Cardio IQ® Insulin Resistance Panel with Score

Know what’s ahead—the earlier,

the better
Detecting insulin resistance now can help you and your patients
take action to change its course
Put your patients on the right path—before it’s too late
Insulin resistance (IR) testing offers significant—and often untapped—clinical value. Identifying
patients who are likely to have insulin resistance can help drive actions to change the course of
prediabetes and diabetes.¹
• Patients can have normal glucose and HbA1c, but their β-cells may be struggling
with glucose load, leading to IR, and subsequently prediabetes and diabetes IR affects

>60m
• IR can be gradual and difficult to recognize1—patients must be identified while
there is still time to reverse course
• IR is also associated with cardiovascular disease (CVD), nonalcoholic fatty liver
disease (NAFLD), and polycystic ovary syndrome (PCOS)¹ Americans²

PROGRESSION OF TYPE 2 DIABETES AND THE ROLE OF IR

IR can begin 10 years or more before type 2 diabetes is diagnosed3

TYPE 2 DIAGNOSIS

Insulin resistance

Prediabetes Diabetes

10 years or more pre-diagnosis 0

For patients whose risk factors may not be as evident, IR testing can provide actionable insight.
Know more with the IR test available only from Quest
Quest offers the Cardio IQ® Insulin Resistance Panel with Score, a simple, accurate, and actionable
way to assess IR and identify prediabetes and diabetes risk.
A routine insulin resistance score validated against the gold standard:
• Validated in a Stanford University study4 against the insulin suppression test, a gold standard method for the direct
measurement of IR
• Provides an enhanced assessment of IR through the combined measurement of insulin and C-peptide from a single
fasting blood specimen
• Offers greater discrimination of IR compared to either insulin or C-peptide levels alone and a better assessment of IR
status than TG/HDL or HOMA-IR4
• Detects IR and possible risk of prediabetes or diabetes before traditional markers can

Clinical evaluation of the Cardio IQ® Insulin Resistance Panel with Score
In the Stanford IR study, 535 apparently healthy individuals were assessed for risk of IR using fasting insulin and C-
peptide, measured by LC/MS/MS assays.4

The IR score showed greater discrimination of IR The IR score provided a better assessment
compared to either insulin or C-peptide levels alone. of IR status compared to TG/HDL-C and HOMA-IR.

Odds Ratio (95%Cl) Odds Ratio (95%Cl)

IR Score 6.9 (3.9 to 12.1), p=2×10-11 IR Score 6.9 (3.9 to 12.1), p=2×10-11

C-peptide 2.2 (1.1 to 4.3), p=0.02 TG/HDL-C 2.7 (1.5 to 4.8), p=9×10-4

Insulin 1.6 (0.8 to 3.0), p=0.15 HOMA-IR 1.5 (0.8 to 2.7), p=0.2

1 2 3 5 10 15 1 2 3 5 10 15

Adjusted for age, sex, body mass index (BMI), fasting plasma glucose In model that includes age, sex, ethnicity, BMI, insulin, C-peptide, FPG,
(FPG), systolic blood pressure (SBP), diastolic blood pressure (DBP), SBP, DBP, TG/HDL-C ratio, LDL-C, creatinine, and ALT.
TG/HDL-C, LDL-C ratio, creatinine, ALT, ethnicity, and C-peptide or insulin,
as appropriate.

The IR score can assess insulin resistance better than other methods, giving you greater
confidence in identifying patients at risk for progression to prediabetes and diabetes.
Take action to change the course of IR
Which patients are suitable for testing?
1. Patients with normal glucose and HbA1c who may be at risk4
2. Individuals with clinical features associated with IR

• Overweight/obese • Hypertension
• Central obesity • Acanthosis nigricans (dark patches of
• Family history of diabetes thick, velvety skin on the back of the neck,
• A history of gestational diabetes mellitus armpits, and groin)

RELEVANCE OF IR SCORE, EVEN IN LEAN PATIENTS4

Insulin sensitive Insulin resistant

1 33 66 100

Normal insulin sensitivity >4-fold more likely to have IR than >15-fold more likely to have IR than
patient with normal insulin sensitivity patient with normal insulin sensitivity
(i.e., risk score <33) (i.e., risk score <33)

Put patients on the right path

Clinical trials have shown that lifestyle or pharmacological interventions that increase insulin sensitivity or induce
weight loss can significantly delay the onset of type 2 diabetes in patients with impaired glucose tolerance.5-8
It is possible that even earlier intervention for insulin-resistant patients who have not yet experienced loss of β-cell
function and progressed to prediabetes could help prevent—not just delay—the development of diabetes.9-10

For patients who already have prediabetes or diabetes, the IR score may help monitor response
to therapy and motivate patients to adhere to lifestyle changes.
Counsel patients with an effective tool
The Cardio IQ® Insulin Resistance Panel with Score provides a risk score report, giving you an effective
counseling tool for patients who need to make lifestyle changes.

