Advertisement

Relationship between surrogate estimates and direct measurement of insulin resistance in women with polycystic ovary syndrome

  • M. H. DahanEmail author
  • F. Abbasi
  • G. Reaven
Original Article
  • 21 Downloads

Abstract

Purpose

To evaluate the relationship between surrogate estimates of insulin resistance and a direct measurement of insulin-mediated glucose uptake women with and without PCOS.

Methods

Retrospective cohort study of 75 PCOS and 118 controls. Fasting plasma glucose and insulin concentrations, insulin resistance as determined by the insulin suppression test, calculation of multiple surrogate estimates of insulin resistance, total and free testosterone concentrations, and correlations between the direct measure and surrogate estimates of insulin resistance were evaluated.

Result(s)

Surrogate markers of insulin resistance were correlated to a variable, but statistically significant degree with the direct measure of insulin resistance in control population and the women with PCOS. There was no correlation between the surrogate estimates of insulin resistance and total or free plasma testosterone concentrations.

Conclusion(s)

The surrogate estimates of insulin resistance evaluated were significantly related to a direct measure of insulin resistance, and this was true of both the control population and women with PCOS. The magnitude of the relationship between the surrogate estimates and the direct measurement was comparable and not significantly altered by androgen levels. Fasting plasma insulin concentration seems to be at least as accurate as any other surrogate estimate, and is by far the simplest.

Keywords

PCOS Insulin resistance QUICKI HOMA-IR Insulin suppression test 

Notes

Funding

Women’s Reproductive Health Research (WRHR) Scholars program, NIH through the NICHD, Grant number: U54 HD031398.

Compliance with ethical standards

Conflict of interest

Drs. Dahan, Abassi and Reaven have no conflicts of interest to report.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

All subjects provided written consent to participate in the study and for analysis of their results and data.

