51
|
Eichenlaub MM, Hattersley JG, Gannon MC, Nuttall FQ, Khovanova NA. Bayesian parameter estimation in the oral minimal model of glucose dynamics from non-fasting conditions using a new function of glucose appearance. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2021; 200:105911. [PMID: 33485076 DOI: 10.1016/j.cmpb.2020.105911] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Accepted: 12/10/2020] [Indexed: 06/12/2023]
Abstract
BACKGROUND AND OBJECTIVE The oral minimal model (OMM) of glucose dynamics is a prominent method for assessing postprandial glucose metabolism. The model yields estimates of insulin sensitivity and the meal-related appearance of glucose from insulin and glucose data after an oral glucose challenge. Despite its success, the OMM approach has several weaknesses that this paper addresses. METHODS A novel procedure introducing three methodological adaptations to the OMM approach is proposed. These are: (1) the use of a fully Bayesian and efficient method for parameter estimation, (2) the model identification from non-fasting conditions using a generalised model formulation and (3) the introduction of a novel function to represent the meal-related glucose appearance based on two superimposed components utilising a modified structure of the log-normal distribution. The proposed modelling procedure is applied to glucose and insulin data from subjects with normal glucose tolerance consuming three consecutive meals in intervals of four hours. RESULTS It is shown that the glucose effectiveness parameter of the OMM is, contrary to previous results, structurally globally identifiable. In comparison to results from existing studies that use the conventional identification procedure, the proposed approach yields an equivalent level of model fit and a similar precision of insulin sensitivity estimates. Furthermore, the new procedure shows no deterioration of model fit when data from non-fasting conditions are used. In comparison to the conventional, piecewise linear function of glucose appearance, the novel log-normally based function provides an improved model fit in the first 30 min of the response and thus a more realistic estimation of glucose appearance during this period. The identification procedure is implemented in freely accesible MATLAB and Python software packages. CONCLUSIONS We propose an improved and freely available method for the identification of the OMM which could become the future standardard for the oral minimal modelling method of glucose dynamics.
Collapse
Affiliation(s)
- Manuel M Eichenlaub
- School of Engineering, University of Warwick, Coventry CV4 7AL, UK; Coventry NIHR CRF Human Metabolic Research Unit, University Hospitals Coventry and Warwickshire NHS Trust, Coventry CV2 2DX, UK
| | - John G Hattersley
- School of Engineering, University of Warwick, Coventry CV4 7AL, UK; Coventry NIHR CRF Human Metabolic Research Unit, University Hospitals Coventry and Warwickshire NHS Trust, Coventry CV2 2DX, UK
| | - Mary C Gannon
- Veterans Affairs Medical Center/University of Minnesota Medical School, Minneapolis, MN, USA
| | - Frank Q Nuttall
- Veterans Affairs Medical Center/University of Minnesota Medical School, Minneapolis, MN, USA
| | - Natasha A Khovanova
- School of Engineering, University of Warwick, Coventry CV4 7AL, UK; University Hospitals Coventry and Warwickshire NHS Trust, Coventry CV2 2DX, UK.
| |
Collapse
|
52
|
Bartlette K, Carreau AM, Xie D, Garcia-Reyes Y, Rahat H, Pyle L, Nadeau KJ, Cree-Green M, Diniz Behn C. Oral minimal model-based estimates of insulin sensitivity in obese youth depend on oral glucose tolerance test protocol duration. Metabol Open 2021; 9:100078. [PMID: 33511337 PMCID: PMC7817496 DOI: 10.1016/j.metop.2021.100078] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Revised: 01/01/2021] [Accepted: 01/02/2021] [Indexed: 12/17/2022] Open
Abstract
Introduction The Oral Minimal Model (OMM), a differential-equations based mathematical model of glucose-insulin dynamics, utilizes data from a frequently sampled oral glucose tolerance test (OGTT) to quantify insulin sensitivity ( S I ). OMM-based estimates of S I can detect differences in insulin resistance (IR) across population groups and quantify effects of clinical or behavioral interventions. These estimates of S I have been validated in healthy adults using data from OGTTs with durations from 2 to 7 h. However, data demonstrating how protocol duration affects S I estimates in highly IR populations such as adolescents with obesity are limited. Methods A 6-h frequently sampled OGTT was performed in adolescent females with obesity. Two, 3-, and 4- hour implementations of OMM assuming an exponentially-decaying rate of glucose appearance beyond measured glucose concentrations were compared to the 6-h implementation. A 4- hour OMM implementation with truncated data (4h Tr) was also considered. Results Data from 68 participants were included (age 15.8 ± 1.2 years, BMI 35.4 ± 5.6 kg/m2). Although S I values were highly correlated for all implementations, they varied with protocol duration (2h: 2.86 ± 3.31, 3h: 2.55 ± 2.62, 4h: 2.81 ± 2.59, 4h tr: 3.13 ± 3.14, 6h: 3.06 ± 2.85 x 10-4 dl/kg/min per U/ml). S I estimates based on 2 or 3 h of data underestimated S I values, whereas 4-h S I estimates more closely approximated 6-h S I values. Discussion These results suggest that OGTT protocol duration should be considered when implementing OMM to estimate S I in adolescents with obesity and other IR populations.
Collapse
Affiliation(s)
- Kai Bartlette
- Department of Applied Mathematics and Statistics, Colorado School of Mines, Golden, CO, 80401, USA
| | - Anne-Marie Carreau
- Division of Endocrinology, Department of Pediatrics, University of Colorado Denver Anschutz Medical Campus, Aurora, CO, 80045, USA
| | - Danielle Xie
- Division of Endocrinology, Department of Pediatrics, University of Colorado Denver Anschutz Medical Campus, Aurora, CO, 80045, USA
| | - Yesenia Garcia-Reyes
- Division of Endocrinology, Department of Pediatrics, University of Colorado Denver Anschutz Medical Campus, Aurora, CO, 80045, USA
| | - Haseeb Rahat
- Division of Endocrinology, Department of Pediatrics, University of Colorado Denver Anschutz Medical Campus, Aurora, CO, 80045, USA
| | - Laura Pyle
- Department of Pediatrics, University of Colorado Denver Anschutz Medical Campus, Aurora, CO, 80045, USA.,Department of Biostatics and Informatics, Colorado School of Public Health, Aurora, CO, 80045, USA
| | - Kristen J Nadeau
- Division of Endocrinology, Department of Pediatrics, University of Colorado Denver Anschutz Medical Campus, Aurora, CO, 80045, USA.,Center for Women's Health Research, Aurora, CO, USA
| | - Melanie Cree-Green
- Division of Endocrinology, Department of Pediatrics, University of Colorado Denver Anschutz Medical Campus, Aurora, CO, 80045, USA.,Department of Biostatics and Informatics, Colorado School of Public Health, Aurora, CO, 80045, USA
| | - Cecilia Diniz Behn
- Department of Applied Mathematics and Statistics, Colorado School of Mines, Golden, CO, 80401, USA.,Division of Endocrinology, Department of Pediatrics, University of Colorado Denver Anschutz Medical Campus, Aurora, CO, 80045, USA
| |
Collapse
|
53
|
Frank S, Jbaily A, Hinshaw L, Basu R, Basu A, Szeri AJ. Modeling the acute effects of exercise on glucose dynamics in healthy nondiabetic subjects. J Pharmacokinet Pharmacodyn 2021; 48:225-239. [PMID: 33394220 DOI: 10.1007/s10928-020-09726-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2020] [Accepted: 11/04/2020] [Indexed: 11/25/2022]
Abstract
To shed light on how acute exercise affects blood glucose (BG) concentrations in nondiabetic subjects, we develop a physiological pharmacokinetic/pharmacodynamic model of postprandial glucose dynamics during exercise. We unify several concepts of exercise physiology to derive a multiscale model that includes three important effects of exercise on glucose dynamics: increased endogenous glucose production (EGP), increased glucose uptake in skeletal muscle (SM), and increased glucose delivery to SM by capillary recruitment (i.e. an increase in surface area and blood flow in capillary beds). We compare simulations to experimental observations taken in two cohorts of healthy nondiabetic subjects (resting subjects (n = 12) and exercising subjects (n = 12)) who were each given a mixed-meal tolerance test. Metabolic tracers were used to quantify the glucose flux. Simulations reasonably agree with postprandial measurements of BG concentration and EGP during exercise. Exercise-induced capillary recruitment is predicted to increase glucose transport to SM by 100%, causing hypoglycemia. When recruitment is blunted, as in those with capillary dysfunction, the opposite occurs and higher than expected BG levels are predicted. Model simulations show how three important exercise-induced phenomena interact, impacting BG concentrations. This model describes nondiabetic subjects, but it is a first step to a model that describes glucose dynamics during exercise in those with type 1 diabetes (T1D). Clinicians and engineers can use the insights gained from the model simulations to better understand the connection between exercise and glucose dynamics and ultimately help patients with T1D make more informed insulin dosing decisions around exercise.