Sample risk score report

Report Status: Final

TEST, CARDIO4

Patient Information Specimen Information Client Information

Specimen: CW029170A Client #: 97502840 11111111
TEST, CARDIO4
Requisition: 0215083 TEST CLIENT (HQ) NEL
DOB: 01/10/1985 AGE: 33 Lab Ref #: ARTEST Attn: TESTING FOR SFDC
Gender: M Fasting: N Collected: 07/17/2018 / 13:00 EDT 400 EGYPT RD # 2009 1/4
Phone: 987.654.1230 Received: 07/17/2018 / 02:49 EDT SUITE 12345
Patient ID: ARTEST Reported: 07/25/2018 / 13:27 EDT NORRISTOWN, PA 19403-3406

Cardio IQ®
Result from
Test Name Units Result and Risk Category Risk Category Ranges
Optimal Moderate High Optimal Moderate High

Metabolic Markers Lab: EZ

INSULIN, INTACT, LC/MS/MS uIU/mL 18 <=16 N/A >16
C-PEPTIDE, LC/MS/MS ng/mL 2.55 <=2.16 N/A >2.16
INSULIN RESISTANCE SCORE 86 <33 33-66 >66

For details on reference ranges please refer to the reference range/comment section of the report.

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Medical Information For Healthcare Providers: If you have any questions about any of the tests in our Cardio IQ offering, please call
1-800-432-7889 opt 3 to speak to a clinical liaison. For frequently asked questions, you can also visit us at
http://education.questdiagnostics.com/faq/FAQ134

Ordering information

Test Name Patient Preparation Test Code CPT Codes*

Cardio IQ® Insulin Resistance Panel with Score Overnight fasting required 36509(X) 83525, 84681

*The CPT codes provided are based on AMA guidelines and are for informational purposes only. CPT coding is the sole responsibility of the billing party. Please direct any
questions regarding coding to the payer being billed.

CLIENT SERVICES: 1.866.697.8378 SPECIMEN: CW029170A PAGE 1 OF 3

Quest, Quest Diagnostics, the associated logo and all associated Quest Diagnostics marks are the trademarks of Quest Diagnostics.
Know more across the entire diabetes care continuum
Quest Diagnostics offers a comprehensive array of diabetes laboratory testing services to help you manage
insulin resistance, prediabetes, and diabetes in all of your patients, no matter where they are on the diabetes
care continuum.

NAFLD/Nonalcoholic Steatohepatitis

Insulin Chronic End-stage

Prediabetes Diabetes
resistance kidney disease renal disease

Cardio IQ® Insulin Tests for screening, diagnosis, and monitoring:

Resistance Panel • Diabetes Risk Panel with Score
with Score
• Diabetes and ASCVD Risk Panel with Scores
• Antibody testing (GAD-65, Islet Cell, IA-2, ZnT8)
• C-Peptide
• Diabetes, Newly Diagnosed and Monitoring Panel
• Diabetes, Advancing CKD Management Panel
• NAFLD Fibrosis Score Panel
• Cystatin C

Knowing what’s ahead can make all the difference. Contact your Quest Diagnostics
sales representative or visit QuestDiagnostics.com/IRscore to learn more.

References
1. Reaven GM. The insulin resistance syndrome. Curr Atheroscler Rep. 2003;5:364-371. 2. American Heart Association. About diabetes. Available at www.heart.org/en/health-
topics/diabetes/about-diabetes. Accessed August 17, 2018. 3. Holman, RR. Assessing the potential for alpha-glucosidase inhibitors in prediabetic states. Diabetes Res Clin Pract.
1998;40 Suppl:S21-25. 4. Abbasi F, Shiffman D, Tong CH, et al. Insulin resistance probability scores for apparently healthy individuals. J Endocr Soc. 2018;2:1050-1057.
5. Knowler WC, Barrett-Connor E, Fowler SE, et al. Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin. N Engl J Med. 2002;346:393-403.
6. Daniel S, Soleymani T, Garvey WT. A complications based clinical staging of obesity to guide treatment modality and intensity. Cur Opin Endocrinol Diabetes Obes.
2013;20:377-388. 7. Torgerson JS, Hauptman J, Boldrin MN, et al. XENical in the prevention of diabetes in obese subjects (XENDOS) study: A randomized study of orlistat as an
adjunct to lifestyle changes for the prevention of type 2 diabetes in obese patients. Diabetes Care. 2004;27:155-161. 8. Garvey WT, Ryan DH, Henry R, et al. Prevention of type 2
diabetes in subjects with prediabetes and metabolic syndrome treated with phentermine and topiramate extended release. Diabetes Care. 2014;37:912-921. 9. American Diabetes
Association, National Institute of Diabetes, Digestive and Kidney Disorders. The prevention or delay of type 2 diabetes. Diabetes Care. 2002;25:742-749. 10. Genuth S, Kahn R.
A step backward—or is it forward? Diabetes Care. 2008;31:1093-1096.

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