Homeostatic Insulin Sensitivity Indices Is the Detection of Gestational Diabetes Mellitus

Shahnaz Hayat; Fatema Jebunnesa; Nasreen Rosy; Liaquat Ali

doi:doi:10.11648/j.ajbls.20190706.16

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Homeostatic Insulin Sensitivity Indices Is the Detection of Gestational Diabetes Mellitus

Shahnaz Hayat, Fatema Jebunnesa, Nasreen Rosy, Liaquat Ali

Published in American Journal of Biomedical and Life Sciences (Volume 7, Issue 6)

Received: 23 September 2019 Accepted: 22 November 2019 Published: 2 December 2019

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Abstract

Background: Early identification of GDM is strongly warranted for prevention of both maternal and fetal complications, but well known disadvantages of the present methods based on oral glucose challenge reduces the compliance and applicability of these methods in the screening of the disorder. Aims: The study aimed to assess FBG-based insulin sensitivity indices (ISIs) regarding their suitability as alternatives of 2 hr 75-g OGTT. Methods and Materials: Out of 300 subjects, 112 had GDM. Finally 84 GDM and 82 normal mothers were analyzed. A nested case control study was conducted with group of pregnant mothers, at 24 to 32 weeks of gestation, were recruited from BIRDEM (the tertiary hospital of Diabetic Association of Bangladesh) was screened for GDM by adapting WHO criteria. Serum glucose and insulin was measured by glucose oxidase and chemluminescence based ELISA. (ISIs) as well as glycemic and insulinemic indices were calculated their ability to detect GDM. Homeostatic formulas were used to quantify insulin sensitivity and B-cell function. McNamara test was used to calculate sensitivity, specificity, PPV and NPV of various tests against the gold standard of OGTT. Results: HOMA%B was significantly (p<0.001) lower in GDM (113.3±51.4) than their non-GDM counterparts (207.9±91.3). In Pearson’s correlation, HOMA%B had a significant correlation with age, FBG, 75-g OGTT and fasting insulin level. HOMA%S showed significantly correlation with FBG, 75-g OGTT, fasting insulin, HOMA%B and QUICKI. Logistic regression provided significant association of HOMA%B with GDM (p=0.002) after adjusting the effect of the confounders. The value of different screening markers for predicting GDM was explored. HOMA%S at optimum cut-off value of 50 showed sensitivity of 50% and specificity of 56%, with PPV and NPV 56% and 55% respectively. QUICKI had 28% and 31% respectively at an optimum cut-off value of 0.54. Fasting insulin showed 54% and 49% respectively at cut-off value of 12.9µU/ml with PPV 50% and NPV 50%. At an optimum cut- off value of 5mmol/l, the sensitivity, specificity, PPV and NPV of FBG was 82%, 78%, 79% and 81% respectively The corresponding value for combined fasting glucose and fasting insulin were 84%, 79%, 82% and 82%.Conclusion: The data suggest that (ISIs), such as simple fasting blood glucose with a cut-off value of 5.0mmol/l, for Bangladeshi population, seems to be an acceptable test in the detection of GDM.

Published in	American Journal of Biomedical and Life Sciences (Volume 7, Issue 6)
DOI	10.11648/j.ajbls.20190706.16
Page(s)	159-163
Creative Commons	This is an Open Access article, distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution and reproduction in any medium or format, provided the original work is properly cited.
Copyright	Copyright © The Author(s), 2019. Published by Science Publishing Group