Collapse
Affiliation(s)
- Spencer Frank
- Department of Mechanical Engineering at the University of California Berkeley, Berkeley, USA.
- Dexcom in San Diego, San Diego, CA, USA.
| | - Abdulrahman Jbaily
- Department of Mechanical Engineering at the University of California Berkeley, Berkeley, USA
- Dexcom in San Diego, San Diego, CA, USA
| | - Ling Hinshaw
- Division of Endocrinology at Mayo Clinic, Rochester, USA
| | - Rita Basu
- Division of Endocrinology at the University of Virginia School of Medicine, Charlottesville, USA
| | - Ananda Basu
- Division of Endocrinology at the University of Virginia School of Medicine, Charlottesville, USA
| | - Andrew J Szeri
- Department of Mechanical Engineering at the University of California Berkeley, Berkeley, USA
- Department of Mechanical Engineering at the University of British Columbia, Vancouver, Canada
| |
Collapse
|
54
|
Schiavon M, Herzig D, Hepprich M, Donath MY, Bally L, Dalla Man C. Model-Based Assessment of C-Peptide Secretion and Kinetics in Post Gastric Bypass Individuals Experiencing Postprandial Hyperinsulinemic Hypoglycemia. Front Endocrinol (Lausanne) 2021; 12:611253. [PMID: 33790855 PMCID: PMC8006944 DOI: 10.3389/fendo.2021.611253] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Accepted: 01/19/2021] [Indexed: 12/05/2022] Open
Abstract
Assessment of insulin secretion is key to diagnose postprandial hyperinsulinemic hypoglycemia (PHH), an increasingly recognized complication following bariatric surgery. To this end, the Oral C-peptide Minimal Model (OCMM) can be used. This usually requires fixing C-peptide (CP) kinetics to the ones derived from the Van Cauter population model (VCPM), which has never been validated in PHH individuals. The objective of this work was to test the validity of the OCMM coupled with the VCPM in PHH subjects and propose a method to overcome the observed limitations. Two cohorts of adults with PHH after gastric bypass (GB) underwent either a 75 g oral glucose (9F/3M; age=42±9 y; BMI=28.3±6.9 kg/m2) or a 60 g mixed-meal (7F/3M; age = 43 ± 11 y; BMI=27.5±4.2 kg/m2) tolerance test. The OCMM was identified on CP concentration data with CP kinetics fixed to VCPM (VC approach). In both groups, the VC approach underestimated CP-peak and overestimated CP-tail suggesting CP kinetics predicted by VCPM to be inaccurate in this population. Thus, the OCMM was identified using CP kinetics estimated from the data (DB approach) using a Bayesian Maximum a Posteriori estimator. CP data were well predicted in all the subjects using the DB approach, highlighting a significantly faster CP kinetics in patients with PHH compared to the one predicted by VCPM. Finally, a simulation study was used to validate the proposed approach. The present findings question the applicability of the VCPM in patients with PHH after GB and call for CP bolus experiments to develop a reliable CP kinetic model in this population.
Collapse
Affiliation(s)
- Michele Schiavon
- Department of Information Engineering, University of Padova, Padova, Italy
| | - David Herzig
- Department of Diabetes, Endocrinology, Nutritional Medicine and Metabolism, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Matthias Hepprich
- Division of Endocrinology, Diabetes and Metabolism, University Hospital Basel, Basel, Switzerland
| | - Marc Y. Donath
- Division of Endocrinology, Diabetes and Metabolism, University Hospital Basel, Basel, Switzerland
| | - Lia Bally
- Department of Diabetes, Endocrinology, Nutritional Medicine and Metabolism, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Chiara Dalla Man
- Department of Information Engineering, University of Padova, Padova, Italy
- *Correspondence: Chiara Dalla Man,
| |
Collapse
|
55
|
Liu X, Liu Y, Liu H, Li H, Yang J, Hu P, Xiao X, Liu D. Dipeptidyl-Peptidase-IV Inhibitors, Imigliptin and Alogliptin, Improve Beta-Cell Function in Type 2 Diabetes. Front Endocrinol (Lausanne) 2021; 12:694390. [PMID: 34616361 PMCID: PMC8488395 DOI: 10.3389/fendo.2021.694390] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Accepted: 08/23/2021] [Indexed: 11/13/2022] Open
Abstract
OBJECTS Imigliptin is a novel dipeptidyl peptidase-4 inhibitor. In the present study, we aimed to evaluate the effects of imigliptin and alogliptin on insulin resistance and beta-cell function in Chinese patients with type-2 diabetes mellitus (T2DM). METHODS A total of 37 Chinese T2DM patients were randomized to receive 25 mg imigliptin, 50 mg imigliptin, placebo, and 25 mg alogliptin (positive drug) for 13 days. Oral glucose tolerance tests were conducted at baseline and on day 13, followed by the oral minimal model (OMM). RESULTS Imigliptin or alogliptin treatment, compared with their baseline or placebo, was associated with higher beta-cell function parameters (φs and φtot) and lower glucose area under the curve (AUC) and postprandial glucose levels. The changes in the AUC for the glucose appearance rate between 0 and 120 min also showed a decrease in imigliptin or alogliptin groups. However, the insulin resistance parameter, fasting glucose, was not changed. For the homeostatic model assessment (HOMA-β and HOMA-IR) parameters or secretory units of islets in transplantation index (SUIT), no statistically significant changes were found both within treatments and between treatments. CONCLUSIONS After 13 days of treatment, imigliptin and alogliptin could decrease glycemic levels by improving beta-cell function. By comparing OMM with HOMA or SUIT results, glucose stimulation might be more sensitive for detecting changes in beta-cell function.
