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Weber DM, Kim JC, Goldman SM, Clarke NJ, Racke MK. New plasma LC-MS/MS assays for the quantitation of beta-amyloid peptides and identification of apolipoprotein E proteoforms for Alzheimer's disease risk assessment. J Investig Med 2024; 72:465-474. [PMID: 38548482 DOI: 10.1177/10815589241246537] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/01/2024]
Abstract
Early detection of Alzheimer's disease (AD) represents an unmet clinical need. Beta-amyloid (Aβ) plays an important role in AD pathology, and the Aβ42/40 peptide ratio is a good indicator for amyloid deposition. In addition, variants of the apolipoprotein E (APOE) gene are associated with variable AD risk. Here, we describe the development and validation of high-throughput liquid chromatography-tandem mass spectrometry (LC-MS/MS) assays for plasma Aβ40 and Aβ42 quantitation, as well as apolipoprotein E (ApoE) proteotype determination as a surrogate for APOE genotype. Aβ40 and Aβ42 were simultaneously immunoprecipitated from plasma, proteolytically digested, and quantitated by LC-MS/MS. ApoE proteotype status was qualitatively assessed by targeting tryptic peptides from the ApoE2, ApoE3, and ApoE4 proteoforms. Both assays were validated according to the Clinical and Laboratory Standards Institute (CLSI) guidelines. Within-run precision was 1.8%-4.2% (Aβ40), 1.9%-7.2% (Aβ42), and 2.6%-8.3% (Aβ42/40 ratio). Between-run precision was 3.5%-5.9% (Aβ40), 3.8%-8.0% (Aβ42), and 3.3%-8.7% (Aβ42/40 ratio). Both Aβ40 and Aβ42 were linear from 10 to 2500 pg/mL. Identified ApoE proteotypes had 100% concordance with APOE genotypes. We have developed a precise, accurate, and sensitive high-throughput LC-MS/MS assay for plasma Aβ40, Aβ42, and proteoforms of ApoE.
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Affiliation(s)
- Darren M Weber
- Quest Diagnostics Nichols Institute, San Juan Capistrano, CA, USA
| | - Jueun C Kim
- Quest Diagnostics Nichols Institute, San Juan Capistrano, CA, USA
| | - Scott M Goldman
- Quest Diagnostics Nichols Institute, San Juan Capistrano, CA, USA
| | - Nigel J Clarke
- Quest Diagnostics Nichols Institute, San Juan Capistrano, CA, USA
| | - Michael K Racke
- Quest Diagnostics Nichols Institute, San Juan Capistrano, CA, USA
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Weber DM, Taylor SW, Lagier RJ, Kim JC, Goldman SM, Clarke NJ, Vaillancourt DE, Duara R, McFarland KN, Wang WE, Golde TE, Racke MK. Clinical utility of plasma Aβ42/40 ratio by LC-MS/MS in Alzheimer's disease assessment. Front Neurol 2024; 15:1364658. [PMID: 38595851 PMCID: PMC11003272 DOI: 10.3389/fneur.2024.1364658] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2024] [Accepted: 03/08/2024] [Indexed: 04/11/2024] Open
Abstract
Introduction Plasma Aβ42/40 ratio can help predict amyloid PET status, but its clinical utility in Alzheimer's disease (AD) assessment is unclear. Methods Aβ42/40 ratio was measured by LC-MS/MS for 250 specimens with associated amyloid PET imaging, diagnosis, and demographic data, and for 6,192 consecutive clinical specimens submitted for Aβ42/40 testing. Results High diagnostic sensitivity and negative predictive value (NPV) for Aβ-PET positivity were observed, consistent with the clinical performance of other plasma LC-MS/MS assays, but with greater separation between Aβ42/40 values for individuals with positive vs. negative Aβ-PET results. Assuming a moderate prevalence of Aβ-PET positivity, a cutpoint was identified with 99% NPV, which could help predict that AD is likely not the cause of patients' cognitive impairment and help reduce PET evaluation by about 40%. Conclusion High-throughput plasma Aβ42/40 LC-MS/MS assays can help identify patients with low likelihood of AD pathology, which can reduce PET evaluations, allowing for cost savings.