Keywords

GDM, Insulin Indices, Insulin Secretory Capacity, Insulin Sensitivity

References

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[2]	Edmond, D. K. (ed.), Dewhurst’s Text book of Obstetrics and Gynecology, 7^th edn., Oxford University Press, London, 2007.
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[4]	Kirwan, J. P., Huston-Presley, L., Kalhan, S. et al., ‘Clinically useful estimates of insulin sensitivity during pregnancy: validation studies in women with normal glucose tolerance and gestational diabetes mellitus’.Diabetes Care, vol. 24, pp. 1519-21, 2001.
[5]	Katz, A., Nambi, S. S., Mather, K. et al., ‘Quantitative insulin sensitivity check index: a simple, accurate method for assessing insulin sensitivity in humans’.J Clin Endocrinol Metabl,vol. 85, pp. 2402-2410, 2000.
[6]	M Keskin; S Kurtoglu; M Kendirci; M. Emre Atabek and C Yazici ‘Homeostasis Model Assessment Is More Reliable Than the Fasting Glucose/Insulin Ratio andquantitative Insulin Sensitivity Check Index for Assessing Insulin Resistance Among Obese Children and Adolescents’. American Academy of Pediatrics. Vol. 115 No. 4 April 2005.
[7]	Kauffman, R. P., Castracane, V. D., Peghee, D. et al., ‘Detection of gestational diabetes mellitus by homeostatic indices of insulin sensitivity: A preliminary study’, Am J Obstet Gynecol, vol. 194, pp. 1576-1584, 2006.
[8]	Buchanan, T. A., ‘Pancreatic B-cell defects in gestational diabetes: implication for the pathogenesis and prevention of type 2 diabetes’. JCEM, vol. 86, no. 3, pp. 989-993, 2001.
[9]	M N Roy, K B Biswas, N Siddiqua, L Ali. ‘Determinants of Insulin Secretion and Sensitivity in Bangladeshi Type 2 Diabetic Subjects’. Metabolic syndrome and related disorders 5 (3): 275-8, 2007.
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[11]	Perucchini, D., Fischer,U., Spinal, G. A. et al, ‘Using fasting plasma glucose concentrations to screen for gestational diabetes mellitus: prospective population based study. BMJ, vol. 319, pp. 812-815, 1999.
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[13]	Rey, E., Hudon, L., Michon, N. et al, ‘Fasting plasma glucose versus glucose challenge test: screening for gestational diabetes and cost effectiveness’, Clin Biochem, vol. 37, pp. 780-784, 2004.
[14]	Mortensen, H. B., Molsted-Pedersen, L., Kuhl, C. et al.1999, ‘Screening procedure for diabetes in pregnancy’, Diabetes Metab, vol. 11, pp. 249-253.
[15]	Reichelt, A.J., Spichler, E.R., Branchtein, L. et al., ‘Fasting plasma glucose is a useful test for the detection of gestational diabetes: Brazilian study of gestational diabetes working group (EBDG) ’, Diabetes Care, vol. 21, pp. 1246-1249, 1998.
[16]	Sacks, D.A., Greenspoon, J.S. & Fotheringhan, N. ‘Could the fasting plasma glucose assay be used to screen for gestational diabetes?’ J Reprod Med, vol. 37, pp. 907-9, 1992.
[17]	American College of Obstetricians and Gynecologists Committee on Practice Bulletin, ‘Clinical management guidelines for obstetrician-gynecologists: gestational diabetes’, Am JObstet Gynecol, vol. 98, no 30, pp. 525-538, 2001.
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APA Style

Shahnaz Hayat, Fatema Jebunnesa, Nasreen Rosy, Liaquat Ali. (2019). Homeostatic Insulin Sensitivity Indices Is the Detection of Gestational Diabetes Mellitus. American Journal of Biomedical and Life Sciences, 7(6), 159-163. https://doi.org/10.11648/j.ajbls.20190706.16

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ACS Style

Shahnaz Hayat; Fatema Jebunnesa; Nasreen Rosy; Liaquat Ali. Homeostatic Insulin Sensitivity Indices Is the Detection of Gestational Diabetes Mellitus. Am. J. Biomed. Life Sci. 2019, 7(6), 159-163. doi: 10.11648/j.ajbls.20190706.16

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AMA Style

Shahnaz Hayat, Fatema Jebunnesa, Nasreen Rosy, Liaquat Ali. Homeostatic Insulin Sensitivity Indices Is the Detection of Gestational Diabetes Mellitus. Am J Biomed Life Sci. 2019;7(6):159-163. doi: 10.11648/j.ajbls.20190706.16

