The Dynamic Insulin Sensitivity and Secretion Test (DISST) - a novel measure of insulin sensitivity
Objective: To validate the methodology for the Dynamic Insulin Sensitivity and Secretion Test (DISST) and to demonstrate its potential in clinical and research settings. Methods: 123 men and women had routine clinical and biochemical measurements, an oral glucose tolerance test and a DISST. For the DISST, participants were cannulated for blood sampling and bolus administration. Blood samples were drawn at t=0, 10, 15, 25 and 35 minutes for measurement of glucose, insulin and C-peptide. A 10g bolus of intravenous glucose at t=5 minutes and 1U of intravenous insulin immediately after the t=15 minute sample were given. Fifty participants also had a hyperinsulinaemic euglycaemic clamp. Relationships between DISST insulin sensitivity (SI) and the clamp, and both DISST SI and secretion and other metabolic variables were measured. Results: A Bland-Altman plot showed little bias in the comparison of DISST with the clamp; with DISST underestimating the glucose clamp by 0.1·10-2·mg·l·kg-1·min-1·pmol-1 (90%CI -0.2 to 0). The correlation between SI as measured by DISST and the clamp was 0.82, the c unit for the ROC analysis for the two tests was 0.96. Metabolic variables showed significant correlations with DISST IS, and the second phase of insulin release. DISST also appears able to distinguish different insulin secretion patterns in individuals with identical SI values. Conclusions: DISST is a simple, dynamic test that compares favourably with the clamp in assessing SI and allows simultaneous assessment of insulin secretion. DISST has the potential to provide even more information about the pathophysiology of diabetes than more complicated tests.
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