Collapse
Affiliation(s)
- Xu Liu
- Savaid Medical School, University of Chinese Academy of Sciences, Beijing, China
- Drug Clinical Trial Center, Peking University Third Hospital, Beijing, China
| | - Yang Liu
- Clinical Pharmacology Research Center, Peking Union Medical College Hospital and Chinese Academy of Medical Sciences, Beijing, China
- Department of Pharmacology, College of Pharmacy, Inner Mongolia Medical University, Hohhot, China
| | - Hongzhong Liu
- Clinical Pharmacology Research Center, Peking Union Medical College Hospital and Chinese Academy of Medical Sciences, Beijing, China
| | - Haiyan Li
- Drug Clinical Trial Center, Peking University Third Hospital, Beijing, China
- Center of Clinical Medical Research, Institute of Medical Innovation and Research, Peking University Third Hospital, Beijing, China
| | - Jianhong Yang
- Savaid Medical School, University of Chinese Academy of Sciences, Beijing, China
| | - Pei Hu
- Clinical Pharmacology Research Center, Peking Union Medical College Hospital and Chinese Academy of Medical Sciences, Beijing, China
| | - Xinhua Xiao
- Department of Endocrinology, Key Laboratory of Endocrinology of National Health Commission, Peking Union Medical College Hospital and Chinese Academy of Medical Sciences, Beijing, China
| | - Dongyang Liu
- Drug Clinical Trial Center, Peking University Third Hospital, Beijing, China
- Center of Clinical Medical Research, Institute of Medical Innovation and Research, Peking University Third Hospital, Beijing, China
| |
Collapse
|
56
|
Laurenti MC, Vella A, Adams JD, Schembri Wismayer DJ, Egan AM, Dalla Man C. Assessment of individual and standardized glucagon kinetics in healthy humans. Am J Physiol Endocrinol Metab 2021; 320:E71-E77. [PMID: 33135460 PMCID: PMC8194411 DOI: 10.1152/ajpendo.00488.2020] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Impaired glucose tolerance arises out of impaired postprandial insulin secretion and delayed suppression of glucagon. These defects occur early and independently in the pathogenesis of prediabetes. Quantification of the contribution of α-cell dysfunction to glucose tolerance has been lacking because knowledge of glucagon kinetics in humans is limited. Therefore, in a series of experiments examining the interaction of glucagon suppression with insulin secretion we studied 51 nondiabetic subjects (age = 54 ± 13 yr, BMI = 28 ± 4 kg/m2). Glucose was infused to mimic the systemic appearance of an oral challenge. Somatostatin was used to inhibit endogenous hormone secretion. 120 min after the start of the experiment, glucagon was infused at 0.65 ng/kg/min. The rise in glucagon concentrations was used to estimate its kinetic parameters [volume of distribution (Vd), half-life (t1/2), and clearance rate (CL)]. A single-exponential model provided the best fit for the data, and individualized kinetic parameters were estimated: Vd = 8.2 ± 2.7 L, t1/2 = 4 ± 1.1 min, CL = 1.4 ± 0.33 L/min. Stepwise linear regression was used to correlate Vd with BMI and sex (R2adj = 0.44), whereas CL similarly correlated with lean body mass or BSA (both R2 = 0.28). This enabled the development of a population-based model using anthropometric characteristics to predict Vd and CL. These data demonstrate that it is feasible to derive glucagon kinetic parameters from anthropometric characteristics, thereby enabling quantitation of the rate of glucagon appearance in the systemic circulation in large populations.NEW & NOTEWORTHY State-of-the-art measurement of insulin secretion in humans is accomplished by deconvolution of peripheral C-peptide concentrations using population-derived parameters of C-peptide kinetics. In contrast, knowledge of the kinetic parameters of glucagon in humans is lacking so that measurement of glucagon secretion to date is largely qualitative. This series of experiments enabled measurement of glucagon kinetics in 51 subjects, and subsequently, stepwise linear regression was used to correlate these parameters with anthropometric characteristics. This enabled the development of a population-based model using anthropometric characteristics to predict the volume of distribution and the rate of clearance. This is a necessary first step in the development of a model to quantitate of glucagon secretion and action (and its contribution to glucose tolerance) in large populations.
Collapse
Affiliation(s)
- Marcello C Laurenti
- Division of Endocrinology, Diabetes & Metabolism, Mayo Clinic College of Medicine, Rochester, Minnesota
| | - Adrian Vella
- Division of Endocrinology, Diabetes & Metabolism, Mayo Clinic College of Medicine, Rochester, Minnesota
| | - Jon D Adams
- Division of Endocrinology, Diabetes & Metabolism, Mayo Clinic College of Medicine, Rochester, Minnesota
| | | | - Aoife M Egan
- Division of Endocrinology, Diabetes & Metabolism, Mayo Clinic College of Medicine, Rochester, Minnesota
| | - Chiara Dalla Man
- Department of Information Engineering, University of Padova, Padova, Italy
| |
Collapse
|
57
|
Mari A, Tura A, Grespan E, Bizzotto R. Mathematical Modeling for the Physiological and Clinical Investigation of Glucose Homeostasis and Diabetes. Front Physiol 2020; 11:575789. [PMID: 33324238 PMCID: PMC7723974 DOI: 10.3389/fphys.2020.575789] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Accepted: 11/04/2020] [Indexed: 12/21/2022] Open
Abstract
Mathematical modeling in the field of glucose metabolism has a longstanding tradition. The use of models is motivated by several reasons. Models have been used for calculating parameters of physiological interest from experimental data indirectly, to provide an unambiguous quantitative representation of pathophysiological mechanisms, to determine indices of clinical usefulness from simple experimental tests. With the growing societal impact of type 2 diabetes, which involves the disturbance of the glucose homeostasis system, development and use of models in this area have increased. Following the approaches of physiological and clinical investigation, the focus of the models has spanned from representations of whole body processes to those of cells, i.e., from in vivo to in vitro research. Model-based approaches for linking in vivo to in vitro research have been proposed, as well as multiscale models merging the two areas. The success and impact of models has been variable. Two kinds of models have received remarkable interest: those widely used in clinical applications, e.g., for the assessment of insulin sensitivity and β-cell function and some models representing specific aspects of the glucose homeostasis system, which have become iconic for their efficacy in describing clearly and compactly key physiological processes, such as insulin secretion from the pancreatic β cells. Models are inevitably simplified and approximate representations of a physiological system. Key to their success is an appropriate balance between adherence to reality, comprehensibility, interpretative value and practical usefulness. This has been achieved with a variety of approaches. Although many models concerning the glucose homeostasis system have been proposed, research in this area still needs to address numerous issues and tackle new opportunities. The mathematical representation of the glucose homeostasis processes is only partial, also because some mechanisms are still only partially understood. For in vitro research, mathematical models still need to develop their potential. This review illustrates the problems, approaches and contribution of mathematical modeling to the physiological and clinical investigation of glucose homeostasis and diabetes, focusing on the most relevant and stimulating models.
Collapse
Affiliation(s)
- Andrea Mari
- Institute of Neuroscience, National Research Council, Padua, Italy
| | - Andrea Tura
- Institute of Neuroscience, National Research Council, Padua, Italy
| | - Eleonora Grespan
- Institute of Neuroscience, National Research Council, Padua, Italy
| | - Roberto Bizzotto
- Institute of Neuroscience, National Research Council, Padua, Italy
| |
Collapse
|
58
|
Visual food cues decrease blood glucose and glucoregulatory hormones following an oral glucose tolerance test in normal-weight and obese men. Physiol Behav 2020; 226:113071. [PMID: 32659394 DOI: 10.1016/j.physbeh.2020.113071] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2019] [Revised: 06/15/2020] [Accepted: 07/09/2020] [Indexed: 11/22/2022]
Abstract
Previous experiments of our group have demonstrated that preprandial processing of food cues attenuates postprandial blood glucose excursions. Here we systematically re-evaluated the glucose-lowering effect of visual food cues by submitting 40 healthy fasted men (20 normal-weight men, mean age 24.8 ± 3.7 years, BMI 21.9 ± 0.3 kg/m2; 20 obese men, 26.8 ± 4.2 years, 34.3 ± 1.3 kg/m2) to an oral glucose tolerance test (OGTT) following exposure to pictures of high-calorie food items versus neutral items. OGTT-related changes in blood concentrations of glucose and relevant glucoregulatory hormones including GLP-1 were assessed and analyzed according to the oral minimal model. Independent of body weight, food-cue compared to neutral stimulus presentation reduced postprandial concentrations of glucose (p = 0.041), insulin (p = 0.026) and C-peptide (p = 0.007); accordingly, oral minimal model analyses yielded a food-cue induced decrease of dynamic-phase insulin secretion (p = 0.036). We also observed a trend towards lower GLP-1 levels directly after food cue stimulation in both body weight groups (p = 0.057), as well as a trend towards decreased heart rate (p = 0.093) and significantly decreased diastolic blood pressure (p = 0.019). While we did not detect indicators of an early rise in insulin levels in terms of a 'cephalic phase insulin response', our findings support the assumption that preprandial processing of food cues exerts marked effect on postprandial glucose regulation, with possible contributions of changes in GLP-1. The mechanisms linking food cue exposure and glucoregulatory improvements should be investigated in greater detail, to potentially open new treatment options for metabolic dysfunctions.
