N. Afzal, M. Z. Ahmed, S. Shahjahan, and A. S. Sheikh, “Obesity indices and lipid levels in healthy relatives of type 2 diabetes mellitus patients,” Pak Postgrad Med J, vol. 14, 189-193, April 2003.
P. Arner. Insulin resistance in type 2 diabetes: Role of fatty acids. Diab Metab Res Rev.2002; 18: S5-S9.
C. E. Tam, S. Ma, D. Wai, S. K. Chen, and E. S. Tai, “Can we apply the National Cholesterol Education Program Adult Treatment Panel definition of the metabolic syndrome to Asians?” Diabetes Care, vol. 27, pp.1182-1186, May 2004.
NCEP, “Third Report of NCEP expert panel on detection, evaluation and treatment of high blood cholesterol in adults (Adult treatment Panel III),” JAMA, vol. 285, pp.486-497, September 2001.
J. D. Bagdade, E. L. Bierman, and D. Porte, “The significance of basal insulin levels in the evaluation of the insulin response to glucose in diabetic and non-diabetic subjects,” J Clin Inves, vol. 46, pp.1549-1557, October 1967.
R. Mack, B. Skurnick, Y. S. Jean, M. P. Nobre, and D. Bigg, “ Fasting insulin levels as a measure of insulin resistance in American Blacks,” J Appl Res, vol. 4, pp.90-94, January 2004.
V. D. Castracane, and R. P. Kauffman, “Controlling PCOS, Part 1: Assessing insulin sensitivity,” Contemporary OG/GYN, January 2003.
K.A. McAuley, S. M. Williams, J. I. Mann, R. J. Walker, N, J. L. Barned, L. A. Temple, and A. W. Duncan, “ Diagnosing insulin resistance in the general population,” Diabetes Care, vol. 24, pp.460-464, 2001.
A. Katz, S. S. Nambi, K. Mather, A. D. Baron, D. A. Follmann, G. Sullivan, and M. J. Quon, “Quantitative insulin sensitivity check index: a simple accurate method for assessing insulin sensitivity in humans,” J Clin Endocrinol Metab, vol. 85, pp.2402-2410, July 2007.
H. Yokoyama, M. Emoto, S. Fujiwara, K. Motoyama, T. Morioka, M. Komatsu et al, “ Quantitative insulin sensitivity check index and the reciprocal index of homeostasis model assessment are useful indexes of insulin resistance in type 2 diabetic patients with wide range of fasting glucose” J Clin Endocrinol Metab,vol. 89, pp.1481-1484,March 2004.
S. Katoh, M. Lehtovirta, J .Kaprio, V. Harjutsalo, M. Kosekenvuo, and J. Eriksson, “Genetic and environmental effects on fasting and post-challenge plasma glucose and serum insulin values in Finnish twins,” J Clin Endocrinol Metab, vol.90, 2642-2647, 2005.
G. A. Bray,and R. F. H. Hamman, “Insulin resistance and pre-diabetes”, 2008. Retrieved from: http://diabetes.niddk.nih.gov/DM/pubs/insulinresistanceon 9thMarch 2010.
W. Hseuh, and A. Collins, Eds. Plasma Insulin (Linco ELISA): In Animal Models of Diabetic Complications Consortium Protocols, Version 1, December 2004 Dec.
D. R. Mathews, J. P. Hosker, A. S. Rudenski, B. A. Naylor, D. F. Treacher,and R. C. Turner, “ Homeostasis Model Assessment: Insulin resistance andβ-cell function from fasting plasma glucose and insulin concentrations in man”,Diabetologia, vol.28, pp.412-419, 1985.
S. Schoppen, B. Cano, I. D. Oya, L. L. Simon, P. Riestra ,and M. D. Oya, “Relationship between leptin, insulin level and homeostatic model assessment (HOMA) index in Spanish pubertal children, ”Summer Meeting, Proceedings of the Nutrition Society,”67(OCE8), E381, June 30th- July 3rd2008.
E. Bonora, S. Kiechl, J. Williet, F. Oberhollenzer, G. Egger, G. Targher, et al. Prevalence of insulin resistance in metabolic disorders: The Bruneck Study. Diabetes, vol. 47, pp.1643-1649, 1998.
N. Ali, N. Afzal, J. Subazwari, A. Ahmed, A. Abbas, and A. Sultan, “Insulin resistance syndrome in type 2 diabetes mellitus patients,”Esculapia J Serv Inst Med Sci, vol. 3, pp.20-22, January 2007.
S. M.S. Ashraf, F. Ziauddin, and U. Jehangir, “Metabolic syndrome in type-2 diabetes mellitus,” Pak J Med Sci, vol. 22, pp.295-299, 2006.
A. C. Guyton, and J. E. Hall, “Insulin, glucagon and diabetes mellitus,” Textbook of Medical Physiology, 11th ed. Philadelphia, PA: Elsevier, 2009; pp.974-975.
D. R. Mathews, “Insulin resistance and β-cell dysfunction: A clinical perspective,”Diab, Obes and Metab, vol. 3, pp. 28-33, January 2001.
F. Masud, M. Hassan, S. Abaidullah, and I. Alam,”Assessment of metabolic profile and body mass index (BMI) in type II diabetics treated with Metformin and insulin,” Pak J Med Sci, vol.9,pp.29-34. January 1991.
H. Maegawa H, A. Kashiwagi, and Y. Shigeta, “Obesity as a risk factor for developing non-insulin dependent diabetes mellitus, obesity, and insulin, insulin resistance,” Nippon Naibumpi Gakkai Zasshi.1995; vol. 71, pp.97-104, February 1995.
M. Keskin, S. Kurtoglu, M. Kendirci, M. E. Atabek, and C. Yazisi, ”Homeostasis model assessment is more reliable than the fasting glucose / insulin ratio and quantitative insulin sensitivity check index for assessing insulin resistance among obese children and adolescents,” Pediatrics, vol.115, pp. 500-503, 2005