Accuracy and precision of commonly used methods for quantifying surgery-induced insulin resistance : Prospective observational study

• BACKGROUND: Insulin resistance develops in the perioperative setting and has an adverse influence on postoperative recovery and well-being.OBJECTIVES: To evaluate the effectiveness of commonly used methods for quantifying surgery-induced insulin resistance.DESIGN: Prospective observational study.SETTING: Surgery department and orthopaedic ward at two regional hospitals.PATIENTS: Twenty-two patients (mean age 68 years) scheduled for elective hip replacement.INTERVENTIONS: A short seven-sample intravenous glucose tolerance test (IVGTT) followed by a euglycaemic hyperinsulinaemic glucose clamp 1 day before and 2 days after the surgery.MAIN OUTCOME MEASURES: Insulin resistance shown by dynamic tests (the IVGTT and the glucose clamp) were compared to static tests [the quantitative insulin sensitivity check index (QUICKI) and the homeostatic model assessment-insulin resistance (HOMA-IR)], which use only the plasma glucose and insulin concentrations at baseline.RESULTS: The linear correlation coefficients for the relationship between insulin resistance as obtained with the glucose clamp and the other methods before or after surgery were 0.76 (IVGTT), 0.58 (QUICKI) and -0.65 (HOMA). The prediction errors (precision) averaged 18, 29 and 31%, respectively. Surgery-induced insulin resistance amounted to 45% (glucose clamp), 26% (IVGTT), 4% (QUICKI) and 3% (HOMA).CONCLUSION: Despite reasonably good linear correlations, the static tests grossly underestimated the degree of insulin resistance that developed in response to surgery.

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