Letter by Bell and O’Keefe Regarding Article, “Use of Alternative Thresholds Defining Insulin Resistance to Predict Incident Type 2 Diabetes Mellitus and Cardiovascular Disease”
To the Editor:
Rutter et al1 reported that 3 surrogate markers of insulin resistance only modestly predicted the development of diabetes and cardiovascular events. In clinical practice, the clearest indicator of the presence of insulin resistance is a triglyceride to high-density lipoprotein ratio >3.5. This ratio has been shown to correlate well with the insulin suppression test and to be comparable with the clinical criteria of the National Cholesterol Education Panel Adult Treatment Panel III.2,3 Would the use of the triglyceride:high-density lipoprotein ratio have predicted the development of diabetes and/or cardiovascular events more accurately than the fasting insulin level, homeostasis model assessment of insulin resistance, and the reciprocal of the Guft insulin sensitivity index in this study?1 If the triglyceride:high-density lipoprotein ratio was equally or more predictive, in clinical practice there would be no reason to measure the highly variable fasting insulin level.