Insulin Resistance: Sensitivity and Specificity

Introduction: As opposed to overt Diabetes. Insulin resistance is a component of the metabolic syndrome, along with hypertension, obesity, and dyslipidemia.

Gold standard is euglycemic hyperinsulinemic clamp, where a constant insulin infusion is given and a separate glucose infusion is titrated to euglycemia. The lower the amount of glucose needed, the more insulin resistant a person is.

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The sensitivity and specificity of findings for Insulin Resistance are listed below. See the left navigation bar to change the display.

Pre-Test Probability (Prevalence): %.	Post-Test Probability (Predictive Value): %.	Switch to display mode.
Note that calculating probabilities from more than one** finding is inherently inaccurate because findings are not independent. (For example, using two positive findings that share a common pathogenesis is likely to overestimate the true probability.)

Physical Exam
Finding	Result	Sensitivity	Specificity
[ + ] Acanthosis Nigricans	+ 0 -	50%	83%
According to this paper the diagnostic effect of AN is superceded by increased body fat density as measured by DXA. Study: J Pediatr. 2001 Apr;138(4):474-80 PMID: 11295708

Untagged
Finding	Result	Sensitivity	Specificity
[ + ] ATP III Criteria	+ 0 -	52%	85%
>= 3 of the following criteria: waist circumference greater than 102 cm in men and greater than 88 cm in women serum triglyceride concentration of 1.69 mmol/L (150 mg/dL) or more serum HDL cholesterol concentration less than 1.03 mmol/L (40 mg/dL) in men and less than 1.29 mmol/L (50 mg/dL) in women, blood pressure of 130/85 mm Hg or greater or therapy with antihypertensive medication fasting plasma glucose level of 6.11 mmol/L (110 mg/dL) or greater. "Since we did not measure waist circumference for most of our participants, we substituted a BMI of 25 kg/m2 or greater for women and 29 kg/m2 or greater for men, values that provided the same prevalence of the metabolic syndrome in the third National Health and Nutrition Examination Survey as did use of waist circumference (Ford E. Personal communication)." Study: Ann Intern Med. 2003 Nov 18;139(10):802-9. PMID: 14623617
[ + ] Body Mass Index	+ 0 -	56%	76%
>=29.3 kg/m2 Study: Diabetes Care. 2001 Mar;24(3):460-4. PMID: 11289468
[ + ] Elevated Triglycerides	+ 0 -	67%	71%
>= 130mg/dl Study: Ann Intern Med. 2003 Nov 18;139(10):802-9. PMID: 14623617
[ + ] Fasting Insulin	+ 0 -	57%	85%
>=15 mcU/ml Similar results in a separate paper with a cutoff of 12.2mU/l. Study: Ann Intern Med. 2003 Nov 18;139(10):802-9. PMID: 14623617 alt: Diabetes Care. 2001 Mar;24(3):460-4. PMID: 11289468
[ + ] Triglyceride to HDL Ratio	+ 0 -	64%	68%
>= 1.8 Study: Ann Intern Med. 2003 Nov 18;139(10):802-9. PMID: 14623617