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The following is a summary of “DI/cle, a Measure Consisting of Insulin Sensitivity, Secretion, and Clearance, Captures Diabetic States,” published in the December 2023 issue of Endocrinology by Sugimoto, et al.
Insulin clearance is pivotal in regulating glucose homeostasis, operating independently of insulin sensitivity and secretion. For a study, researchers sought to understand the relationship between blood glucose levels and insulin sensitivity, secretion, and clearance parameters.
A hyperglycemic clamp, a hyperinsulinemic-euglycemic clamp, and an oral glucose tolerance test (OGTT) were conducted on 47, 16, and 49 subjects representing normal glucose tolerance (NGT), impaired glucose tolerance (IGT), and type 2 diabetes mellitus (T2DM) respectively. Mathematical analyses were then performed on this dataset.
The disposition index (DI), representing the product of insulin sensitivity and secretion, exhibited a weak correlation with blood glucose levels, especially among those with IGT (r = 0.04; 95% CI, −0.63 to 0.44). However, an equation that connects DI, insulin clearance, and blood glucose levels remained consistent, irrespective of the degree of glucose intolerance. Based on this equation, a new index, the disposition index/clearance (DI/cle), was introduced. In subjects with IGT, the DI/cle did not indicate impairment compared to those with NGT, likely due to a compensatory decrease in insulin clearance as DI was reduced. However, in T2DM subjects, DI/cle was impaired relative to IGT. Notably, DI/cle values derived from different tests—hyperinsulinemic-euglycemic clamp, OGTT, or fasting blood tests—showed significant correlations with values from two clamp tests (r = 0.52; 95% CI, 0.37 to 0.64, r = 0.43; 95% CI, 0.24 to 0.58, r = 0.54; 95% CI, 0.38 to 0.68, respectively).
The DI/cle serves as a novel indicator, effectively tracking changes in glucose tolerance trajectories and shedding light on the intricate relationship between insulin sensitivity, secretion, and clearance in modulating blood glucose levels.
Source: academic.oup.com/jcem/article/108/12/3080/7219887
