SPISE (Single Point Insulin Sensitivity Estimator) Screening of High-Risk Patients

Not all overweight individuals develop metabolic syndrome. Particularly in young adults, it is often difficult to predict whether they are at increased risk of developing metabolic syndrome later in life.

The Single Point Insulin Sensitivity Estimator (SPISE) is a mathematical model used to estimate insulin sensitivity in individuals without diabetes mellitus. It is based on routinely measured clinical parameters, making it a practical and cost-effective tool because it does not require complex testing procedures or extensive data collection.

  • HDL-C = high-density lipoprotein cholesterol (mg/dL)
  • TG = triglycerides (mg/dL)
  • BMI = body mass index (kg/m²)

The Single Point Insulin Sensitivity Estimator (SPISE) was calculated using the following formula:

where HDL-C represents high-density lipoprotein cholesterol (mg/dL), TG represents triglycerides (mg/dL), and BMI represents body mass index (kg/m²). Lower SPISE values indicate reduced insulin sensitivity and increased insulin resistance.

Only HDL cholesterol, triglycerides, and BMI are required for calculation.

SPISE values below the cut-off value of 6.61 indicate insulin resistance and demonstrate diagnostic accuracy comparable to other models of insulin sensitivity assessment, particularly the Homeostatic Model Assessment of Insulin Resistance (HOMA-IR).

SPISE was developed to provide a rapid and reliable estimation of insulin sensitivity and has been shown to be predictive of future diabetes risk. It should be noted that SPISE provides an estimate rather than a direct measurement of insulin sensitivity. Nevertheless, it offers a useful overview of an individual’s insulin status.

In patients with newly diagnosed diabetes mellitus, SPISE demonstrates a sensitivity of approximately 67% and a specificity of 69%. Therefore, SPISE can be a valuable counseling tool for identifying individuals at increased metabolic risk and motivating them to adopt lifestyle modifications.

The SPISE concept has also been expanded for use in patients with metabolic syndrome and diabetes mellitus to provide additional information regarding the degree of insulin resistance, which may influence therapeutic decision-making.

Furthermore, replacing BMI with waist circumference in the calculation has been reported to increase the sensitivity of the model to more than 90%, making it an even more effective screening tool for identifying insulin resistance and cardiometabolic risk.

References

  1. Mikael Paulmichl, Hatunic M, Højlund K, et al. (2016). Modification and validation of the Single Point Insulin Sensitivity Estimator (SPISE) for prediction of insulin sensitivity in adults and adolescents. Scientific Reports, 6, 24890.
  2. Mikael Paulmichl et al. (2016). A single-point insulin sensitivity estimator (SPISE) predicts type 2 diabetes mellitus and metabolic syndrome. Scientific Reports, 6, 24890.
  3. David R. Matthews et al. (1985). Homeostasis model assessment: Insulin resistance and β-cell function from fasting plasma glucose and insulin concentrations in man. Diabetologia, 28(7), 412–419.
  4. Kåre Birkeland et al. (2018). Validation of surrogate markers of insulin sensitivity and comparison with SPISE in clinical populations. Diabetes Research and Clinical Practice, 142, 297–304.
  5. Anoop Misra et al. (2020). Insulin resistance and cardiometabolic risk assessment in obesity and metabolic syndrome. Journal of Clinical Endocrinology & Metabolism, 105(9), e3365–e3378.
  6. American Diabetes Association (2024). Standards of Care in Diabetes 2024. Diabetes Care, 47(Suppl. 1), S1–S350.
  7. European Association for the Study of Diabetes (2023). Clinical recommendations for the assessment of insulin resistance and cardiometabolic risk. Diabetologia, 66, 1247–1261.
  8. International Diabetes Federation (2021). Clinical Practice Recommendations for Metabolic Syndrome and Diabetes Risk Assessment. Brussels: International Diabetes Federation.