The Endocrine Society of Australia
Recommendations from the Endocrine Society of Australia on thyroid tests, testosterone therapy, insulin sensitivity tests & blood glucose self-monitoring. The Endocrine Society of Australia (ESA) is a national non-profit organisation of scientists and clinicians who conduct research and practice in the field of Endocrinology. The society was founded in 1958 and incorporated in 1986 in the State of Victoria.
3.
Do not measure insulin concentration in the fasting state or during an oral glucose tolerance test to assess insulin sensitivity.
Measurement of insulin either in the fasting state or during an oral glucose tolerance test is not a clinically useful method (and may be costly because of the insulin assay) to estimate insulin sensitivity. The hyperinsulinemic-euglycemic (HIEG) clamp is the gold standard for assessing insulin sensitivity as it is possible to assess tissue specific sensitivity and can be used in all types of populations. This feature is important because a method of standardisation must be developed to control for various factors prior to any methods for measurement.
Supporting evidence
- Antuna-Puente R. How can we measure insulin sensitivity/resistance?, Diabetes & Metabolism 2011;37(3):179-88.
- Teede HJ. Assessment and management of polycystic ovary syndrome Medical Journal of Australia 2011;195(6).
- Borai A, Livingstone C, Kaddam I, et al. Selection of the appropriate method for the assessment of insulin resistance. BMC Medical Research Methodology 2011, 11:158.
- Samaras K. Insulin levels in insulin resistance: phantom of the metabolic opera? Medical Journal of Australia 2006;185(3):159-61.
How this list was made
The Medical Affairs sub-committee of the Endocrine Society of Australia (ESA) collaborated with the Royal Australasian College of Physicians (RACP) to compile a list of 44 possible low-value interventions using desktop research.
The list was examined and refined down to 8 interventions: comprising 6 that were deemed sufficiently common or important to warrant consideration and two additional practices identified by the committee. A review of the evidence for these 8 was completed and circulated to the whole ESA membership for feedback via an on-line survey. Based on the results of the survey, which attracted 146 respondents, a top 5 was identified.
- 1 Don’t routinely order a thyroid ultrasound in patients with abnormal thyroid function tests if there is no palpable abnormality of the thyroid gland.
- 2 Don’t prescribe testosterone therapy unless there is evidence of proven testosterone deficiency.
- 3 Do not measure insulin concentration in the fasting state or during an oral glucose tolerance test to assess insulin sensitivity.
- 4 Avoid multiple daily glucose self-monitoring in adults with stable type 2 diabetes on agents that do not cause hypoglycaemia.
- 5 Don’t order a total or free T3 level when assessing thyroxine dose in hypothyroid patients.