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Insulin sensitivity was assessed by total GDR measured during the hyperinsulinemic–euglycemic clamp in a subgroup of 50 patients [27] and by homeostatic model assessment in all patients [28]

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19 , 20 Dysfunction in any of these functions may possibly account for clinical symptoms in ME/CFS, 20 however, mitochondrial bioenergetics is the main area of focus of this review, because dysfunction in mitochondrial respiration and metabolic changes have been found in ME/CFS,21, 22, 23 and these give a biologically plausible link to some of the symptoms seen in ME/CFS