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Affiliation(s)
- Darren M. Weber
- Quest Diagnostics Nichols Institute, San Juan Capistrano, CA, United States
| | - Steven W. Taylor
- Quest Diagnostics Nichols Institute, San Juan Capistrano, CA, United States
| | - Robert J. Lagier
- Quest Diagnostics Nichols Institute, San Juan Capistrano, CA, United States
| | - Jueun C. Kim
- Quest Diagnostics Nichols Institute, San Juan Capistrano, CA, United States
| | - Scott M. Goldman
- Quest Diagnostics Nichols Institute, San Juan Capistrano, CA, United States
| | - Nigel J. Clarke
- Quest Diagnostics Nichols Institute, San Juan Capistrano, CA, United States
| | - David E. Vaillancourt
- Department of Applied Physiology and Kinesiology, University of Florida, Gainesville, FL, United States
| | - Ranjan Duara
- Department of Applied Physiology and Kinesiology, University of Florida, Gainesville, FL, United States
- Wien Center for Alzheimer's Disease and Memory Disorders, Mount Sinai Medical Center, Miami Beach, FL, United States
| | - Karen N. McFarland
- Department of Neurology, Center for Translational Research in Neurodegenerative Disease, 1Florida Alzheimer’s Disease Research Center (ADRC), University of Florida, Gainesville, FL, United States
| | - Wei-en Wang
- Department of Applied Physiology and Kinesiology, University of Florida, Gainesville, FL, United States
| | - Todd E. Golde
- Department of Neurology, Center for Translational Research in Neurodegenerative Disease, 1Florida Alzheimer’s Disease Research Center (ADRC), University of Florida, Gainesville, FL, United States
- Department of Pharmacology and Chemical Biology, Department of Neurology, Emory Center for Neurodegenerative Disease, Emory University, Atlanta, GA, United States
| | - Michael K. Racke
- Quest Diagnostics Nichols Institute, San Juan Capistrano, CA, United States
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Weber DM, Taylor SW, Lagier RJ, Kim JC, Goldman SM, Clarke NJ, Vaillancourt DE, Duara R, McFarland KN, Wang WE, Golde TE, Racke MK. Clinical utility of plasma Aβ42/40 ratio by LC-MS/MS in Alzheimer's disease assessment. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2023:2023.12.12.23299878. [PMID: 38168329 PMCID: PMC10760303 DOI: 10.1101/2023.12.12.23299878] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/05/2024]
Abstract
INTRODUCTION Plasma Aβ42/40 ratio can be used to help predict amyloid PET status, but its clinical utility in Alzheimer's disease (AD) assessment is unclear. METHODS Aβ42/40 ratio was measured by LC-MS/MS in 250 specimens with associated amyloid PET imaging, diagnosis, and demographic data, and 6,192 consecutive clinical specimens submitted for Aβ42/40 testing. RESULTS High diagnostic sensitivity and negative predictive value (NPV) for Aβ-PET positivity were observed, consistent with the clinical performance of other plasma LC-MS/MS assays, but with greater separation between Aβ42/40 values for individuals with positive vs negative Aβ-PET results. Assuming a moderate prevalence of Aβ-PET positivity, a cutpoint was identified with 99% NPV, which could help predict that AD is likely not the cause of patients' cognitive impairment and help reduce PET evaluation by about 40%. DISCUSSION Using high-throughput plasma Aβ42/40 LC-MS/MS assays can help reduce PET evaluations in patients with low likelihood of AD pathology, allowing for cost savings.
