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[fasting serum insulin (^U/mL) X fasting plasma glucose (mmol/L)]/22.5 |

The HOMA method has been shown to correlate strongly to glucose disposal methods as assessed by clamp studies (69).

The total integrated insulin response to a 75-g oral glucose challenge was recently found to be the best surrogate marker of insulin resistance, accounting

& u for over two-thirds in the variability in insulin-mediated glucose disposal in 490 healthy, nondiabetic volunteers (71).

However, from a clinical perspective, the most practical way of assessing insulin resistance is the measurement of plasma insulin levels (5). It is suggested that these levels be assessed in the overnight fasting condition, since glucose levels in the postprandial state are changing rapidly and confound the simultaneous measure of insulin. There is a significant correlation between fasting insulin levels and insulin action as measured by the clamp technique. In addition, it is generally true that very high plasma insulin values in the setting of normal glucose tolerance are very likely to reflect insulin resistance. The utility of assessment of fasting insulin is limited by the fact that, again, there is considerable overlap between results in insulin-resistant and in nondiabetic patients. Another major limitation is the lack of standardization of the insulin assay procedure. However, if the insulin assay were definitive, it would be useful to detect insulin resistance early and before clinical disease appears (5).

Studies that have used any or all of these techniques have demonstrated that there is a wide range of insulin sensitivity in nondiabetic individuals and these values overlap with similar values in type 2 diabetics. Therefore, it is very difficult to distinguish between nondiabetic and diabetic individuals on the basis of insulin resistance (5).

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