Evaluation of Insulin Resistance in Diabetes: Standard Protocol for a Euglycemic-Hyperinsulinemic Clamp Using an Artificial Pancreas
Insulin resistance plays a pivotal pathognomonic role in various pathophysiological states, including diabetes, obesity, and metabolic syndromes. A euglycemic-hyperinsulinemic (EH) clamp, the gold-standard method for evaluating insulin resistance in humans, has been performed according to the original protocol for each hospital or institute, which makes it difficult to compare the findings of different studies. We have established a standard protocol for the EH clamp using an artificial pancreas (AP, models STG-22 and STG-55, Nikkiso Co. Ltd. Tokyo), which has been widely used in Japan since 1987. Among the 351 Japanese subjects, 301 were type 2 diabetics, 12 were impaired glucose tolerance with obesity, and 38 had normal glucose tolerance. In this chapter, the standard protocol using the AP and the insulin resistance data are described in detail. By using an AP for the clamp, stable steady-state euglycemia and glucose infusion rates (GIR, metabolizable glucose [M] value) were achieved with high precision. The insulin resistance index, M/I, in type 2 diabetics was approximately 49 % lower than in patients with normal glucose tolerance and had a strong inverse correlation with body mass index. Furthermore, the validity and clinical implications of insulin resistance were clarified and reported according to the standard protocol for an EH clamp using an AP. In conclusion, a standard protocol for using an AP for an EH clamp would allow us to evaluate insulin resistance in detail and with high precision in various pathological states/diseases.
KeywordsInsulin resistance Euglycemic-hyperinsulinemic clamp Artificial pancreas Diabetes Japanese
We sincerely acknowledge the contribution of our colleagues, known as “clampers” in our hospitals, who have been engaged in euglycemic clamp projects using the STG-22 and STG-55 models of the artificial pancreas since 1993, especially Yoshikazu Hiura MD PhD, Kyoko Satoh-Kogawa MD PhD, Hiroyuki Kanda MD PhD, Miyoko Matsuyoshi-Komatsu MD PhD, Shigehiko Fujiwara MD PhD, Takahiro Araki MD PhD, Megumi Teramura-Okada MD PhD, Eiko Lee-Kobayashi MD PhD, Naoya Kawano MD PhD, and Satoshi Imamura MD PhD.
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