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Ralph A DeFronzo, Masafumi Matsuda
Reduced Time Points to Calculate the Composite Index
DIABETES CARE, 33,(7):e93, 2010
2010年7月1日 8:30-8:55
８階医局
埼玉医科大学総合医療センター内分泌・糖尿病内科
Department of Endocrinology and Diabetes,
Saitama Medical Center, Saitama Medical University
松田昌文
Matsuda, Masafumi
http://mmatsuda.diabetes-smc.jp/english.html
RALPH A. DEFRONZO, MD1, MASAFUMI MATSUDA, MD, PHD2
1Department of Medicine, Diabetes Division, The University of Texas Health
Science Center at San Antonio, San Antonio, Texas
2Saitama Medical Center, Saitama Medical University, Saitama, Japan.
DOI: 10.2337/dc10-0646
DIABETES CARE, 33(7):e93, 2010
Background
Since the original publication of the composite
(Matsuda) index for the measurement of insulin
sensitivity from plasma glucose and insulin
concentrations during the oral glucose tolerance
test (OGTT), this index has been widely used by
investigators throughout the world. According to
Scopus, more than 1,000 articles have cited the
original article during the last 10 years, and several
modifications of this index have been published.
Although the basic idea is to use the plasma insulin
and glucose areas under the curve (AUCs), the
actual time points at which plasma insulin and
glucose levels are measured during the OGTT may
be few and the time intervals may not be equal.
Aim
We show here that calculation of the
composite index using these fewer time
points agrees well with the original
calculation, which was based on five plasma
glucose and insulin measurements.
Although it is difficult to imagine a
reasonable AUC when samples from only 0
and 120 min are available, the simple index
below works quite well.
Methods
Using the data from the original publication
(N = 153), correlation coefficients were
calculated relating whole-body
ISI(composite) to 1) the rate of insulin
stimulated glucose disposal (Rd) during the
euglycemic insulin clamp and 2) hepatic
insulin sensitivity (His) measured with
tritiated glucose: His=1,000/HGP×FPI, where
HGP is hepatic glucose production, the
primary determinant of fasting plasma
glucose level, and FPI is fasting plasma
insulin.
ISI(composite) = k/sqrt（G0 × I0 × <G> × <I>)
ISI(composite) = k/sqrt（G0 × I0 × G120 × I120)
• where ISI(composite) is the insulin sensitivity index,
• k (= 10,000) is a constant that provides numbers that
are easy to deal with,
• <G> and <I> represent the average plasma glucose
and insulin concentrations after oral glucose load
• G0 and G120 represent the plasma glucose
concentrations at times 0 and 120 min,
• I0 and I120 represent the plasma insulin concentrations
at times 0 and 120 min,
• and sqrt is the mathematical function to calculate the
square root.
ISI(composite) = k/sqrt（G0 × I0 × G120 × I120)
<G>≒G120 ，<I> ≒ I120
Normal Glucose Tolerant (n = 62)
Rd
ISI (comp)
His
0.727
0.613
ISI(comp)
(0,60,120 min)
0.738
0.632
ISI(comp)
0.734
0.582
(0,30,60,90,120 min)
(0,120 min)
Impaired Glucose Tolerant (n = 31)
Rd
ISI (comp)
Rd
0.732
His
0.670
(0,30,60,90,120 min)
ISI(comp)
(0,60,120 min)
0.741
ISI(comp)
0.772
His
ISI (comp)
(0,30,60,90,120 min)
0.663
0.435
ISI(comp)
(0,60,120 min)
0.684
0.458
ISI(comp)
(0,120 min)
0.793
0.450
Rd
0.544
His
0.669
0.546
0.653
0.610
0.634
0.680
Type 2 Diabetic Subjects (n = 60)
0.651
(0,120 min)
Table 1 Correlation coefficients (n=153) relating whole body
insulin sensitivity index [ISI(comp)] (i) to the rate of insulinstimulated glucose disposal [Rd] during the euglycemic insulin
clamp and (ii) to hepatic insulin sensitivity measured with
tritiated glucose (1000/HGP x FPI), where HGP is the primary
determinant of the FPG.
ISI (comp)
(0,30,60,90,120 min)
ISI(comp)
(0,60,120 min)
ISI(comp)
(0,120 min)
Results
Rd (or His) and an ISI(composite)
calculated from 0, 30, 60, 90, and 120
min (set A); 0, 60, and 120 min (set B);
and 0 and 120 min (set C) were
significantly (P < 0.01) correlated with r
= 0.732 (r = 0.670) in set A, r = 0.741 (r =
0.680) in set B, and r = 0.772 (r = 0.651)
in set C.
Conclusion
Although ISI(composite) calculated
using different time points cannot be
compared between different studies,
within any given study the index
provides a reasonable index of wholebody insulin sensitivity.
http://mmatsuda.diabetes-smc.jp/newpage115.html
De-convolusion technique to calculate glucose
sensitivity (insulin secretion)
ブドウ糖負荷試験の血中グルコース濃度，血中インスリン濃度は数式化すれば
インスリン分泌が評価できる。
Message
Matsuda Indexは非常によく用いられているが，概念的
には基礎状態の血中グルコースとインスリン濃度，ブ
ドウ糖負荷試験のグルコースとインスリン濃度の平均
値が計算に必要である。
ブドウ糖負荷後の反応の平均は0,60,120分や0,120分の
値からでも計算は十分に可能である。
(インスリン感受性の強い集団では0,60,120分を使った
方がよい)
他にも患者さんのデータが無駄にならず世の中の為に
なります！
⇒OGTTでは0,30,60,90,120分を測定してください
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