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@article{10.11648/j.ajbls.20190706.16,
  author = {Shahnaz Hayat and Fatema Jebunnesa and Nasreen Rosy and Liaquat Ali},
  title = {Homeostatic Insulin Sensitivity Indices Is the Detection of Gestational Diabetes Mellitus},
  journal = {American Journal of Biomedical and Life Sciences},
  volume = {7},
  number = {6},
  pages = {159-163},
  doi = {10.11648/j.ajbls.20190706.16},
  url = {https://doi.org/10.11648/j.ajbls.20190706.16},
  eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.ajbls.20190706.16},
  abstract = {Background: Early identification of GDM is strongly warranted for prevention of both maternal and fetal complications, but well known disadvantages of the present methods based on oral glucose challenge reduces the compliance and applicability of these methods in the screening of the disorder. Aims: The study aimed to assess FBG-based insulin sensitivity indices (ISIs) regarding their suitability as alternatives of 2 hr 75-g OGTT. Methods and Materials: Out of 300 subjects, 112 had GDM. Finally 84 GDM and 82 normal mothers were analyzed. A nested case control study was conducted with group of pregnant mothers, at 24 to 32 weeks of gestation, were recruited from BIRDEM (the tertiary hospital of Diabetic Association of Bangladesh) was screened for GDM by adapting WHO criteria. Serum glucose and insulin was measured by glucose oxidase and chemluminescence based ELISA. (ISIs) as well as glycemic and insulinemic indices were calculated their ability to detect GDM. Homeostatic formulas were used to quantify insulin sensitivity and B-cell function. McNamara test was used to calculate sensitivity, specificity, PPV and NPV of various tests against the gold standard of OGTT. Results: HOMA%B was significantly (p<0.001) lower in GDM (113.3±51.4) than their non-GDM counterparts (207.9±91.3). In Pearson’s correlation, HOMA%B had a significant correlation with age, FBG, 75-g OGTT and fasting insulin level. HOMA%S showed significantly correlation with FBG, 75-g OGTT, fasting insulin, HOMA%B and QUICKI. Logistic regression provided significant association of HOMA%B with GDM (p=0.002) after adjusting the effect of the confounders. The value of different screening markers for predicting GDM was explored. HOMA%S at optimum cut-off value of 50 showed sensitivity of 50% and specificity of 56%, with PPV and NPV 56% and 55% respectively. QUICKI had 28% and 31% respectively at an optimum cut-off value of 0.54. Fasting insulin showed 54% and 49% respectively at cut-off value of 12.9µU/ml with PPV 50% and NPV 50%. At an optimum cut- off value of 5mmol/l, the sensitivity, specificity, PPV and NPV of FBG was 82%, 78%, 79% and 81% respectively The corresponding value for combined fasting glucose and fasting insulin were 84%, 79%, 82% and 82%.Conclusion: The data suggest that (ISIs), such as simple fasting blood glucose with a cut-off value of 5.0mmol/l, for Bangladeshi population, seems to be an acceptable test in the detection of GDM.},
 year = {2019}
}

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TY - JOUR
T1 - Homeostatic Insulin Sensitivity Indices Is the Detection of Gestational Diabetes Mellitus
AU - Shahnaz Hayat
AU - Fatema Jebunnesa
AU - Nasreen Rosy
AU - Liaquat Ali
Y1 - 2019/12/02
PY - 2019
N1 - https://doi.org/10.11648/j.ajbls.20190706.16
DO - 10.11648/j.ajbls.20190706.16
T2 - American Journal of Biomedical and Life Sciences
JF - American Journal of Biomedical and Life Sciences
JO - American Journal of Biomedical and Life Sciences
SP - 159
EP - 163
PB - Science Publishing Group
SN - 2330-880X
UR - https://doi.org/10.11648/j.ajbls.20190706.16
AB - Background: Early identification of GDM is strongly warranted for prevention of both maternal and fetal complications, but well known disadvantages of the present methods based on oral glucose challenge reduces the compliance and applicability of these methods in the screening of the disorder. Aims: The study aimed to assess FBG-based insulin sensitivity indices (ISIs) regarding their suitability as alternatives of 2 hr 75-g OGTT. Methods and Materials: Out of 300 subjects, 112 had GDM. Finally 84 GDM and 82 normal mothers were analyzed. A nested case control study was conducted with group of pregnant mothers, at 24 to 32 weeks of gestation, were recruited from BIRDEM (the tertiary hospital of Diabetic Association of Bangladesh) was screened for GDM by adapting WHO criteria. Serum glucose and insulin was measured by glucose oxidase and chemluminescence based ELISA. (ISIs) as well as glycemic and insulinemic indices were calculated their ability to detect GDM. Homeostatic formulas were used to quantify insulin sensitivity and B-cell function. McNamara test was used to calculate sensitivity, specificity, PPV and NPV of various tests against the gold standard of OGTT. Results: HOMA%B was significantly (p<0.001) lower in GDM (113.3±51.4) than their non-GDM counterparts (207.9±91.3). In Pearson’s correlation, HOMA%B had a significant correlation with age, FBG, 75-g OGTT and fasting insulin level. HOMA%S showed significantly correlation with FBG, 75-g OGTT, fasting insulin, HOMA%B and QUICKI. Logistic regression provided significant association of HOMA%B with GDM (p=0.002) after adjusting the effect of the confounders. The value of different screening markers for predicting GDM was explored. HOMA%S at optimum cut-off value of 50 showed sensitivity of 50% and specificity of 56%, with PPV and NPV 56% and 55% respectively. QUICKI had 28% and 31% respectively at an optimum cut-off value of 0.54. Fasting insulin showed 54% and 49% respectively at cut-off value of 12.9µU/ml with PPV 50% and NPV 50%. At an optimum cut- off value of 5mmol/l, the sensitivity, specificity, PPV and NPV of FBG was 82%, 78%, 79% and 81% respectively The corresponding value for combined fasting glucose and fasting insulin were 84%, 79%, 82% and 82%.Conclusion: The data suggest that (ISIs), such as simple fasting blood glucose with a cut-off value of 5.0mmol/l, for Bangladeshi population, seems to be an acceptable test in the detection of GDM.
VL - 7
IS - 6
ER -

