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Correlation of calculated indices of insulin resistance (QUICKI and HOMA) with the euglycaemic hyperinsulinaemic clamp technique for evaluating insulin resistance in critically ill patients

Published online by Cambridge University Press:  01 November 2007

U. Holzinger ,
R. Kitzberger ,
V. Fuhrmann ,
G.-C. Funk ,
C. Madl  and
K. Ratheiser
U. Holzinger*
Affiliation:
Medical University of Vienna, Intensive Care Unit, Department of Internal Medicine IV, Waehringer Guertel, Vienna, Austria
R. Kitzberger
Affiliation:
Medical University of Vienna, Intensive Care Unit, Department of Internal Medicine IV, Waehringer Guertel, Vienna, Austria
V. Fuhrmann
Affiliation:
Medical University of Vienna, Intensive Care Unit, Department of Internal Medicine IV, Waehringer Guertel, Vienna, Austria
G.-C. Funk
Affiliation:
Medical University of Vienna, Intensive Care Unit, Department of Internal Medicine IV, Waehringer Guertel, Vienna, Austria
C. Madl
Affiliation:
Medical University of Vienna, Intensive Care Unit, Department of Internal Medicine IV, Waehringer Guertel, Vienna, Austria
K. Ratheiser
Affiliation:
Medical University of Vienna, Intensive Care Unit, Department of Internal Medicine IV, Waehringer Guertel, Vienna, Austria
*
Correspondence to: Ulrike Holzinger, Department of Internal Medicine IV, ICU, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria. E-mail: ulrike.holzinger@meduniwien.ac.at; Tel: +43 1 40400 4767; Fax: +43 1 40400 4797
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Summary

Background and objective

Insulin resistance is frequently observed in critical illness. It can be quantified by the expensive and time-consuming euglycaemic hyperinsulinaemic clamp technique (M-value) and calculated indices of insulin resistance (Quantitative Insulin Sensitivity Check Index; QUICKI and Homeostasis Model Assessment; HOMA) with lower costs and efforts. We performed an observational study to assess the reliability of QUICKI and HOMA to evaluate insulin resistance in critically ill patients compared with the current gold standard method, the euglycaemic hyperinsulinaemic clamp technique.

Methods

Insulin resistance was measured in 30 critically ill medical patients by the euglycaemic hyperinsulinaemic clamp technique (M-value) as well as calculated using QUICKI and HOMA. Correlations between the M-values as well as QUICKI and HOMA were assessed by means of the Pearson’s correlation coefficient.

Results

M-value, QUICKI and HOMA indicated insulin resistance in all 30 patients. However, both indices QUICKI and HOMA did not correlate with the M-values in our patients (r2 = 0.008 and 0.0005, respectively). A significant negative correlation was found between the M-value and the severity of illness assessed by the APACHE (Acute Physiology and Chronic Health Evaluation) III score (r2 = 0.16; P < 0.05). In contrast, neither HOMA nor QUICKI correlated with the APACHE III score (r2 = 0.034 and 0.033, respectively).

Conclusions

Although QUICKI and HOMA indicated insulin resistance in the critically ill medical patients, both indices did not correlate with the M-value. Therefore, the euglycaemic hyperinsulinaemic clamp technique remains the gold standard for estimating insulin resistance in critically ill patients.

Keywords

CRITICAL CAREINSULIN RESISTANCEMETABOLISM, response to stressGLUCOSE CLAMP TECHNIQUE
Type
Original Article
Information
European Journal of Anaesthesiology , Volume 24 , Issue 11 , November 2007 , pp. 966 - 970
Copyright
Copyright © European Society of Anaesthesiology 2007

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