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Affiliation(s)
- Darren M Weber
- Quest Diagnostics Nichols Institute, San Juan Capistrano, CA USA
| | - Steven W Taylor
- Quest Diagnostics Nichols Institute, San Juan Capistrano, CA USA
| | - Robert J Lagier
- Quest Diagnostics Nichols Institute, San Juan Capistrano, CA USA
| | - Jueun C Kim
- Quest Diagnostics Nichols Institute, San Juan Capistrano, CA USA
| | - Scott M Goldman
- Quest Diagnostics Nichols Institute, San Juan Capistrano, CA USA
| | - Nigel J Clarke
- Quest Diagnostics Nichols Institute, San Juan Capistrano, CA USA
| | - David E Vaillancourt
- Department of Applied Physiology and Kinesiology, Fixel Institute for Neurological Disorders, and 1Florida ADRC, University of Florida, Gainesville, FL USA
| | - Ranjan Duara
- Department of Applied Physiology and Kinesiology, Fixel Institute for Neurological Disorders, and 1Florida ADRC, University of Florida, Gainesville, FL USA
- Wien Center for Alzheimer's Disease and Memory Disorders, Mount Sinai Medical Center, Miami Beach, FL USA
| | - Karen N McFarland
- Department of Neurology, Center for Translational Research in Neurodegenerative Disease, 1Florida Alzheimer's Disease Research Center (ADRC), University of Florida, Gainesville, FL USA
| | - Wei-En Wang
- Department of Applied Physiology and Kinesiology, Fixel Institute for Neurological Disorders, and 1Florida ADRC, University of Florida, Gainesville, FL USA
| | - Todd E Golde
- Department of Neurology, Center for Translational Research in Neurodegenerative Disease, 1Florida Alzheimer's Disease Research Center (ADRC), University of Florida, Gainesville, FL USA
- Department of Pharmacology and Chemical Biology and Department of Neurology Center for Neurodegenerative Disease, Goizueta Institute Emory Brain Health, Emory University, School of Medicine. Atlanta, GA USA
| | - Michael K Racke
- Quest Diagnostics Nichols Institute, San Juan Capistrano, CA USA
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Louie JZ, Shiffman D, McPhaul MJ, Melander O. Insulin resistance probability score and incident cardiovascular disease. J Intern Med 2023; 294:531-535. [PMID: 37424183 DOI: 10.1111/joim.13687] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/11/2023]
Abstract
BACKGROUND Insulin resistance (IR) is associated with cardiovascular disease (CVD). However, insulin immunoassay variability and scarce research of the elderly have hindered the adoption of IR assessment for CVD prevention. We asked whether the probability of having IR [p(IR)]-derived from insulin and C-peptide mass-spectrometry assays-was associated with CVD in the elderly. METHODS A random cohort was drawn from MPP, a population-based study of the elderly. After excluding those with missing data, CVD, or diabetes, 3645 participants (median age = 68) remained. RESULTS During follow-up (13.3 years), 794 incident CVD events were observed. p(IR) > 80% (n = 152) compared with p(IR) ≤ 80% was associated with incident CVD (HR = 1.51, 95% CI 1.12-2.05, p = 0.007) and CVD or all-cause mortality (HR = 1.43, 95% CI 1.16-1.77, p = 0.0009) after adjusting for age, sex, hypertension, smoking, HDL-cholesterol, total cholesterol, triglycerides, BMI, and prediabetes. CONCLUSION High p(IR) was associated with >50% greater risk of incident CVD. IR assessment in the elderly may be warranted.
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Affiliation(s)
- Judy Z Louie
- Endocrine Division, Quest Diagnostics Nichols Institute, San Juan Capistrano, California, USA
| | - Dov Shiffman
- Endocrine Division, Quest Diagnostics Nichols Institute, San Juan Capistrano, California, USA
| | - Michael J McPhaul
- Endocrine Division, Quest Diagnostics Nichols Institute, San Juan Capistrano, California, USA
| | - Olle Melander
- Department of Clinical Sciences, Lund University, Malmö, Sweden
- Department of Emergency and Internal Medicine, Skåne University Hospital, Malmö, Sweden
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Weber DM, Yang JY, Goldman SM, Clarke NJ, Taylor SW, McPhaul MJ. Antibody-Free Quantification of Serum Chromogranin A by Targeted Mass Spectrometry. Clin Chem 2021; 67:1618-1627. [PMID: 34718463 DOI: 10.1093/clinchem/hvab191] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Accepted: 08/19/2021] [Indexed: 11/14/2022]
Abstract
BACKGROUND Chromogranin A (CgA) is a 48 kDa protein that serves as a diagnostically sensitive, but nonspecific, serum biomarker for neuroendocrine tumors. Immunoassays for CgA are not standardized and have a narrow dynamic range, which requires dilution of concentrated specimens. We developed and validated an antibody-free, liquid chromatography-tandem mass spectrometry (LC-MS/MS)-based method for CgA without these limitations. METHODS CgA was extracted from serum using a mixed-mode anion exchange solid-phase extraction plate, digested with trypsin, and analyzed by LC-MS/MS using well-characterized CgA calibration standards. After validation, the mass spectrometry method was compared with the CISBIO immunoassay using 200 serum specimens previously submitted for CgA analysis. Specimens with discordant results were reanalyzed by high-resolution mass spectrometry- (HRMS) -based methods to assess the contribution of truncated and post-translationally modified forms of CgA. RESULTS The assay had a linear range of 50 to 50 000 ng/mL, recoveries between 89% and 115%, and intra- and interassay imprecision <10%. LC-MS/MS assay results showed a Pearson's correlation of r = 0.953 with the CISBIO immunoassay, with CgA values being a mean 2- to 4-fold higher. Concordance for CgA between the 2 assays was 80.9% (95% CI 72.8%-89.2%), showing substantial agreement. Truncation and posttranslational modification, including 2 phosphorylation sites that had not been previously observed or predicted to our knowledge, did not appear to contribute directly to discordance between the 2 assays. CONCLUSION Quantification of CgA by LC-MS/MS provides an analytically sensitive and reproducible alternative to commercially available immunoassays.