Collapse
|
59
|
Carreau AM, Xie D, Garcia-Reyes Y, Rahat H, Bartlette K, Diniz Behn C, Pyle L, Nadeau KJ, Cree-Green M. Good agreement between hyperinsulinemic-euglycemic clamp and 2 hours oral minimal model assessed insulin sensitivity in adolescents. Pediatr Diabetes 2020; 21:1159-1168. [PMID: 32592269 PMCID: PMC7762730 DOI: 10.1111/pedi.13072] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Revised: 06/09/2020] [Accepted: 06/23/2020] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND/OBJECTIVE Rates of dysglycemia are increasing in youth, secondary to obesity and decreased insulin sensitivity (IS) in puberty. The oral minimal model (OMM) has been developed in order to measure IS using an easy oral glucose load, such as an oral glucose tolerance test (OGTT), instead of an hyperinsulinemic-euglycemic clamp (HE-clamp), a more invasive and time-consuming procedure. However, this model, following a standard 2 hour- OGTT has never been validated in youth, a population known for a different physiologic response to OGTT than adults. Thus, we compared IS measurements obtained from OMM following a 2-hour OGTT to HE-clamp and isotope tracer-assessed tissue IS in adolescents. We also compared the liver/muscle-specific IS from HE-clamp with other liver/muscle-specific IS surrogates following an OGTT previously validated in adults. METHODS Secondary analysis of a cross-sectional study. Adolescent girls with (n = 26) and without (n = 7) polycystic ovary syndrome (PCOS) (14.6 ± 1.7 years; BMI percentile 23.3%-98.2%) underwent a 2-hour 75 g OGTT and a 4-phase HE-clamp. OMM IS (Si), dynamic Si (Sid ) and other OGTT-derived muscle and liver IS indices were correlated with HE-clamp tissue-specific IS. RESULTS OMM Si and Sid correlated with HE-clamp-measured peripheral IS (r = 0.64, P <.0001 and r = 0.73; P <.0001, respectively) and the correlation coefficient trended higher than the Matsuda index (r = 0.59; P =.003). The other tissue-specific indices were poorly correlated with their HE-clamp measurements. CONCLUSION In adolescent girls, the 2-hour OMM provided the best estimate of peripheral IS. Additional surrogates for hepatic IS are needed for youth.
Collapse
Affiliation(s)
- Anne-Marie Carreau
- Department of Pediatrics, Division of Pediatric Endocrinology, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Danielle Xie
- Department of Pediatrics, Division of Pediatric Endocrinology, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Yesenia Garcia-Reyes
- Department of Pediatrics, Division of Pediatric Endocrinology, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Haseeb Rahat
- Department of Pediatrics, Division of Pediatric Endocrinology, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Kai Bartlette
- Department of Applied Mathematics and Statistics, Colorado School of Mines, Golden, Colorado
| | - Cecilia Diniz Behn
- Department of Pediatrics, Division of Pediatric Endocrinology, University of Colorado Anschutz Medical Campus, Aurora, Colorado,Department of Applied Mathematics and Statistics, Colorado School of Mines, Golden, Colorado
| | - Laura Pyle
- Department of Pediatrics, University of Colorado Anschutz Medical Campus, Aurora, Colorado,Department of Biostatistics and Informatics, Colorado School of Public Health, Aurora, Colorado
| | - Kristen J. Nadeau
- Department of Pediatrics, Division of Pediatric Endocrinology, University of Colorado Anschutz Medical Campus, Aurora, Colorado,Center for Women’s Health Research, Aurora, Colorado
| | - Melanie Cree-Green
- Department of Pediatrics, Division of Pediatric Endocrinology, University of Colorado Anschutz Medical Campus, Aurora, Colorado,Center for Women’s Health Research, Aurora, Colorado
| |
Collapse
|
60
|
Galderisi A, Tricò D, Pierpont B, Shabanova V, Samuels S, Dalla Man C, Galuppo B, Santoro N, Caprio S. A Reduced Incretin Effect Mediated by the rs7903146 Variant in the TCF7L2 Gene Is an Early Marker of β-Cell Dysfunction in Obese Youth. Diabetes Care 2020; 43:2553-2563. [PMID: 32788279 PMCID: PMC7510033 DOI: 10.2337/dc20-0445] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Accepted: 07/10/2020] [Indexed: 02/03/2023]
Abstract
OBJECTIVE The risk genotype for the common variant rs7903146 of the transcription factor 7-like-2 (TCF7L2) gene has been found to affect the incretin response in healthy and obese adults; however, whether a similar functional defect is also present in obese adolescents remains unexplored. Herein, we examined the functional effect of the rs7903146 variant in the TCF7L2 gene on the incretin effect and determined its translational metabolic manifestation by performing deep phenotyping of the incretin system, β-cell function relative to insulin sensitivity, the gastrointestinal-induced glucose disposal (GIGD) in obese youth with normal and impaired glucose tolerance. RESEARCH DESIGN AND METHODS Thirty-nine obese adolescents without diabetes (median age 15 [25th, 75th percentile 14, 18] years; BMI 37 [33, 43] kg/m2) were genotyped for the rs7903146 variant of TCF7L2 and underwent a 3-h oral glucose tolerance test (OGTT) followed by an isoglycemic intravenous glucose infusion (iso-intravenous glucose tolerance test [IVGTT]) to match the plasma glucose concentrations during the OGTT and a hyperglycemic clamp with arginine stimulation. The incretin effect was measured as 100 * (AUC-SROGTT - AUC-SRiso-IVGTT) / AUC-SROGTT, where AUC-SR = area under the curve of C-peptide secretion rate. Participants were grouped into tertiles according to the percentage incretin effect (high, moderate, and low) to describe their metabolic phenotype. RESULTS The presence of T risk allele for TCF7L2 was associated with a markedly reduced incretin effect compared with the wild-type genotype (0.3% [-7.2, 14] vs. 37.8% [12.5, 52.4], P < 0.002). When the cohort was stratified by incretin effect, the high, moderate, and low incretin effect groups did not differ with respect to anthropometric features, while the low incretin effect group exhibited higher 1-h glucose (P = 0.015) and a reduced disposition index, insulin sensitivity, and insulin clearance compared with the high incretin effect group. GIGD was reduced in the low incretin effect group (P = 0.001). The three groups did not differ with respect to intravenous glucose-induced insulin secretion and arginine response during the hyperglycemic clamp. CONCLUSIONS A reduced incretin effect and its association with the TCF7L2 variant rs7903146 identify an early metabolic phenotype in obese youth without diabetes, featuring a higher plasma glucose peak at 1 h; lower insulin secretion, sensitivity, and clearance; and GIGD.
Collapse
Affiliation(s)
- Alfonso Galderisi
- Pediatrics Endocrinology and Diabetes Section, Department of Pediatrics, Yale School of Medicine, New Haven, CT.,Department of Woman and Child's Health, University of Padova, Padova, Italy
| | - Domenico Tricò
- Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, University of Pisa, Pisa, Italy.,Institute of Life Sciences, Sant'Anna School of Advanced Studies, Pisa, Italy
| | - Bridget Pierpont
- Pediatrics Endocrinology and Diabetes Section, Department of Pediatrics, Yale School of Medicine, New Haven, CT
| | - Veronika Shabanova
- Pediatrics Endocrinology and Diabetes Section, Department of Pediatrics, Yale School of Medicine, New Haven, CT.,Yale School of Public Health, New Haven, CT
| | - Stephanie Samuels
- Pediatrics Endocrinology and Diabetes Section, Department of Pediatrics, Yale School of Medicine, New Haven, CT
| | - Chiara Dalla Man
- Department of Information Engineering, University of Padova, Padova, Italy
| | - Brittany Galuppo
- Pediatrics Endocrinology and Diabetes Section, Department of Pediatrics, Yale School of Medicine, New Haven, CT
| | - Nicola Santoro
- Pediatrics Endocrinology and Diabetes Section, Department of Pediatrics, Yale School of Medicine, New Haven, CT
| | - Sonia Caprio
- Pediatrics Endocrinology and Diabetes Section, Department of Pediatrics, Yale School of Medicine, New Haven, CT
| |
Collapse
|
61
|
Abstract
Diabetes is a chronic, progressive disease that calls for longitudinal data and analysis. We introduce a longitudinal mathematical model that is capable of representing the metabolic state of an individual at any point in time during their progression from normal glucose tolerance to type 2 diabetes (T2D) over a period of years. As an application of the model, we account for the diversity of pathways typically followed, focusing on two extreme alternatives, one that goes through impaired fasting glucose (IFG) first and one that goes through impaired glucose tolerance (IGT) first. These two pathways are widely recognized to stem from distinct metabolic abnormalities in hepatic glucose production and peripheral glucose uptake, respectively. We confirm this but go beyond to show that IFG and IGT lie on a continuum ranging from high hepatic insulin resistance and low peripheral insulin resistance to low hepatic resistance and high peripheral resistance. We show that IFG generally incurs IGT and IGT generally incurs IFG on the way to T2D, highlighting the difference between innate and acquired defects and the need to assess patients early to determine their underlying primary impairment and appropriately target therapy. We also consider other mechanisms, showing that IFG can result from impaired insulin secretion, that non-insulin-dependent glucose uptake can also mediate or interact with these pathways, and that impaired incretin signaling can accelerate T2D progression. We consider whether hyperinsulinemia can cause insulin resistance in addition to being a response to it and suggest that this is a minor effect.