References

  1. 1.
    Azziz R, Woods KS, Reyna R, Key TJ, Knochenhauer ES, Yildiz BO (2004) The prevalence and features of the polycystic ovary syndrome in an unselected population. J Clin Endocrinol Metab 89:2745–2749CrossRefGoogle Scholar
  2. 2.
    Ovalle F, Azziz R (2002) Insulin resistance, polycystic ovary syndrome, and type 2 diabetes mellitus. Fertil Steril 77:1095–1105CrossRefGoogle Scholar
  3. 3.
    Chang RJ, Nakamura RM, Judd HL, Kaplan SA (1983) Insulin resistance in nonobese participants with polycystic ovarian disease. J Clin Endocrinol Metab 57:356–359CrossRefGoogle Scholar
  4. 4.
    Dunaif A, Mandeli J, Fluhr H, Dobrjansky A (1988) The impact of obesity and chronic hyperinsulinemia on gonadotropin release and gonadal steroid secretion in the polycystic ovary syndrome. J Clin Endocrinol Metab 66:131–139CrossRefGoogle Scholar
  5. 5.
    Yeni-Komshian H, Carantoni M, Abbasi F, Reaven GM (2000) Relationship between several surrogate estimates of insulin resistance and quantification of insulin mediated glucose disposal in 490 healthy nondiabetic volunteers. Diabetes Care 23(2):171–175CrossRefGoogle Scholar
  6. 6.
    Abbasi F, Reaven GM (2002) Evaluation of the quantitative insulin sensitivity check index as an estimate of insulin sensitivity in humans. Metabolism 51(2):235–237CrossRefGoogle Scholar
  7. 7.
    Diamanti-Kandarakis E, Kouli C, Alexandraki K, Spina G (2004) Failure of mathematical indices to accurately assess insulin resistance in lean, overweight, or obese women with polycystic ovary syndrome. J Clin Endocrinol Metab 89(3):1273–1276CrossRefGoogle Scholar
  8. 8.
    Pei D, Jones CNO, Bhargava R, Chen Y-DI, Reaven GM (1994) Evaluation of octreotide to assess insulin-mediated glucose disposal by the insulin suppression test. Diabetologia 37:843–845CrossRefGoogle Scholar
  9. 9.
    Shen S-W, Reaven GM, Farquhar JW (1970) Comparison of impedance to insulin-mediated glucose uptake in normal subjects and in subjects with latent diabetes. J Clin Investig 49:2151–2160CrossRefGoogle Scholar
  10. 10.
    Greenfield MS, Doberne L, Kraemer F, Tobey T, Reaven G (1981) Assessment of insulin resistance with the insulin suppression test and the euglycemic clamp. Diabetes 30:387–392CrossRefGoogle Scholar
  11. 11.
    Knowles J, Assimes TL, Tsao PS et al (2013) Measurement of insulin mediated glucose uptake: direct comparison of the modified insulin suppression test and the euglycemic, hyperinsulinemic clamp. Metabolism 62:548–553CrossRefGoogle Scholar
  12. 12.
    Matthews DR, Hosker JP, Rudenski AS, Naylor BA, Treacher DF, Turner RC (1985) Homeostasis model assessment: insulin resistance and beta-cell function from fasting plasma glucose and insulin concentrations in man. Diabetologia 28:412–419CrossRefGoogle Scholar
  13. 13.
    Katz A, Nambi SS, Mather K, Baron AD, Follmann DA, Sullivan G et al (2000) Quantitative insulin sensitivity check index: a simple, accurate method for assessing insulin sensitivity in humans. J Clin Endocrinol Metab 85:2402CrossRefGoogle Scholar
  14. 14.
    Sodergard R, Backstrom T, Shanbhag V, Carstensen H (1982) Calculation of free and bound fractions of testosterone and estradiol-17 beta to human plasma proteins at body temperature. J Steroid Biochem 16:801–810CrossRefGoogle Scholar
  15. 15.
    Kim SH, Abbasi F, Reaven GM (2004) Impact of degree of obesity on surrogate estimates of insulin resistance. Diabetes Care 27:1998–2002CrossRefGoogle Scholar
  16. 16.
    Abbasi F, Okeke Q, Reaven GM (2014) Evaluation of fasting plasma insulin concentration as an estimate of insulin action in nondiabetic individuals: comparison with the homeostasis model assessment of insulin resistance (HOMA-IR). Acta Diabetol 51:193–197CrossRefGoogle Scholar
  17. 17.
    Pasquali R, Gambineri A (2018) New perspectives on the definition and management of polycystic ovary syndrome. J Endocrinol Investig 41:1123–1135CrossRefGoogle Scholar
  18. 18.
    O’Reilly MW, Taylor AE, Crabtree NJ, Hughes BA, Capper F, Crowley RK, Stewart PM, Tomlinson JW, Arlt W (2014) Hyperandrogenemia predicts metabolic phenotype in polycystic ovary syndrome: the utility of serum androstenedione. J Clin Endocrinol Metab 99:1027–1036CrossRefGoogle Scholar
  19. 19.
    Pasquali R, Zanotti L, Fanelli F, Mezzullo M, Fazzini A, Morselli Labate AM, Repaci A, Ribichini D, Gambineri A (2016) Defning hyperandrogenism in women with polycystic ovary syndrome: a challenging perspective. J Clin Endocrinol Metab 101:2013–2022CrossRefGoogle Scholar
  20. 20.
    Mu L, Li R, Lai Y, Zhao Y, Qiao J (2018) Adipose insulin resistance is associated with cardiovascular risk factors in polycystic ovary syndrome. J Endocrinol Investig.  https://doi.org/10.1007/s40618-018-0949-2 (Epub ahead of print) Google Scholar
  21. 21.
    Dahan MH, Abbasi F, Reaven GM (2017) Cardiovascular disease in PCOS is related to severe insulin resistance, not mild. Minerva Endocrinol 42:294–296Google Scholar
  22. 22.
    Polak K, Czyzyk A, Simoncini T, Meczekalski B (2017) New markers of insulin resistance in polycystic ovary syndrome. J Endocrinol Investig 2017(40):1–8CrossRefGoogle Scholar
  23. 23.
    Sepilian V, Nagamani M (2005) Adiponectin levels in women with polycystic ovary syndrome and severe insulin resistance. J Soc Gynecol Investig 12:129–134CrossRefGoogle Scholar
  24. 24.
    Leroy P, Dessolin S, Villageois P, Moon BC, Friedman JM, Ailhaud G, Dani C (1996) Expression of ob gene in adipose cells and regulation by insulin. J Biol Chem 271:2365–2368CrossRefGoogle Scholar
  25. 25.
    Panidis D, Rousso D, Koliakos G, Kourtis A, Katsikis I, Farmakiotis D, Votsi E, Diamanti-Kandarakis E (2006) Plasma metastin levels are negatively correlated with insulin resistance and free androgens in women with polycystic ovary syndrome. Fertil Steril 85:1778–1783CrossRefGoogle Scholar
  26. 26.
    Li M, Yang M, Zhou X, Fang X, Hu W, Zhu W, Wang C, Liu D, Li S, Liu H, Yang G, Li L (2015) Elevated circulating levels of irisin and the effect of metformin treatment in women with polycystic ovary syndrome. J Clin Endocrinol Metab 100:1485–1493CrossRefGoogle Scholar
  27. 27.
    Li H, Xu X, Wang X, Liao X, Li L, Yang G, Gao L (2016) Free androgen index and Irisin in polycystic ovary syndrome. J Endocrinol Investig 39:549–556CrossRefGoogle Scholar
  28. 28.
    Tosi F, Bonora E, Moghetti P (2017) Insulin resistance in a large cohort of women with polycystic ovary syndrome: a comparison between euglycaemic–hyperinsulinaemic clamp and surrogate indexes. Hum Reprod 32:2515–2521CrossRefGoogle Scholar

Copyright information

© Italian Society of Endocrinology (SIE) 2019

Authors and Affiliations

  1. 1.Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and GynecologyMcGill UniversityMontrealCanada
  2. 2.Division of Cardiovascular Medicine, Department of Internal MedicineStanford UniversityStanfordUSA

Personalised recommendations