Validation of a new clinical test for insulin sensitivity
Insulin resistance is a major risk factor for type 2 diabetes and heart disease. Currently the most accurate methods for measuring insulin sensitivity are the 'gold-standard' euglycaemic clamp and the intravenous glucose tolerance test, which are complicated and expensive and can only be used in small research trials. For larger population-based studies crude surrogates are available to measure insulin sensitivity (most are based on fasting insulin and glucose). We propose a new, dynamic, 30-minute test developed from our clinical model-based glucose and insulin control trials. This model's clinical accuracy is vastly superior to those described previously and has been compared (under simulated conditions) with 146 euglycaemic clamp tests, where it has performed remarkably well.
We are currently validating this novel test against the gold standard euglycaemic clamp test in a new population. If this test proves to be easy to perform and relatively inexpensive and reliable, it could be used in large research studies of individuals at high risk of diabetes and cardiovascular disease. We believe the proposed test could potentially be used in clinical practice and would be of major international importance given the increasing numbers of individuals at risk of diabetes and heart disease.
This project is a collaboration with Associate Professor Geoff Chase (Department of Biomedical Engineering, University of Canterbury) and Dr Geoff Shaw (Senior Clinical Lecturer, Christchurch School of Medicine; Intensive Care Specialist, Christchurch Hospital) winners of the 2006 Health Innovation Awards Supreme Award.
Funding:
National Heart Foundation of New Zealand
University of Otago
Health Research Council of New Zealand
Publications:
Docherty PD, Chase JG, Lotz TF, Hann CE, Shaw GM, Berkeley JE, Mann JI, McAuley K. Independent cohort cross-validation of the real-time DISTq estimation of insulin sensitivity. Computer Methods and Programs in Biomedicine 2011;102(2):94-104 (invited)
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Lotz TF, Chase JG, McAuley KA, Shaw GM, Dicherty PD, Berekley JE, Williams SM, Hann CE, Mann JI. Design and Clinical Pilot Testing of the Model-Based Dynamic Insulin Sensitivity and Secretion Test (DISST). Journal of Diabetes Science and Technology 2010;4(6):1408-1423.
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Chase JG, Mayntzhusen K, Docherty PD, Andreassen S, McAuley KA, Lotz TF, Hann CE. A three-compartment model of the C-peptide-insulin dynamic during the DIST test. Mathematical Biosciences 2010;228(2):136-146.
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Chase, JG, Andreassen, S, Pielmeier, U, Hann, CE, McAuley, KA and Mann, JI (2009). A glucose-insulin pharmacodynamic surface modeling validation and comparison of metabolic system models. Biomedical Signal Processing & Control. 2009; 4(4): 355-63.
Docherty PD, Chase JG, Lotz T, Hann CE, Shaw GM, Berkeley JE, Mann JI, McAuley K. DISTq: An Iterative Analysis of Glucose Data for Low-Cost, Real-Time and Accurate Estimation of Insulin Sensitivity. Open Med Inform J. 2009; 3: 65-76.
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Lotz TF, Chase JG, McAuley KA, Shaw GM, Wong XW, Lin J, Lecompte A, Hann CE, Mann JI. Monte Carlo analysis of a new model-based method for insulin sensitivity testing. Comput Methods Programs Biomed. 2008; 89(3):215-25.
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McAuley KA, Mann JI, Chase JG, Lotz TF, Shaw GM. Point: HOMA - Satisfactory for the time being. HOMA: The best bet for the simple determination of insulin sensitivity, until something better comes along. Diabetes Care 2007, 30 (9): 2411-2413.
Lotz TF, Chase JG, Shaw GM, McAuley KA, Wong XW, Lin J, LeCompte A, Hann CE, Mann JI. Monte Carlo analysis of a new model-based method for insulin sensitivity testing. Computer Methods and Programs in Biomedicine. Submitted 17 July 2006, to appear, ISSN: 0169-2607.
Lotz T, Chase J, McAuley K, Lee D, Lin J, Hann C and Mann JI. Transient and steady state euglycemic clamp validation of a model for glycemic control and insulin sensitivity testing. Diabetes Technology and Therapeutics 2006; 8(3): 338-346.
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Chase JG, Lotz T, McAuley KA, Shaw GM, Hann CE, Lin J and Mann JI. Model-based Assessment of Insulin Resistance in Broad Populations. New Zealand Medical Journal 31 March 2006, Technical Note, Vol 119, No. 1231. Journal is online-only (www.nzma.org.nz). ISSN: 0028-8446. URL:
http://www.nzma.org.nz/journal/119-1231/1922/
Media coverage:
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'Determining insulin resistance'
April/May 2006
Engineering World