Collapse
Affiliation(s)
- Joon Ha
- Laboratory of Biological Modeling, National Institutes of Health, Bethesda, Maryland
| | - Arthur Sherman
- Laboratory of Biological Modeling, National Institutes of Health, Bethesda, Maryland
| |
Collapse
|
62
|
Mather KJ, Chen M, Hannon TS. Linearization of the Disposition Index equation allows evaluation of secretion-sensitivity coupling slopes. J Diabetes Complications 2020; 34:107589. [PMID: 32376087 DOI: 10.1016/j.jdiacomp.2020.107589] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Revised: 03/29/2020] [Accepted: 03/29/2020] [Indexed: 12/28/2022]
Abstract
AIMS The Disposition Index (DI) is widely used in clinical studies of β-cell function. However, direct physiologic interpretation of the DI value and the inverse exponential slope relating insulin secretion and insulin sensitivity terms is difficult. We evaluated a linearization of the relationship that allows separate evaluation of the DI term and the slope. METHODS Insulin secretion and sensitivity indices were derived from standardized oral glucose tolerance testing, including commonly used terms and model-derived terms. The population included participants with normoglycemia, dysglycemia or Type 2 diabetes. Logarithmic transformation of the DI equation to linearize the secretion-sensitivity relationship was performed, and the resulting secretion-sensitivity relationships were evaluated using standard linear regression methods. RESULTS Simple logarithmic transformation linearized the secretion-sensitivity relationships available from a variety of OGTT-derived metrics. In normoglycemic subjects the slopes approximated -1 in insulin-basedsecretion-sensitivity pairs, and approximated -0.6 in C-peptide based secretion-sensitivity pairs. Group differences in DI terms were observed as expected. These analyses also revealed differing secretion-sensitivity slopes, with IGT and T2D demonstrating progressively impaired coupling. CONCLUSIONS Linearization of the secretion-sensitivity relationship provides simplified interpretation of the DI value and allows simple analysis and meaningful interpretation of the secretion-sensitivity slope. This linear relationship is amenable to standard statistical evaluations for comparisons of insulin secretion responses and of secretion-sensitivity coupling across groups.
Collapse
Affiliation(s)
- Kieren J Mather
- Indiana University School of Medicine, United States of America.
| | - Melinda Chen
- University of Nebraska School of Medicine, United States of America
| | - Tamara S Hannon
- Indiana University School of Medicine, United States of America
| |
Collapse
|
63
|
|
64
|
Huang R, Yin S, Ye Y, Chen N, Luo S, Xia M, Zhao L. Circulating Retinol-Binding Protein 4 Is Inversely Associated With Pancreatic β-Cell Function Across the Spectrum of Glycemia. Diabetes Care 2020; 43:1258-1265. [PMID: 32265192 DOI: 10.2337/dc19-2432] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Accepted: 03/14/2020] [Indexed: 02/03/2023]
Abstract
OBJECTIVE The aim of this study was to examine the association of circulating retinol-binding protein 4 (RBP4) levels with β-cell function across the spectrum of glucose tolerance from normal to overt type 2 diabetes. RESEARCH DESIGN AND METHODS A total of 291 subjects aged 35-60 years with normal glucose tolerance (NGT), newly diagnosed impaired fasting glucose or glucose tolerance (IFG/IGT), or type 2 diabetes were screened by a standard 2-h oral glucose tolerance test (OGTT) with the use of traditional measures to evaluate β-cell function. From these participants, 74 subjects were recruited for an oral minimal model test, and β-cell function was assessed with model-derived indices. Circulating RBP4 levels were measured by a commercially available ELISA kit. RESULTS Circulating RBP4 levels were significantly and inversely correlated with β-cell function indicated by the Stumvoll first-phase and second-phase insulin secretion indices, but not with HOMA of β-cell function, calculated from the 2-h OGTT in 291 subjects across the spectrum of glycemia. The inverse association was also observed in subjects involved in the oral minimal model test with β-cell function assessed by both direct measures and model-derived measures, after adjustment for potential confounders. Moreover, RBP4 emerged as an independent factor of the disposition index-total insulin secretion. CONCLUSIONS Circulating RBP4 levels are inversely and independently correlated with β-cell function across the spectrum of glycemia, providing another possible explanation of the linkage between RBP4 and the pathogenesis of type 2 diabetes.
Collapse
Affiliation(s)
- Rong Huang
- Guangdong Provincial Key Laboratory of Food, Nutrition and Health, Guangzhou, Guangdong, People's Republic of China.,Department of Nutrition, School of Public Health, Sun Yat-sen University, Guangzhou, Guangdong, People's Republic of China
| | - Songping Yin
- Guangdong Provincial Key Laboratory of Food, Nutrition and Health, Guangzhou, Guangdong, People's Republic of China.,Department of Nutrition, School of Public Health, Sun Yat-sen University, Guangzhou, Guangdong, People's Republic of China
| | - Yongxin Ye
- Guangdong Provincial Key Laboratory of Food, Nutrition and Health, Guangzhou, Guangdong, People's Republic of China.,Department of Nutrition, School of Public Health, Sun Yat-sen University, Guangzhou, Guangdong, People's Republic of China
| | - Nixuan Chen
- Guangdong Provincial Key Laboratory of Food, Nutrition and Health, Guangzhou, Guangdong, People's Republic of China.,Department of Nutrition, School of Public Health, Sun Yat-sen University, Guangzhou, Guangdong, People's Republic of China
| | - Shiyun Luo
- Guangdong Provincial Key Laboratory of Food, Nutrition and Health, Guangzhou, Guangdong, People's Republic of China.,Department of Nutrition, School of Public Health, Sun Yat-sen University, Guangzhou, Guangdong, People's Republic of China
| | - Min Xia
- Guangdong Provincial Key Laboratory of Food, Nutrition and Health, Guangzhou, Guangdong, People's Republic of China .,Department of Nutrition, School of Public Health, Sun Yat-sen University, Guangzhou, Guangdong, People's Republic of China
| | - Lina Zhao
- Guangdong Provincial Key Laboratory of Food, Nutrition and Health, Guangzhou, Guangdong, People's Republic of China .,Department of Nutrition, School of Public Health, Sun Yat-sen University, Guangzhou, Guangdong, People's Republic of China
| |
Collapse
|
65
|
Theoretical Modeling of Oral Glucose Tolerance Tests Guides the Interpretation of the Impact of Perinatal Cadmium Exposure on the Offspring's Glucose Homeostasis. TOXICS 2020; 8:toxics8020030. [PMID: 32326427 PMCID: PMC7357044 DOI: 10.3390/toxics8020030] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/23/2020] [Revised: 04/03/2020] [Accepted: 04/06/2020] [Indexed: 12/11/2022]
Abstract
Oral glucose tolerance tests, in which the concentration of glucose is monitored in the circulation over 2 h after ingesting a bolus, probe diabetic or pre-diabetic conditions. The resulting glucose curves inform about glucose turnover, insulin production and sensitivity, and other parameters. However, extracting the relevant parameters from a single complex curve is not straightforward. We propose a simple modeling method recapitulating the most salient features of the role of insulin-secreting pancreatic β-cells and insulin sensitive tissues. This method implements four ordinary differential equations with ten parameters describing the time-dependence of glucose concentration, its removal rate, and the circulating and stored insulin concentrations. From the initial parameter set adjusted to a reference condition, fitting is done by minimizing a weighted least-square residual. In doing so, the sensitivity of β-cells to glucose was identified as the most likely impacted function at weaning for the progeny of rats that were lightly exposed to cadmium in the perigestational period. Later in life, after young rats received non-contaminated carbohydrate enriched food, differences are more subtle, but modeling agrees with long-lasting perturbation of glucose homeostasis.
