Euglycemic hyperinsulinemic clampSeminarios de diabetes
- Vol.24 N.4 julio-agosto 2008A. Gómez-Urbano1, F.J. Berral de la Rosa2, J.A. Paniagua González3
Insulin is the principal hormone of glucose metabolic regulation. Reduced
glucose responses to insulin constitute an underlying feature
of type 2 diabetes. In addition, insulin resistance is a common condition
related with the metabolic syndrome and strongly associated
with an increased risk of cardiovascular disease. The importance of
the insulin-resistant phenotype for the assessment of cardiovascular
risk and response to intervention is increasingly being recognized.
Therefore, there is a need for an accurate and reproducible method
for measuring insulin resistance in vivo. The euglycemic hyperinsulinemic
clamp (EHC) is currently the gold standard method available
for the determination of whole glucose uptake in response to
insulin, from which several derived indices of insulin sensitivity are
obtained. The clamp technique is both expensive and complex to
undertake and has prompted the use of surrogate methods, notably
the insulin tolerance test and frequently sampled intravenous glucose
tolerance test. Indices may be derived from these methods and correlate
well with those derived from clamp studies. However, important
limitations of these procedures are that not only does insulin
sensitivity change in pathological situations, but also in normal physiology.
Variations also occur in time–depending on the physiological
state of the individual or following diurnal rhythms. In conclusion, the
quantitative assessment of insulin sensitivity with EHC is not used for
routine clinical purposes, but the emerging importance of insulin resistance
has led to its wider application to research studies that have
examined its pathogenesis, etiology and consequences.
Correspondencia: J.A. Paniagua González. Servicio de Endocrinología y Nutrición. Hospital
Universitario Reina Sofía. Avda. Menéndez Pidal, s/n. 14004 Córdoba (Spain).
Palabras claveclamp technique insulin action resistencia a la insulina
Evaluación de la sensibilidad a la insulina en investigación y en la práctica clínica