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Insulin resistance: Risk factors, diagnostic approaches and mathematical models for clinical practice, epidemiological studies, and beyond

Krzymien Janusz, Ladyzynski Piotr

Biocybernetics and Biomedical Engineering

2024

Vol. 44, no. 1

55--67

Insulin resistance (IR) is a multifactorial metabolic disorder associated with the development of cardiometabolic syndrome, cardiovascular diseases and obesity. Factors such as inflammation, hyperinsulinemia, hyperglucagonemia, mitochondrial dysfunction, glucotoxicity and lipotoxicity contribute to the development of IR. Despite being extensively studied for over 60 years, assessing the incidence of IR, developing effective prevention strategies, and implementing appropriate therapeutic approaches remain challenging. This review explores the multifaceted nature of IR, including its association with various conditions such as obesity, primary hypertension, dyslipidemia, obstructive sleep apnea, Alzheimer’s disease, non-alcoholic fatty liver disease, polycystic ovary syndrome, chronic kidney disease and cancer. Additionally, we discuss the complexity of diagnosing and quantifying IR, emphasizing the lack of absolute, common criteria for classification. We delve into the use of mathematical models in clinical and epidemiological studies, focusing on the choice between insulin, triglycerides, or waist-to-hip ratio as IR determinants. Furthermore, we highlight the importance of reliable input data and caution in interpreting results when utilizing mathematical models for IR assessment. This narrative review aims to provide insights into the challenges and considerations involved in conducting IR diagnostics, with implications for clinical practice, epidemiological research, and future advancements in this field.

Tissue insulin sensitivity measurements in men. Quality factors and performance determinants for successful clamp experiments. Design and development of the TISS system and its clinical verifications

Wójcicki J. M., Ładyżyński P., Foltyński P., Mikulicz H., Blachowicz J.

Biocybernetics and Biomedical Engineering

2002

Vol. 22, no. 2-3

129-144

Insulin sensitivity (IS) is one of the important diagnostic parameters used in treatments of diabetes, hypertension and other diseases as well as during evaluation of new drug therapies. Euglycaemic glucose clamp is the most accurate method of the IS measurement. Effectiveness of this procedure depends on accuracy of the tissue glucose utilization measurements (GU) and proper realization of the insulin infusion. Application of the accurate glucose control algorithm, sampling site, sampling frequency, duration of the procedure are also very important factors. Possible technical realization includes manual, semi-automatic and automatic modes. Recently the computerized semi-automatic system realizing this type of measurement has been designed and developed in the IBBE PAS. A developed system consist of control unit, infusion unit, glycaemia measurement unit and printer. Endogenous glucose secretion is suppressed by insulin infusion, which is determined according to individual patients parameters. The newest version of the measurement procedure allows to realize euglycaemic or normoglycaemic clamp studies. TISS system is inexpensive and easily operated by one person from middle medical staff. Till now GU measurements using TISS system were performed on over 200 patients in 4 Polish clinical centers. Developed and clinically tested TISS system seems to provide satisfying quality of the GU measurement in men.