Work

Interactive online calculator for estimation of muscle and hepatic insulin sensitivity in adults with Type 1 diabetes using clinical and research biomarkers

Year: 2026

Type: article

Abstract: Aims Impaired insulin sensitivity is an under‐recognised risk in Type 1 diabetes but is challenging to measure with ‘gold‐standard’ euglycaemic clamps. Adding stable‐isotope glucose distinguishes hepatic and muscle insulin action (assessed by endogenous glucose production [EGP] and glucose infusion rate [GIR], respectively). We therefore searched for a blood‐biomarker alternative. Methods Two‐step clamps were conducted in 40 adults with Type 1 diabetes, participating in the INTIMET trial (INsulin resistance in Type 1 diabetes managed with METformin, ACTRN12619001440112). Participants were characterised with 33 baseline biomarkers. Results Exhaustive search analyses derived a formula predicting an ‘unfavourable GIR’ (dichotomous variable: below median of 60.4 μmol/kg fat‐free mass [FFM]/min) using: total daily insulin dose (TDI), fasting triglycerides (TGs), insulin‐like growth factor 1 and aspartate aminotransferase levels (area under the receiver operating characteristic curve (AUROC) 0.97, p < 0.0001, R 2 [Nagelkerke] = 0.83, 92.5% accuracy). An ‘unfavourable EGP level’ (above median of 6.2 μmol/kg FFM/min) during low‐dose clamp was predicted by TDI, TGs, alkaline phosphatase and uric acid levels (AUROC 0.86, p = 0.001, R 2 (Nagelkerke) = 0.50, 80% accuracy). A free online tool ( https://bit.ly/EGP-GIR-calculator ) converts these variables into dichotomised EGP and GIR estimates. Conclusions We demonstrate that clinical and research biomarkers can be used to estimate tissue specific insulin sensitivity in adults with Type 1 diabetes.

Source: Diabetes Obesity and Metabolism

DOI: 10.1111/dom.70517