Collapse
|
66
|
Laurenti MC, Dalla Man C, Varghese RT, Andrews JC, Rizza RA, Matveyenko A, De Nicolao G, Cobelli C, Vella A. Diabetes-associated genetic variation in TCF7L2 alters pulsatile insulin secretion in humans. JCI Insight 2020; 5:136136. [PMID: 32182220 DOI: 10.1172/jci.insight.136136] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2020] [Accepted: 03/05/2020] [Indexed: 12/13/2022] Open
Abstract
BACKGROUNDMetabolic disorders such as type 2 diabetes have been associated with a decrease in insulin pulse frequency and amplitude. We hypothesized that the T allele at rs7903146 in TCF7L2, previously associated with β cell dysfunction, would be associated with changes in these insulin pulse characteristics.METHODSTwenty-nine nondiabetic subjects (age 46 ± 2, BMI 28 ± 1 kg/m2) participated in this study. Of these, 16 were homozygous for the C allele at rs7903146 and 13 were homozygous for the T allele. Deconvolution of peripheral C-peptide concentrations allowed the reconstruction of portal insulin secretion over time. These data were used for subsequent analyses. Pulse orderliness was assessed by approximate entropy (ApEn), and the dispersion of insulin pulses was measured by a frequency dispersion index (FDI) after a Fast Fourier Transform (FFT) of individual insulin secretion rates.RESULTSDuring fasting conditions, the CC genotype group exhibited decreased pulse disorderliness compared with the TT genotype group (1.10 ± 0.03 vs. 1.19 ± 0.04, P = 0.03). FDI decreased in response to hyperglycemia in the CC genotype group, perhaps reflecting less entrainment of insulin secretion during fasting.CONCLUSIONDiabetes-associated variation in TCF7L2 is associated with decreased orderliness and pulse dispersion, unchanged by hyperglycemia. Quantification of ApEn and FDI could represent novel markers of β cell health.FUNDINGThis work was funded by US NIH (DK78646, DK116231), University of Padova research grant CPDA145405, and Mayo Clinic General Clinical Research Center (UL1 TR000135).
Collapse
Affiliation(s)
- Marcello C Laurenti
- Division of Endocrinology, Diabetes & Metabolism, Mayo Clinic, Rochester, Minnesota, USA
| | - Chiara Dalla Man
- Department of Information Engineering, University of Padova, Padova, Italy
| | - Ron T Varghese
- Division of Endocrinology, Diabetes & Metabolism, Mayo Clinic, Rochester, Minnesota, USA
| | | | - Robert A Rizza
- Division of Endocrinology, Diabetes & Metabolism, Mayo Clinic, Rochester, Minnesota, USA
| | - Aleksey Matveyenko
- Division of Endocrinology, Diabetes & Metabolism, Mayo Clinic, Rochester, Minnesota, USA.,Physiology and Biomedical Engineering, Mayo Clinic, Rochester, Minnesota, USA
| | - Giuseppe De Nicolao
- Department of Computer Engineering and Systems Science, University of Pavia, Pavia, Italy
| | - Claudio Cobelli
- Department of Information Engineering, University of Padova, Padova, Italy
| | - Adrian Vella
- Division of Endocrinology, Diabetes & Metabolism, Mayo Clinic, Rochester, Minnesota, USA
| |
Collapse
|
67
|
Visentin R, Schiavon M, Göbel B, Riz M, Cobelli C, Klabunde T, Dalla Man C. Dual glucagon-like peptide-1 receptor/glucagon receptor agonist SAR425899 improves beta-cell function in type 2 diabetes. Diabetes Obes Metab 2020; 22:640-647. [PMID: 31808298 DOI: 10.1111/dom.13939] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2019] [Revised: 12/02/2019] [Accepted: 12/02/2019] [Indexed: 12/15/2022]
Abstract
AIM To evaluate the change in insulin sensitivity, β-cell function and glucose absorption after 28 days of treatment with high and low doses of SAR425899, a novel dual glucagon-like peptide-1 receptor/glucagon receptor agonist, versus placebo. MATERIALS AND METHODS Thirty-six overweight to obese subjects with type 2 diabetes were randomized to receive daily subcutaneous administrations of low-dose SAR425899 (0.03, 0.06 and 0.09 mg) and high-dose SAR425899 (0.06, 0.12 and 0.18 mg) or placebo for 28 days; dose escalation occurred after days 7 and 14. Mixed meal tolerance tests were conducted before treatment (day -1) and on days 1 and 28. Oral glucose and C-peptide minimal models were used to quantify metabolic indices of insulin sensitivity, β-cell responsiveness and glucose absorption. RESULTS With low-dose SAR425899, high-dose SAR425899 and placebo, β-cell function from day -1 to day 28 increased by 163%, 95% and 23%, respectively. The change in area under the curve for the rate of meal glucose appearance between 0 and 120 minutes was -32%, -20% and 8%, respectively. CONCLUSIONS After 28 days of treatment, SAR425899 improved postprandial glucose control by significantly enhancing β-cell function and slowing glucose absorption rate.
Collapse
Affiliation(s)
- Roberto Visentin
- Department of Information Engineering, University of Padova, Padova, Italy
| | - Michele Schiavon
- Department of Information Engineering, University of Padova, Padova, Italy
| | - Britta Göbel
- Sanofi-Aventis Deutschland GmbH, Frankfurt am Main, Germany
| | - Michela Riz
- Sanofi-Aventis Deutschland GmbH, Frankfurt am Main, Germany
| | - Claudio Cobelli
- Department of Information Engineering, University of Padova, Padova, Italy
| | | | - Chiara Dalla Man
- Department of Information Engineering, University of Padova, Padova, Italy
| |
Collapse
|
68
|
Fabris C, Nass RM, Pinnata J, Carr KA, Koravi CLK, Barnett CL, Oliveri MC, Anderson SM, Chernavvsky DR, Breton MD. The Use of a Smart Bolus Calculator Informed by Real-time Insulin Sensitivity Assessments Reduces Postprandial Hypoglycemia Following an Aerobic Exercise Session in Individuals With Type 1 Diabetes. Diabetes Care 2020; 43:799-805. [PMID: 32144167 PMCID: PMC10026354 DOI: 10.2337/dc19-1675] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2019] [Accepted: 01/18/2020] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Insulin dosing in type 1 diabetes (T1D) is oftentimes complicated by fluctuating insulin requirements driven by metabolic and psychobehavioral factors impacting individuals' insulin sensitivity (IS). In this context, smart bolus calculators that automatically tailor prandial insulin dosing to the metabolic state of a person can improve glucose management in T1D. RESEARCH DESIGN AND METHODS Fifteen adults with T1D using continuous glucose monitors (CGMs) and insulin pumps completed two 24-h admissions in a hotel setting. During the admissions, participants engaged in an early afternoon 45-min aerobic exercise session, after which they received a standardized dinner meal. The dinner bolus was computed using a standard bolus calculator or smart bolus calculator informed by real-time IS estimates. Glucose control was assessed in the 4 h following dinner using CGMs and was compared between the two admissions. RESULTS The IS-informed bolus calculator allowed for a reduction in postprandial hypoglycemia as quantified by the low blood glucose index (2.02 vs. 3.31, P = 0.006) and percent time <70 mg/dL (8.48% vs. 15.18%, P = 0.049), without increasing hyperglycemia (high blood glucose index: 3.13 vs. 2.09, P = 0.075; percent time >180 mg/dL: 13.24% vs. 10.42%, P = 0.5; percent time >250 mg/dL: 2.08% vs. 1.19%, P = 0.317). In addition, the number of hypoglycemia rescue treatments was reduced from 12 to 7 with the use of the system. CONCLUSIONS The study shows that the proposed IS-informed bolus calculator is safe and feasible in adults with T1D, appropriately reducing postprandial hypoglycemia following an exercise-induced IS increase.
