You’ve seen hundreds of patients like him: late fifties, not as active as he used to be, gaining about 5 pounds a year the past few years. He’s a nonsmoker and complains of fatigue. His family has a history of diabetes and heart disease, but to date his labs have been unremarkable save for slightly elevated LDL-C (103 mg/dL). His LDL-C hasn’t concerned you because his HDL-C is quite good (82 mg/dL) and his triglyceride level is well within standard range (93 mg/dL). His glucose and HbA1c are normal.
In the past, you have urged this patient to try to lose “just 5 pounds,” counseling that even modest weight loss would create positive physiological changes and healthier biochemistry. Today he confesses that despite this modest goal and his best intentions, he is working longer hours at his sit-down job and just not getting to the gym. He also admits to snacking late at night, jokingly referring to it as “my stress management program.”
His blood work indicates he’s fairly healthy, but you’re concerned that with his family medical history, his gradual climb toward obesity, and some unhealthy habits, your patient is heading for the danger zone. You know that insulin sensitivity is an early development in the progression to diabetes, and you consider that it could be hiding in someone with this patient’s profile—seemingly healthy but concerning nonetheless. If insulin resistance (IR) were present in this patient now and you could document it, it could help convince him to make some healthy lifestyle changes to reverse course.
Why IR testing might help this patient
Insulin resistance, together with beta cell dysfunction, leads to persistent hyperglycemia. It can be present in apparently healthy individuals who have risk factors for diabetes. It is known that IR can be present 10 years or more before diabetes is diagnosed,1 and that by the time diabetes is evident, 80% of beta cell function has already been lost.2 Patients suitable for testing include those with normal glucose and HbA1c and those with clinical features associated with IR, including overweight/obese, central obesity, family history of diabetes, a history of gestational diabetes mellitus, hypertension, and acanthosis nigricans.
Quest Diagnostics offers the Cardio IQ® Insulin Resistance Panel with Score to help establish whether a patient is insulin resistant, and thus at higher risk for developing pre-diabetes and diabetes. The Cardio IQ Insulin Resistance Panel with Score correlates with steady-state glucose levels achieved during an insulin suppression test, a standard research test for insulin resistance. The score is based on the combination of insulin and C-peptide results, and provides a reliable probability of a patient’s insulin resistance.3 A score below 33 is optimal.
As an example, imagine that you have ordered the panel for this patient and the following results came back:
|Insulin resistance score||86||High|
An effective tool to help counsel patients
The Cardio IQ Insulin Resistance Panel with Score helps to counsel patients who may need to make lifestyle changes.
A score of 86 means the patient is insulin resistant and at higher risk for pre-diabetes and diabetes. This creates an opportunity to discuss with the patient the devastating consequences of diabetes and to reinforce the need to reverse course.
An actionable result
Cardio IQ Insulin Resistance Panel with Score gives your patient an early warning about his or her health status and helps you counsel your patients who may need to make lifestyle changes. In the case of this patient, such changes could include a healthier diet, short- and long-term weight loss goals, and enrollment in a diabetes prevention program. You now have a baseline against which to measure your patient’s progress—and your patient has an easy-to-grasp motivation for following the treatment plan you’ve prescribed.
The treatment considerations are provided for informational purposes only and are not intended as medical advice. A physician’s test selection and interpretation, diagnosis, and patient management decisions should be based on his/her education, clinical expertise, and assessment of the patient.
Know more across the entire diabetes care continuum
Quest Diagnostics offers a comprehensive array of diabetes laboratory testing services to help you manage insulin resistance, pre-diabetes, and diabetes in all of your patients, no matter where they are on the diabetes care continuum. Contact your Quest Diagnostics sales representative or visit QuestDiagnostics.com/IRscore to learn more.
1. Holman RR. Assessing the potential for alpha-glucosidase inhibitors in prediabetic states. Diabetes Res Clin Pract. 1998;40 Suppl:S21-S25.
2. Dall T, Thiselton D, Varvel S. Targeting insulin resistance: the ongoing paradigm shift in diabetes prevention. AJMC. April 11, 2013. https://www.ajmc.com/journals/evidence-based-diabetes-management/2013/2013-1-vol19-sp2/targeting-insulin-resistance-the-ongoing-paradigm-shift-in-diabetes-prevention. Accessed September 20, 2018.
3. Abbasi F, Shiffman D, Tong CH, et al. Insulin resistance probability scores for apparently healthy individuals. J Endocr Soc. 2018 Aug 9;2(9):1050-1057. doi: 10.1210/js.2018-00107 .