Diabetes, obesity & metabolism · 2026
Interactive online calculator for estimation of muscle and hepatic insulin sensitivity in adults with Type 1 diabetes using clinical and research biomarkers.
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Januszewski Andrzej S, Snaith Jennifer R, Kowalski Greg M, Bruce Clinton R, Holmes-Walker D Jane, Jenkins Alicia J, Greenfield Jerry R
Аннотация
AIMS: Impaired insulin sensitivity is an under-recognised risk in Type 1 diabetes but is challenging to measure with 'gold-standard' euglycaemic clamps. Adding stable-isotope glucose distinguishes hepatic and muscle insulin action (assessed by endogenous glucose production [EGP] and glucose infusion rate [GIR], respectively). We therefore searched for a blood-biomarker alternative.
METHODS: Two-step clamps were conducted in 40 adults with Type 1 diabetes, participating in the INTIMET trial (INsulin resistance in Type 1 diabetes managed with METformin, ACTRN12619001440112). Participants were characterised with 33 baseline biomarkers.
RESULTS: Exhaustive search analyses derived a formula predicting an 'unfavourable GIR' (dichotomous variable: below median of 60.4 μmol/kg fat-free mass [FFM]/min) using: total daily insulin dose (TDI), fasting triglycerides (TGs), insulin-like growth factor 1 and aspartate aminotransferase levels (area under the receiver operating characteristic curve (AUROC) 0.97, p < 0.0001, R2 [Nagelkerke] = 0.83, 92.5% accuracy). An 'unfavourable EGP level' (above median of 6.2 μmol/kg FFM/min) during low-dose clamp was predicted by TDI, TGs, alkaline phosphatase and uric acid levels (AUROC 0.86, p = 0.001, R2 (Nagelkerke) = 0.50, 80% accuracy). A free online tool (https://bit.ly/EGP-GIR-calculator) converts these variables into dichotomised EGP and GIR estimates.
CONCLUSIONS: We demonstrate that clinical and research biomarkers can be used to estimate tissue specific insulin sensitivity in adults with Type 1 diabetes.
METHODS: Two-step clamps were conducted in 40 adults with Type 1 diabetes, participating in the INTIMET trial (INsulin resistance in Type 1 diabetes managed with METformin, ACTRN12619001440112). Participants were characterised with 33 baseline biomarkers.
RESULTS: Exhaustive search analyses derived a formula predicting an 'unfavourable GIR' (dichotomous variable: below median of 60.4 μmol/kg fat-free mass [FFM]/min) using: total daily insulin dose (TDI), fasting triglycerides (TGs), insulin-like growth factor 1 and aspartate aminotransferase levels (area under the receiver operating characteristic curve (AUROC) 0.97, p < 0.0001, R2 [Nagelkerke] = 0.83, 92.5% accuracy). An 'unfavourable EGP level' (above median of 6.2 μmol/kg FFM/min) during low-dose clamp was predicted by TDI, TGs, alkaline phosphatase and uric acid levels (AUROC 0.86, p = 0.001, R2 (Nagelkerke) = 0.50, 80% accuracy). A free online tool (https://bit.ly/EGP-GIR-calculator) converts these variables into dichotomised EGP and GIR estimates.
CONCLUSIONS: We demonstrate that clinical and research biomarkers can be used to estimate tissue specific insulin sensitivity in adults with Type 1 diabetes.