Collapse
Affiliation(s)
- Chiara Fabris
- Center for Diabetes Technology, University of Virginia, Charlottesville, VA
| | - Ralf M Nass
- Division of Endocrinology and Metabolism, Department of Medicine, University of Virginia, Charlottesville, VA
| | - Jennifer Pinnata
- Center for Diabetes Technology, University of Virginia, Charlottesville, VA
| | - Kelly A Carr
- Center for Diabetes Technology, University of Virginia, Charlottesville, VA
| | | | | | - Mary C Oliveri
- Center for Diabetes Technology, University of Virginia, Charlottesville, VA
| | - Stacey M Anderson
- Center for Diabetes Technology, University of Virginia, Charlottesville, VA
| | - Daniel R Chernavvsky
- Center for Diabetes Technology, University of Virginia, Charlottesville, VA
- Dexcom, Inc., Charlottesville, VA
| | - Marc D Breton
- Center for Diabetes Technology, University of Virginia, Charlottesville, VA
| |
Collapse
|
69
|
Adams JD, Dalla Man C, Laurenti MC, Andrade MDH, Cobelli C, Rizza RA, Bailey KR, Vella A. Fasting glucagon concentrations are associated with longitudinal decline of β-cell function in non-diabetic humans. Metabolism 2020; 105:154175. [PMID: 32045582 PMCID: PMC7093233 DOI: 10.1016/j.metabol.2020.154175] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2019] [Revised: 02/05/2020] [Accepted: 02/07/2020] [Indexed: 01/31/2023]
Abstract
PURPOSE Abnormal glucagon concentrations are a feature of prediabetes but it is uncertain if α-cell dysfunction contributes to a longitudinal decline in β-cell function. We therefore sought to determine if a decline in β-cell function is associated with a higher nadir glucagon in the postprandial period or with higher fasting glucagon. METHODS This was a longitudinal study in which 73 non-diabetic subjects were studied on 2 occasions 6.6 ± 0.3 years apart using a 2-hour, 7-sample oral glucose tolerance test. Disposition Index (DI) was calculated using the oral minimal model applied to the measurements of glucose, insulin, C-peptide concentrations during the studies. We subsequently examined the relationship of glucagon concentrations at baseline with change in DI (used as a measure of β-cell function) after adjusting for changes in weight and the baseline value of DI. RESULTS After adjusting for covariates, nadir postprandial glucagon concentrations were not associated with changes in β-cell function as quantified by DI. On the other hand, fasting glucagon concentrations during the baseline study were inversely correlated with longitudinal changes in DI. CONCLUSIONS Defects in α-cell function, manifest as elevated fasting glucagon, are associated with a subsequent decline in β-cell function. It remains to be ascertained if abnormal α-cell function contributes directly to loss of β-cell secretory capacity in the pathogenesis of type 2 diabetes.
Collapse
Affiliation(s)
- Jon D Adams
- Division of Endocrinology, Diabetes & Metabolism, Mayo Clinic College of Medicine, Rochester, MN, USA
| | - Chiara Dalla Man
- Department of Information Engineering, University of Padua, Padua, Italy
| | - Marcello C Laurenti
- Division of Endocrinology, Diabetes & Metabolism, Mayo Clinic College of Medicine, Rochester, MN, USA
| | - M Daniela Hurtado Andrade
- Division of Endocrinology, Diabetes & Metabolism, Mayo Clinic College of Medicine, Rochester, MN, USA
| | - Claudio Cobelli
- Department of Information Engineering, University of Padua, Padua, Italy
| | - Robert A Rizza
- Division of Endocrinology, Diabetes & Metabolism, Mayo Clinic College of Medicine, Rochester, MN, USA
| | - Kent R Bailey
- Biomedical Statistics and Informatics, Mayo Clinic College of Medicine, Rochester, MN, USA
| | - Adrian Vella
- Division of Endocrinology, Diabetes & Metabolism, Mayo Clinic College of Medicine, Rochester, MN, USA.
| |
Collapse
|
70
|
Gómez-Peralta F, Abreu C, Cos X, Gómez-Huelgas R. When does diabetes start? Early detection and intervention in type2 diabetes mellitus. Rev Clin Esp 2020; 220:305-314. [PMID: 32107016 DOI: 10.1016/j.rce.2019.12.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2019] [Revised: 12/12/2019] [Accepted: 12/14/2019] [Indexed: 01/09/2023]
Abstract
Type 2 diabetes mellitus (DM2) is a progressive disease whose pathophysiological changes occur several years before its detection. An approach based on the pathophysiological development of DM2 and its complications emphasises the importance of early and intensive intervention, not only to prevent beta-cell dysfunction but also to act on the potential associated cardiovascular risk factors before reaching the blood glucose thresholds currently set for diagnosing DM2. In the field of recently diagnosed DM2, the VERIFY study has shown that early treatment combined with metformin-vildagliptin provides relevant improvements in long-term glycaemic control and can positively affect the disease's progression.
Collapse
Affiliation(s)
- F Gómez-Peralta
- Unidad de Endocrinología y Nutrición, Hospital General de Segovia, Segovia, España.
| | - C Abreu
- Unidad de Endocrinología y Nutrición, Hospital General de Segovia, Segovia, España
| | - X Cos
- Innovation and Health in Primary Care Barcelona City, Gerència Barcelona Ciutat, Institut Català de la Salut, Barcelona, España; Fundació Institut Universitari d'Investigació en Atenció Primària Jordi Gol i Gurina (IDIAPJGol), Barcelona, España
| | - R Gómez-Huelgas
- Departamento de Medicina Interna, Hospital Regional Universitario, Instituto de Investigación Biomédica de Málaga (IBIMA), Universidad de Málaga (UMA), Málaga, España
| |
Collapse
|
71
|
Galderisi A, Tricò D, Dalla Man C, Santoro N, Pierpont B, Groop L, Cobelli C, Caprio S. Metabolic and Genetic Determinants of Glucose Shape After Oral Challenge in Obese Youths: A Longitudinal Study. J Clin Endocrinol Metab 2020; 105:5714814. [PMID: 31972003 PMCID: PMC6977541 DOI: 10.1210/clinem/dgz207] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Accepted: 11/15/2019] [Indexed: 02/08/2023]
Abstract
CONTEXT The time-to-glucose-peak following the oral glucose tolerance test (OGTT) is a highly reproducible marker for diabetes risk. In obese youths, we lack evidence for the mechanisms underlying the effects of the TCF7L2 rs7903146 variant on glucose peak. METHODS We analyzed the metabolic phenotype and the genotype for the TCF7L2 rs7903146 in 630 obese youths with normal (NGT) and impaired (IGT) glucose tolerance. Participants underwent a 3-hour, 9-point OGTT to estimate, using the oral minimal model, the disposition index (DI), the static (φstatic) and dynamic (φdynamic) components β-cell responsiveness and insulin sensitivity (SI). In a subgroup (n = 241) longitudinally followed for 2 years, we estimated the effect of time-to-glucose-peak on glucose tolerance change. RESULTS Participants were grouped into early (<30 minutes) and late (≥30 minutes) glucose peakers. A delayed glucose peak was featured by a decline in φstatic (P < .001) in the absence of a difference in φdynamic. The prevalence of T-risk allele for TCF7L2 rs7903146 variant significantly increased in the late peak group. A lower DI was correlated with higher glucose concentration at 1 and 2 hours, whereas SI was inversely associated with 1-hour glucose. Glucose peak <30 minutes was protective toward worsening of glucose tolerance overtime (odds ratio 0.35 [0.15-0.82]; P = .015), with no subjects progressing to NGT or persisting IGT, in contrast to the 40% of progressor in those with late glucose peak. CONCLUSION The prevalence of T-risk allele for the TCF7L2 rs7903146 prevailed in the late time-to-glucose peak group, which in turn is associated with impaired β-cell responsiveness to glucose (φ), thereby predisposing to prediabetes and diabetes in obese youths.
