Original Research

Determining a diagnostic algorithm for hyperinsulinaemia

Catherine A.P. Crofts, Grant Schofield, Mark C. Wheldon, Caryn Zinn, Joseph R. Kraft
Journal of Insulin Resistance | Vol 4, No 1 | a49 | DOI: https://doi.org/10.4102/jir.v4i1.49 | © 2019 Catherine A.P. Crofts, Grant Schofield, Mark C. Wheldon, Caryn Zinn, Joseph R. Kraft | This work is licensed under CC Attribution 4.0
Submitted: 13 March 2019 | Published: 26 June 2019

About the author(s)

Catherine A.P. Crofts, Human Potential Centre, Faculty of Health and Environmental Sciences, Auckland University of Technology, Auckland, New Zealand; and, School of Interprofessional Health Studies, Auckland University of Technology, Auckland, New Zealand
Grant Schofield, Human Potential Centre, Faculty of Health and Environmental Sciences, Auckland University of Technology, Auckland, New Zealand
Mark C. Wheldon, Department of Biostatistics and Epidemiology, Auckland University of Technology, Auckland, New Zealand
Caryn Zinn, Human Potential Centre, Faculty of Health and Environmental Sciences, Auckland University of Technology, Auckland, New Zealand
Joseph R. Kraft, Department of Clinical Pathology and Nuclear Medicine, St Joseph Hospital, Chicago, United States


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Abstract

Background: Ascertaining Kraft dynamic insulin response patterns following a 3-h 100 g oral glucose tolerance test seems to be the most reliable method for diagnosing hyperinsulinaemia. However, this test may be too resource-intensive for standard clinical use.

Aim: This study aims to see if Kraft patterns can be accurately predicted using fewer blood samples with sensitivity and specificity analyses.

Setting: St Joseph Hospital, Chicago, Illinois, United States and Human Potential Centre, Auckland University of technology, Auckland, New Zealand.

Method: We analysed the results of 4185 men and women with a normal glucose tolerance, who had a 100 g oral glucose tolerance test with Kraft pattern analysis. Participants were dichotomised into normal–low insulin tolerance (Kraft I or V patterns) or hyperinsulinaemia (Kraft IIA–IV patterns). Sensitivity and specificity analysis was applied to available variables (including age, body mass index, fasting insulin or glucose) both individually and in combination.

Results: Out of a maximal combined sensitivity and specificity score of 2.0, 2-h insulin level > 45 µU/mL attained the highest score (1.80). Two-hour insulin also attained the highest sensitivity (> 30 µU/mL, 0.98) and the highest specificity (> 50 µU/mL, 0.99) scores. Combining the 2-h insulin with other variables reduced the sensitivity and/or specificity. Dynamic measures had a better combined sensitivity and specificity compared to fasting or anthropological measures.

Conclusion: People with a 2-h plasma insulin level < 30 µU/mL are unlikely to be hyperinsulinaemic. Given that first-line treatment is lifestyle modification, we recommend that a 2-h plasma insulin level > 30 µU/mL following a 100 g oral glucose tolerance test be used to identify the hyperinsulinaemic individual.


Keywords

type 2 diabetes; insulin resistance; hyperinsulinaemia; Kraft patterns; insulin response patterns; diagnosis

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