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Affiliation(s)
- Darren M Weber
- Quest Diagnostics Nichols Institute, San Juan Capistrano, CA, USA
| | - Jane Y Yang
- Quest Diagnostics Nichols Institute, San Juan Capistrano, CA, USA
| | - Scott M Goldman
- Quest Diagnostics Nichols Institute, San Juan Capistrano, CA, USA
| | - Nigel J Clarke
- Quest Diagnostics Nichols Institute, San Juan Capistrano, CA, USA
| | - Steven W Taylor
- Quest Diagnostics Nichols Institute, San Juan Capistrano, CA, USA
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Bril F, McPhaul MJ, Kalavalapalli S, Lomonaco R, Barb D, Gray ME, Shiffman D, Rowland CM, Cusi K. Intact Fasting Insulin Identifies Nonalcoholic Fatty Liver Disease in Patients Without Diabetes. J Clin Endocrinol Metab 2021; 106:e4360-e4371. [PMID: 34190318 DOI: 10.1210/clinem/dgab417] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Indexed: 01/08/2023]
Abstract
CONTEXT Patients with nonalcoholic fatty liver disease (NAFLD) are characterized by insulin resistance and hyperinsulinism. However, insulin resistance measurements have not been shown to be good diagnostic tools to predict NAFLD in prior studies. OBJECTIVE We aimed to assess a newly validated method to measure intact molecules of insulin by mass spectrometry to predict NAFLD. METHODS Patients underwent a 2-hour oral glucose tolerance test (OGTT), a liver magnetic resonance spectroscopy (1H-MRS), and a percutaneous liver biopsy if they had a diagnosis of NAFLD. Mass spectrometry was used to measure intact molecules of insulin and C-peptide. RESULTS A total of 180 patients were recruited (67% male; 52 ± 11 years of age; body mass index [BMI] 33.2 ± 5.7 kg/m2; 46% with diabetes and 65% with NAFLD). Intact fasting insulin was higher in patients with NAFLD, irrespective of diabetes status. Patients with NAFLD without diabetes showed ~4-fold increase in insulin secretion during the OGTT compared with all other subgroups (P = 0.008). Fasting intact insulin measurements predicted NAFLD in patients without diabetes (area under the receiver operating characteristic curve [AUC] of 0.90 [0.84-0.96]). This was significantly better than measuring insulin by radioimmunoassay (AUC 0.80 [0.71-0.89]; P = 0.007). Intact fasting insulin was better than other clinical variables (eg, aspartate transaminase, triglycerides, high-density lipoprotein, glucose, HbA1c, and BMI) to predict NAFLD. When combined with alanine transaminase (ALT) (intact insulin × ALT), it detected NAFLD with AUC 0.94 (0.89-0.99) and positive and negative predictive values of 93% and 88%, respectively. This newly described approach was significantly better than previously validated noninvasive scores such as NAFLD-LFS (P = 0.009), HSI (P < 0.001), and TyG index (P = 0.039). CONCLUSION In patients without diabetes, accurate measurement of fasting intact insulin levels by mass spectrometry constitutes an easy and noninvasive strategy to predict presence of NAFLD.