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Author Information

Shahnaz Hayat

Department of Gynaecology and Obstetrics, Dhaka Medical College, Dhaka, Bangladesh
Fatema Jebunnesa

Department of Biochemistry and Cell Biology, Faculty of Sciences, Bangladesh University of Health Sciences, Dhaka, Bangladesh
Nasreen Rosy

Department of Gynaecology and Obstetrics, Sir Solimullah Medical College and Hospital, Dhaka, Bangladesh
Liaquat Ali

Department of Biochemistry and Cell Biology, Faculty of Sciences, Bangladesh University of Health Sciences, Dhaka, Bangladesh

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Plain Text BibTeX RIS

APA Style

Shahnaz Hayat, Fatema Jebunnesa, Nasreen Rosy, Liaquat Ali. (2019). Homeostatic Insulin Sensitivity Indices Is the Detection of Gestational Diabetes Mellitus. American Journal of Biomedical and Life Sciences, 7(6), 159-163. https://doi.org/10.11648/j.ajbls.20190706.16

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ACS Style

Shahnaz Hayat; Fatema Jebunnesa; Nasreen Rosy; Liaquat Ali. Homeostatic Insulin Sensitivity Indices Is the Detection of Gestational Diabetes Mellitus. Am. J. Biomed. Life Sci. 2019, 7(6), 159-163. doi: 10.11648/j.ajbls.20190706.16

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AMA Style

Shahnaz Hayat, Fatema Jebunnesa, Nasreen Rosy, Liaquat Ali. Homeostatic Insulin Sensitivity Indices Is the Detection of Gestational Diabetes Mellitus. Am J Biomed Life Sci. 2019;7(6):159-163. doi: 10.11648/j.ajbls.20190706.16

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@article{10.11648/j.ajbls.20190706.16,
  author = {Shahnaz Hayat and Fatema Jebunnesa and Nasreen Rosy and Liaquat Ali},
  title = {Homeostatic Insulin Sensitivity Indices Is the Detection of Gestational Diabetes Mellitus},
  journal = {American Journal of Biomedical and Life Sciences},
  volume = {7},
  number = {6},
  pages = {159-163},
  doi = {10.11648/j.ajbls.20190706.16},
  url = {https://doi.org/10.11648/j.ajbls.20190706.16},
  eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.ajbls.20190706.16},
  abstract = {Background: Early identification of GDM is strongly warranted for prevention of both maternal and fetal complications, but well known disadvantages of the present methods based on oral glucose challenge reduces the compliance and applicability of these methods in the screening of the disorder. Aims: The study aimed to assess FBG-based insulin sensitivity indices (ISIs) regarding their suitability as alternatives of 2 hr 75-g OGTT. Methods and Materials: Out of 300 subjects, 112 had GDM. Finally 84 GDM and 82 normal mothers were analyzed. A nested case control study was conducted with group of pregnant mothers, at 24 to 32 weeks of gestation, were recruited from BIRDEM (the tertiary hospital of Diabetic Association of Bangladesh) was screened for GDM by adapting WHO criteria. Serum glucose and insulin was measured by glucose oxidase and chemluminescence based ELISA. (ISIs) as well as glycemic and insulinemic indices were calculated their ability to detect GDM. Homeostatic formulas were used to quantify insulin sensitivity and B-cell function. McNamara test was used to calculate sensitivity, specificity, PPV and NPV of various tests against the gold standard of OGTT. Results: HOMA%B was significantly (p<0.001) lower in GDM (113.3±51.4) than their non-GDM counterparts (207.9±91.3). In Pearson’s correlation, HOMA%B had a significant correlation with age, FBG, 75-g OGTT and fasting insulin level. HOMA%S showed significantly correlation with FBG, 75-g OGTT, fasting insulin, HOMA%B and QUICKI. Logistic regression provided significant association of HOMA%B with GDM (p=0.002) after adjusting the effect of the confounders. The value of different screening markers for predicting GDM was explored. HOMA%S at optimum cut-off value of 50 showed sensitivity of 50% and specificity of 56%, with PPV and NPV 56% and 55% respectively. QUICKI had 28% and 31% respectively at an optimum cut-off value of 0.54. Fasting insulin showed 54% and 49% respectively at cut-off value of 12.9µU/ml with PPV 50% and NPV 50%. At an optimum cut- off value of 5mmol/l, the sensitivity, specificity, PPV and NPV of FBG was 82%, 78%, 79% and 81% respectively The corresponding value for combined fasting glucose and fasting insulin were 84%, 79%, 82% and 82%.Conclusion: The data suggest that (ISIs), such as simple fasting blood glucose with a cut-off value of 5.0mmol/l, for Bangladeshi population, seems to be an acceptable test in the detection of GDM.},
 year = {2019}
}

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