Japanese suggest insulin, leptin and adiponectin levels to find IR

Link to easier reading of: Early diagnosis of type 2 diabetes

Japanese trial 2018

"Insulin resistance was correlated with

1- fasting levels of insulin and

2- leptin/adiponectin (r = 0.913);

3-retinol binding protein 4 and

4-glycated albumin"

" However, the OGTT is a time-consuming and invasive test."

"Adiponectin and leptin are secreted exclusively by adipose tissue and
act as hormones with antagonistic effects."

"The results of this study demonstrate that multiple markers including

1- insulin,

2- leptin/adiponectin,(ratio) and

3- 10- and 12-Z,E-HODE/LA

can be used to detect diabetes risk at an early stage."

" Leptin has pro-inflammatory effects while adiponectin has insulin-sensitizing
and anti-inflammatory properties.

" It is therefore reasonable that L/A(leptin to adiponectin ratio) is
highly correlated with insulin levels during the OGTT. "

"In contrast, quantitative measurements and immunological assays for our biomarkers
(i.e., insulin, adiponectin and leptin) are much easier to perform. "

"We believe that these multiple biomarkers will provide sufficient information
to detect diabetes risk during annual health examinations.

Lifestyle modification or pharmacotherapy with metformin plus low-dose pioglitazone
has been recommended for patients with IFG ± IGT.(23)"

"The results presented here confirm the robustness and effectiveness of our proposed algorithm, which can predict

1- diabetes risk,

2- glucose tolerance, and

3-insulin resistance

before diabetes onset.

At a minimum, the algorithm consisted of

1-fasting plasma insulin and

2-leptin/adiponectin levels, and preferably

3- 10- and 12-Z,E-HODE levels.

In addition, the OGTT was useful when insulin data were obtained.

However, given that the OGTT is a time-consuming, invasive and
inconvenient test that is limited to healthy individuals, we propose that it
be replaced by a more convenient annual health examination that measures
only the 4 fasting plasma biomarkers confirmed in this study,
which are more reliable than plasma levels of
HbA1c that reflect the accumulation of 3 months of physical conditioning."

Conventional advise from Medical literature for clinical practice

UpToDate: 

Insulin levels not advised with OGTT(oral glucose tolerance test) or with fasting glucose(see bottom)

Prevention of type 2 diabetes mellitus

Literature review current through: Mar 2018

Authors:

David K McCulloch, MD

R Paul Robertson, MD

Section Editor:

David M Nathan, MD

Deputy Editor:

Jean E Mulder, MD

INTRODUCTION

"Type 2 diabetes mellitus is characterized by 

1-hyperglycemia,

2- insulin resistance, and 

3-relative impairment in insulin secretion.

 Although the lifetime risk of type 2 diabetes is high, our ability to predict and prevent type 2 diabetes in the general population is limited. 

However, individuals at high risk, including those with

1- impaired fasting glucose (IFG), 

2-impaired glucose tolerance (IGT), 

3-obesity, 

4-close relatives with type 2 diabetes, or who are 

4-members of certain ethnic groups (Asian, Hispanic, African American), 

are appropriate candidates for preventive interventions [1]"

My opinion: These high risk patients should be started on metformin. 

If also obese, they should also be given after maximum dose of metformin tolerated.

Dx. of Pre-diabetic states.

In large population epidemiology studies,

 simple ratios derived from fasting insulin and glucose 

1-glucose to insulin ratios, 

2-homeostasis model assessment of insulin resistance [HOMA-IR or HOMA]) 

have been extensively used. 

There are limitations to their use, including

1- lack of a standardized universal insulin assay, and 

2-lack of data demonstrating that markers of insulin resistance predict response to treatment. 

As a result, although indexes such as HOMA, quantitative insulin sensitivity check index (QUICKI), etc, have been proposed and cut-points identified [11], 

none are recommended for routine assessment of insulin resistance in the clinic.