Journal of Diabetology

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Editorial - Journal of Diabetology (2023) Volume 7, Issue 4

Euglycemic hyperinsulinemic clamp: A gold standard technique for assessing insulin sensitivity

Samuel Dagogo *

Department of Medicine, Division of Endocrinology, Diabetes and Metabolism, University of Tennessee Health Science Center, Memphis, USA

Corresponding Author:
Samuel Dagog
Department of Medicine
Division of Endocrinology, Diabetes and Metabolism, University of Tennessee Health Science Center, Memphis, USA.
E-mail: sdj@uthsc.edu

Received: 30-Jun-2023, Manuscript No. AADY-23-112211; Editor assigned: 01-Jul-2023, PreQC No. AADY-23-112211 (PQ); Reviewed: 17-Jul-2023, QC No. AADY-23-112211; Revised: 19-Jul-2023, Manuscript No: AADY-23-112211 (R); Published: 25-Jul-2023, DOI:10.35841/aady-7.4.159

Citation: Dagogo S. Euglycemic hyperinsulinemic clamp: A gold standard technique for assessing insulin sensitivity. J Diabetol. 2023; 7(4):159

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Insulin resistance, characterized by reduced responsiveness of peripheral tissues to insulin action, is a central feature of type 2 diabetes, obesity, and other metabolic disorders. Accurate assessment of insulin sensitivity is essential for understanding the pathophysiology of these conditions and evaluating interventions. The euglycemic hyperinsulinemic clamp technique, introduced by DeFronzo [1].

In the 1970s, has become the gold standard method for quantifying insulin sensitivity in vivo. Insulin resistance lies at the heart of various metabolic disorders, including type 2 diabetes, obesity, and cardiovascular diseases. Understanding the intricate interplay between insulin sensitivity and glucose metabolism is crucial for unraveling the mechanisms underlying these conditions and for developing effective interventions. Among the diverse array of methods available for assessing insulin sensitivity, the euglycemic hyperinsulinemic clamp technique stands as a cornerstone, offering unparalleled insights into the dynamics of insulin action and glucose regulation. Insulin, a hormone secreted by the pancreas, plays a pivotal role in maintaining glucose homeostasis. It facilitates the uptake of glucose into cells, particularly skeletal muscle and adipose tissue, while suppressing glucose production by the liver. Dysregulation of these processes due to insulin resistance can lead to elevated blood glucose levels and contribute to the onset and progression of metabolic disorders [2].

 

Consequently, accurate measurement of insulin sensitivity is essential for both research purposes and clinical management.

 

Principles of the euglycemic hyperinsulinemic clamp

The euglycemic hyperinsulinemic clamp involves the continuous infusion of insulin and glucose to maintain both euglycemia (normal blood glucose levels) and a hyperinsulinemic state. The rate of glucose infusion required to maintain euglycemia is considered a measure of insulin sensitivity [3].

The technique allows for the direct assessment of insulin's ability to promote glucose disposal into peripheral tissues, primarily skeletal muscle, and suppress hepatic glucose production.

 

Methodology

Study participants

Participants undergoing the euglycemic hyperinsulinemic clamp typically include healthy individuals, those with obesity, impaired glucose tolerance, or diabetes, and individuals participating in clinical trials [4].

Study procedure

Catheter placement: Intravenous catheters are inserted into different veins for insulin and glucose infusions.

Insulin infusion: A primed continuous insulin infusion is initiated to achieve and maintain a hyperinsulinemia state.

Glucose infusion: A variable rate glucose infusion is administered to maintain blood glucose levels within a narrow range.

Blood sampling: Blood samples are collected at regular intervals to monitor glucose and insulin levels.

Steady State: Once steady-state conditions are achieved, the glucose infusion rate (GIR) required to maintain euglycemia reflects insulin sensitivity.

Clinical applications

The euglycemic hyperinsulinemic clamp technique has numerous clinical applications:

 

Type 2 diabetes research: It provides insights into the severity of insulin resistance in diabetes and evaluates the efficacy of therapeutic interventions.

Obesity studies: The technique helps elucidate the relationship between obesity, insulin sensitivity, and metabolic dysfunction.

Metabolic syndrome: It aids in understanding the underlying mechanisms of metabolic syndrome and related cardiovascular risks.

Drug development: The clamp is used to assess the insulin-sensitizing effects of novel medications targeting insulin resistance rol.

Physiological Studies: It has contributed to our understanding of insulin action, glucose metabolism, and tissue-specific responses.

Limitations and considerations

Invasiveness: The technique requires catheter placement, making it invasive and potentially uncomfortable for participants.

Resource-Intensive: Conducting a clamp study demands specialized equipment, skilled personnel, and extended monitoring.

Physiological Response: The hyperinsulinemic state may not exactly replicate physiological conditions, impacting real-world relevance.

Interpretation challenges: Variability in steady-state glucose levels and individual responses can complicate data interpretation [5].

Conclusion

The euglycemic hyperinsulinemic clamp technique remains an invaluable tool for assessing insulin sensitivity and unraveling the complexities of insulin resistance-related metabolic disorders. Despite its limitations, its precision and ability to provide direct measurements of insulin action make it indispensable in research and clinical practice. As our understanding of insulin resistance deepens, the euglycemic hyperinsulinemic clamp continues to play a crucial role in advancing our knowledge and guiding therapeutic strategies.

References

  1. Kim JK. Hyperinsulinemic–euglycemic clamp to assess insulin sensitivity in vivo. Type 2 Diabetes: Methods and Protocols. 2009:221-38.

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  2. Henderson M, Rabasa-Lhoret R, Bastard JP, et al. Measuring insulin sensitivity in youth: How do the different indices compare with the gold-standard method?. Diabetes & metabolism. 2011;37(1):72-8.

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  3. Straczkowski M, Stepie? A, Kowalska I, Kinalska I. Comparison of simple indices of insulin sensitivity using the euglycemic hyperinsulinemic clamp technique. JMSCR. 2004;10(8):CR480-4.

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  4. De Koster J, Hostens M, Hermans K, et al. Validation of different measures of insulin sensitivity of glucose metabolism in dairy cows using the hyperinsulinemic euglycemic clamp test as the gold standard. Domest. Anim. Endocrinol. 2016;57:117-26.

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  5. Rabasa-Lhoret R, Laville M. How to measure insulin sensitivity in clinical practice?. Diabetes Metab J. 2001;27(2 Pt 2):201-8.

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