Objective

The hyperinsulinemic euglycemic clamp (HEC) is the “gold standard” for measuring insulin sensitivity (Si-clamp). Here, we determined the reproducibility of serial HEC data in healthy subjects.

Research design and methods

The Pathobiology of Prediabetes in A Biracial Cohort study assessed incident prediabetes in healthy African Americans (AA) and European Americans (EA) with parental type 2 diabetes mellitus during 5.5 years of follow-up. Assessments included anthropometry, OGTT, and HEC. Ninety subjects (44 AA, 46 EA) who underwent Year-1HEC consented to Year-3 HEC. We calculated coefficients of variation (CVs), 95% limits of agreement, and repeatability coefficients for Year-1 and Year-3 data, and assessed the association of change in Si-clamp with incident prediabetes.

Results

The mean (SD) baseline age was 47.5 ± 8.13y, body mass index was 30.4 ± 9.16 kg/m², fasting plasma glucose was 93.7 ± 7.82 mg/dL and 2-hrPG was 126 ± 26.8 mg/dL. Si-clamp (umol/kg/min·pmol/L⁻¹) was 0.071 ± 0.04 in Year 1 and 0.067 ± 0.04 in Year 3 (P = 0.22). Year 1 and Year 3 values were strongly correlated (r = 0.81, P < 0.0001); the CV was 13.6% and repeatability coefficient was ±0.025. Intrasubject differences in serial Si-clamp were less than the repeatability coefficients and within the 95% limits of agreement. After 5.5 years of follow-up, 40 subjects progressed to prediabetes and 50 were nonprogressors. The change in Si-clamp was greater in progressors than nonprogressors (−10% vs. −2.5%, P = 0.02).

Conclusions

The HEC is reproducible over ~2 years in free-living individuals, with a temporal decline in Si-clamp that predicts prediabetes risk.

中文翻译：

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自由生活成人高胰岛素正常血糖钳夹衍生的胰岛素敏感性的多年重现性：与 POP-ABC 研究中糖尿病前期的关联。

客观的

高胰岛素正常血糖钳 (HEC) 是测量胰岛素敏感性的“金标准”（Si 钳）。在这里，我们确定了健康受试者中连续 HEC 数据的可重复性。

研究设计和方法

混血儿队列研究中糖尿病前期的病理生物学评估了健康的非裔美国人 (AA) 和欧洲裔美国人 (EA) 在 5.5 年的随访期间患有父母 2 型糖尿病的糖尿病前期事件。评估包括人体测量学、OGTT 和 HEC。接受第 1 年 HEC 的 90 名受试者（44 AA，46 EA）同意接受第 3 年 HEC。我们计算了第 1 年和第 3 年数据的变异系数 (CV)、95% 的一致性限制和可重复性系数，并评估了 Si-clamp 变化与糖尿病前期的关联。

结果

平均 (SD) 基线年龄为 47.5 ± 8.13 岁，体重指数为 30.4 ± 9.16 kg/m ²，空腹血糖为 93.7 ± 7.82 mg/dL，2-hrPG 为 126 ± 26.8 mg/dL。Si-clamp (umol/kg/min·pmol/L ^-1 ) 第 1 年为 0.071 ± 0.04，第 3 年为 0.067 ± 0.04 ( P  = 0.22)。第 1 年和第 3 年的值有很强的相关性（r  = 0.81，P  < 0.0001）；CV 为 13.6%，重复性系数为 ±0.025。串行 Si 夹中的受试者内差异小于重复性系数并且在 95% 的一致性范围内。经过 5.5 年的随访，40 名受试者进展为前驱糖尿病，50 名未进展。Si-clamp 的变化在进展者中大于非进展者（-10% 对 -2.5%，P  = 0.02）。

结论

HEC 在自由生活的个体中可重复约 2 年，Si 钳位的时间下降可预测前驱糖尿病风险。