Comput Methods Programs Biomed - Independent cohort cross-validation of the real-time DISTq estimation of insulin sensitivity.


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Insulin sensitivity (SI) is useful in the diagnosis, screening and treatment of diabetes. However, most current tests cannot provide an accurate, immediate or real-time estimate. The DISTq method does not require insulin or C-peptide assays like most SI tests, thus enabling real-time, low-cost SI estimation. The method uses a posteriori parameter estimations in the absence of insulin or C-peptide assays to simulate accurate, patient-specific, insulin concentrations that enable SI identification. Mathematical functions for the a posteriori parameter estimates were generated using data from 46 fully sampled DIST tests (glucose, insulin and C-peptide). SI values found using the DISTq from the 46 test pilot cohort and a second independent 218 test cohort correlated R=0.890 and R=0.825, respectively, to the fully sampled (including insulin and C-peptide assays) DIST SI metrics. When the a posteriori insulin estimation functions were derived using the second cohort, correlations for the pilot and second cohorts reduced to 0.765 and 0.818, respectively. These results show accurate SI estimation is possible in the absence of insulin or C-peptide assays using the proposed method. Such estimates may only need to be generated once and then used repeatedly in the future for isolated cohorts. The reduced correlation using the second cohort was due to this cohort's bias towards low SI insulin resistant subjects, limiting the data set's ability to generalise over a wider range. All the correlations remain high enough for the DISTq to be a useful test for a number of clinical applications. The unique real-time results can be generated within minutes of testing as no insulin and C-peptide assays are required and may enable new clinical applications.

Resumo Limpo

insulin sensit si use diagnosi screen treatment diabet howev current test provid accur immedi realtim estim distq method requir insulin cpeptid assay like si test thus enabl realtim lowcost si estim method use posteriori paramet estim absenc insulin cpeptid assay simul accur patientspecif insulin concentr enabl si identif mathemat function posteriori paramet estim generat use data fulli sampl dist test glucos insulin cpeptid si valu found use distq test pilot cohort second independ test cohort correl r r respect fulli sampl includ insulin cpeptid assay dist si metric posteriori insulin estim function deriv use second cohort correl pilot second cohort reduc respect result show accur si estim possibl absenc insulin cpeptid assay use propos method estim may need generat use repeat futur isol cohort reduc correl use second cohort due cohort bias toward low si insulin resist subject limit data set abil generalis wider rang correl remain high enough distq use test number clinic applic uniqu realtim result can generat within minut test insulin cpeptid assay requir may enabl new clinic applic

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