• Stefan Ljunggren, Thomas Nyström, and Robert G Hahn.
• From the Research Unit, Södertälje Hospital, Södertälje (SL, RGH), Section of Internal Medicine, Department of Clinical Science and Education, Karolinska Institutet, Södersjukhuset, Stockholm (SL, TN) and Department of Anesthesia, Linköping University, Linköping (RGH), Sweden.
• Eur J Anaesthesiol. 2014 Feb 1; 31 (2): 110-6.

BackgroundInsulin resistance develops in the perioperative setting and has an adverse influence on postoperative recovery and well-being.ObjectivesTo evaluate the effectiveness of commonly used methods for quantifying surgery-induced insulin resistance.DesignProspective observational study.SettingSurgery department and orthopaedic ward at two regional hospitals.PatientsTwenty-two patients (mean age 68 years) scheduled for elective hip replacement.InterventionsA 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 MeasuresInsulin 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.ResultsThe 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).ConclusionDespite reasonably good linear correlations, the static tests grossly underestimated the degree of insulin resistance that developed in response to surgery.

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