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Affiliation(s)
- Fernando Bril
- Internal Medicine, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL 35294, USA
- Division of Endocrinology, Diabetes and Metabolism, University of Florida, Gainesville, FL 32610, USA
| | - Michael J McPhaul
- Quest Diagnostics Nichols Institute, San Juan Capistrano, CA 92675, USA
| | - Srilaxmi Kalavalapalli
- Division of Endocrinology, Diabetes and Metabolism, University of Florida, Gainesville, FL 32610, USA
| | - Romina Lomonaco
- Division of Endocrinology, Diabetes and Metabolism, University of Florida, Gainesville, FL 32610, USA
| | - Diana Barb
- Division of Endocrinology, Diabetes and Metabolism, University of Florida, Gainesville, FL 32610, USA
| | - Meagan E Gray
- Division of Gastroenterology, Hepatology and Nutrition, University of Alabama at Birmingham, Birmingham, AL 35294, USA
| | - Dov Shiffman
- Quest Diagnostics Nichols Institute, San Juan Capistrano, CA 92675, USA
| | - Charles M Rowland
- Quest Diagnostics Nichols Institute, San Juan Capistrano, CA 92675, USA
| | - Kenneth Cusi
- Division of Endocrinology, Diabetes and Metabolism, University of Florida, Gainesville, FL 32610, USA
- Division of Endocrinology, Diabetes and Metabolism, Malcom Randall, VAMC, Gainesville, FL 32611, USA
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Biological Activity of c-Peptide in Microvascular Complications of Type 1 Diabetes-Time for Translational Studies or Back to the Basics? Int J Mol Sci 2020; 21:ijms21249723. [PMID: 33419247 PMCID: PMC7766542 DOI: 10.3390/ijms21249723] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Revised: 12/15/2020] [Accepted: 12/16/2020] [Indexed: 12/15/2022] Open
Abstract
People with type 1 diabetes have an increased risk of developing microvascular complications, which have a negative impact on the quality of life and reduce life expectancy. Numerous studies in animals with experimental diabetes show that c-peptide supplementation exerts beneficial effects on diabetes-induced damage in peripheral nerves and kidneys. There is substantial evidence that c-peptide counteracts the detrimental changes caused by hyperglycemia at the cellular level, such as decreased activation of endothelial nitric oxide synthase and sodium potassium ATPase, and increase in formation of pro-inflammatory molecules mediated by nuclear factor kappa-light-chain-enhancer of activated B cells: cytokines, chemokines, cell adhesion molecules, vascular endothelial growth factor, and transforming growth factor beta. However, despite positive results from cell and animal studies, no successful c-peptide replacement therapies have been developed so far. Therefore, it is important to improve our understanding of the impact of c-peptide on the pathophysiology of microvascular complications to develop novel c-peptide-based treatments. This article aims to review current knowledge on the impact of c-peptide on diabetic neuro- and nephropathy and to evaluate its potential therapeutic role.
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Weber DM, Tran D, Goldman SM, Taylor SW, Ginns EI, Lagier RJ, Rissman RA, Brewer JB, Clarke NJ. High-Throughput Mass Spectrometry Assay for Quantifying β-Amyloid 40 and 42 in Cerebrospinal Fluid. Clin Chem 2019; 65:1572-1580. [PMID: 31628138 DOI: 10.1373/clinchem.2018.300947] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2018] [Accepted: 09/23/2019] [Indexed: 01/11/2023]
Abstract
BACKGROUND The ratio of β-amyloid 1-42 (Aβ42) to Aβ40 in cerebrospinal fluid (CSF) may be useful for evaluating Alzheimer disease (AD), but quantification is limited by factors including preanalytical analyte loss. We developed an LC-MS/MS assay that limits analyte loss. Here we describe the analytical characteristics of the assay and its performance in differentiating patients with AD from non-AD dementia and healthy controls. METHODS To measure Aβ42/Aβ40, we used unique proteolytically derived C-terminal peptides as surrogate markers of Aβ40 and Aβ42, which were analyzed and quantified by LC-MS/MS. The assay was analytically validated and applied to specimens from individuals with clinically diagnosed AD (n = 102), mild cognitive impairment (n = 37), and non-AD dementias (n = 22), as well as from healthy controls (n = 130). Aβ42/Aβ40 values were compared with APOE genotype inferred from phenotype, also measured by LC-MS/MS. RESULTS The assay had a reportable range of 100 to 25000 pg/mL, a limit of quantification of 100 pg/mL, recoveries between 93% and 111%, and intraassay and interassay CV <15% for both peptides. An Aβ42/Aβ40 ratio cutoff of <0.16 had a clinical sensitivity of 78% for distinguishing patients with AD from non-AD dementia (clinical specificity, 91%) and from healthy controls (clinical specificity, 81%). The Aβ42/Aβ40 ratio decreased significantly (P < 0.001) with increasing dose of APOE4 alleles. CONCLUSIONS This assay can be used to determine Aβ42/Aβ40 ratios, which correlate with the presence of AD.
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Affiliation(s)
- Darren M Weber
- Quest Diagnostics Nichols Institute, San Juan Capistrano, CA
| | - Diana Tran
- Quest Diagnostics Nichols Institute, San Juan Capistrano, CA
| | - Scott M Goldman
- Quest Diagnostics Nichols Institute, San Juan Capistrano, CA
| | - Steven W Taylor
- Quest Diagnostics Nichols Institute, San Juan Capistrano, CA
| | | | | | - Robert A Rissman
- University of California, San Diego (UCSD) ADRC Neuropathology Core and Brain Bank, La Jolla, CA.,Veterans Affairs San Diego Healthcare System, La Jolla, CA
| | - James B Brewer
- UC San Diego Department of Neurosciences and Shiley Marcos Alzheimer's Disease Research Center, La Jolla, CA
| | - Nigel J Clarke
- Quest Diagnostics Nichols Institute, San Juan Capistrano, CA;
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Abbasi F, Shiffman D, Tong CH, Devlin JJ, McPhaul MJ. Insulin Resistance Probability Scores for Apparently Healthy Individuals. J Endocr Soc 2018; 2:1050-1057. [PMID: 30187017 PMCID: PMC6117401 DOI: 10.1210/js.2018-00107] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2018] [Accepted: 08/06/2018] [Indexed: 11/23/2022] Open
Abstract
Context Insulin resistance (IR) can progress to type 2 diabetes. Therefore, timely identification of IR could facilitate disease prevention efforts. However, direct measurement of IR is not feasible in a clinical setting. Objective Develop a clinically practical probability score to assess IR in apparently healthy individuals based on levels of insulin, C-peptide, and other risk factors. Design Cross-sectional study. Participants Apparently healthy individuals who volunteered to participate in studies of IR. Main Outcome Measure IR, defined as the top tertile of steady-state plasma glucose during an insulin-suppression test. Results In a study of 535 participants, insulin, C-peptide, creatinine, body mass index (BMI), and triglycerides to high-density lipoprotein cholesterol ratio (TG/HDL-C) were independently associated with IR (all P < 0.05) in a model that included age, sex, ethnicity, BMI, blood pressure, insulin, C-peptide, fasting glucose, low-density lipoprotein cholesterol, TG/HDL-C, alanine aminotransferase, and creatinine. For an IR probability score based on a model that included insulin, C-peptide, creatinine, TG/HDL-C, and BMI, the odds ratio was 26.7 (95% CI 14.0 to 50.8) for those with scores >66% compared with those with scores <33%. When only insulin and C-peptide were included in the model, the odds ratio was 15.6 (95% CI 7.5 to 32.4) for those with scores >66% compared with those with scores <33%. Conclusions An IR probability score based on insulin, C-peptide, creatinine, TG/HDL-C, and BMI or a score based on only insulin and C-peptide may help assess IR in apparently healthy individuals.
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Affiliation(s)
- Fahim Abbasi
- Division of Cardiovascular Medicine, Department of Medicine, Stanford University School of Medicine, Stanford, California
| | - Dov Shiffman
- Quest Diagnostics Nichols Institute, San Juan Capistrano, California
| | - Carmen H Tong
- Quest Diagnostics Nichols Institute, San Juan Capistrano, California
| | - James J Devlin
- Quest Diagnostics Nichols Institute, San Juan Capistrano, California
| | - Michael J McPhaul
- Quest Diagnostics Nichols Institute, San Juan Capistrano, California
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