Collapse
Affiliation(s)
- Alfonso Galderisi
- Department of Pediatrics, Pediatrics Endocrinology and Diabetes Section, Yale School of Medicine, New Haven, Connecticut
- Department of Woman’s and Child’s Health, University of Padova, Padova, Italy
- Correspondence and Reprint Requests: Sonia Caprio, MD, Division of Pediatric Endocrinology, Department of Pediatrics, Yale University School of Medicine, 333 Cedar Street, New Haven, Connecticut 06520. E-mail:
| | - Domenico Tricò
- Institute of Life Sciences, Sant’Anna School of Advanced Studies, Pisa, Italy
| | - Chiara Dalla Man
- Department of Information Engineering, University of Padova, Padova, Italy
| | - Nicola Santoro
- Department of Pediatrics, Pediatrics Endocrinology and Diabetes Section, Yale School of Medicine, New Haven, Connecticut
| | - Bridget Pierpont
- Department of Pediatrics, Pediatrics Endocrinology and Diabetes Section, Yale School of Medicine, New Haven, Connecticut
| | - Leif Groop
- Department of Clinical Sciences, Lund University, Malmö, Sweden
| | - Claudio Cobelli
- Department of Information Engineering, University of Padova, Padova, Italy
| | - Sonia Caprio
- Department of Pediatrics, Pediatrics Endocrinology and Diabetes Section, Yale School of Medicine, New Haven, Connecticut
| |
Collapse
|
72
|
Human Physiology of Genetic Defects Causing Beta-cell Dysfunction. J Mol Biol 2020; 432:1579-1598. [PMID: 31953147 DOI: 10.1016/j.jmb.2019.12.038] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2019] [Revised: 12/17/2019] [Accepted: 12/18/2019] [Indexed: 02/07/2023]
Abstract
The last decade has revealed hundreds of genetic variants associated with type 2 diabetes, many especially with insulin secretion. However, the evidence for their single or combined effect on beta-cell function relies mostly on genetic association of the variants or genetic risk scores with simple traits, and few have been functionally fully characterized even in cell or animal models. Translating the measured traits into human physiology is not straightforward: none of the various indices for beta-cell function or insulin sensitivity recapitulates the dynamic interplay between glucose sensing, endogenous glucose production, insulin production and secretion, insulin clearance, insulin resistance-to name just a few factors. Because insulin sensitivity is a major determinant of physiological need of insulin, insulin secretion should be evaluated in parallel with insulin sensitivity. On the other hand, multiple physiological or pathogenic processes can either mask or unmask subtle defects in beta-cell function. Even in monogenic diabetes, a clearly pathogenic genetic variant can result in different phenotypic characteristics-or no phenotype at all. In this review, we evaluate the methods available for studying beta-cell function in humans, critically examine the evidence linking some identified variants to a specific beta-cell phenotype, and highlight areas requiring further study.
Collapse
|
73
|
Liu C, Avari P, Leal Y, Wos M, Sivasithamparam K, Georgiou P, Reddy M, Fernández-Real JM, Martin C, Fernández-Balsells M, Oliver N, Herrero P. A Modular Safety System for an Insulin Dose Recommender: A Feasibility Study. J Diabetes Sci Technol 2020; 14:87-96. [PMID: 31117804 PMCID: PMC7189144 DOI: 10.1177/1932296819851135] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND Delivering insulin in type 1 diabetes is a challenging, and potentially risky, activity; hence the importance of including safety measures as part of any insulin dosing or recommender system. This work presents and clinically evaluates a modular safety system that is part of an intelligent insulin dose recommender platform developed within the EU-funded PEPPER project. METHODS The proposed safety system is composed of four modules which use a novel glucose forecasting algorithm. These modules are predictive glucose alerts and alarms; a predictive low-glucose basal insulin suspension module; an advanced rescue carbohydrate recommender for resolving hypoglycemia; and a personalized safety constraint applied to insulin recommendations. The technical feasibility of the proposed safety system was evaluated in a pilot study including eight adult subjects with type 1 diabetes on multiple daily injections over a duration of six weeks. Glycemic control and safety system functioning were compared between the two-weeks run-in period and the end point at eight weeks. A standard insulin bolus calculator was employed to recommend insulin doses. RESULTS Overall, glycemic control improved over the evaluated period. In particular, percentage time in the hypoglycemia range (<3.0 mmol/l) significantly decreased from 0.82% (0.05-4.79) at run-in to 0.33% (0.00-0.93) at endpoint (P = .02). This was associated with a significant increase in percentage time in target range (3.9-10.0 mmol/l) from 52.8% (38.3-61.5) to 61.3% (47.5-71.7) (P = .03). There was also a reduction in number of carbohydrate recommendations. CONCLUSION A safety system for an insulin dose recommender has been proven to be a viable solution to reduce the number of adverse events associated to glucose control in type 1 diabetes.
Collapse
Affiliation(s)
- Chengyuan Liu
- Centre for Bio-Inspired Technology,
Department of Electrical and Electronic Engineering, Imperial College London,
London, UK
| | - Parizad Avari
- Division of Diabetes, Endocrinology and
Metabolism, Department of Medicine, Faculty of Medicine Imperial College, London,
UK
| | - Yenny Leal
- Institut d’Investigació Biomèdica de
Girona Dr Josep Trueta, Girona, Spain
| | - Marzena Wos
- Institut d’Investigació Biomèdica de
Girona Dr Josep Trueta, Girona, Spain
| | - Kumuthine Sivasithamparam
- Division of Diabetes, Endocrinology and
Metabolism, Department of Medicine, Faculty of Medicine Imperial College, London,
UK
| | - Pantelis Georgiou
- Centre for Bio-Inspired Technology,
Department of Electrical and Electronic Engineering, Imperial College London,
London, UK
| | - Monika Reddy
- Division of Diabetes, Endocrinology and
Metabolism, Department of Medicine, Faculty of Medicine Imperial College, London,
UK
| | | | - Clare Martin
- Department of Computing and
Communication Technologies, Oxford Brookes University, Oxford, UK
| | | | - Nick Oliver
- Division of Diabetes, Endocrinology and
Metabolism, Department of Medicine, Faculty of Medicine Imperial College, London,
UK
| | - Pau Herrero
- Centre for Bio-Inspired Technology,
Department of Electrical and Electronic Engineering, Imperial College London,
London, UK
- Pau Herrero, PhD, Centre for Bio-Inspired
Technology, Department of Electrical and Electronic Engineering, Imperial
College London, South Kensington Campus, London SW7 2AZ, UK.
| |
Collapse
|
74
|
Anderson B, Carlson P, Laurenti M, Vella A, Camilleri M, Desai A, Feuerhak K, Bharucha AE. Association between allelic variants in the glucagon-like peptide 1 and cholecystokinin receptor genes with gastric emptying and glucose tolerance. Neurogastroenterol Motil 2020; 32:e13724. [PMID: 31691451 PMCID: PMC6923543 DOI: 10.1111/nmo.13724] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2019] [Revised: 08/06/2019] [Accepted: 08/28/2019] [Indexed: 02/08/2023]
Abstract
BACKGROUND Nutrient-mediated release of cholecystokinin and glucagon-like peptide-1 (GLP-1) regulates gastric emptying (GE) via duodenogastric feedback mechanisms; GLP-1 also regulates postprandial insulin secretion. Some patients with functional upper gastrointestinal symptoms have impaired glucose tolerance during enteral dextrose infusion. Our hypothesis was that variants in CCK, GLP-1, and TCF7L2 (transcription factor 7-like 2 locus), which is associated with greatest genetic risk for development of type 2 diabetes mellitus, are associated with GE and independently with glucose tolerance. Our aims were to evaluate the associations between these GE, glucose tolerance, and these single nucleotide polymorphisms (SNPs). METHODS Genetic variants, scintigraphic GE of solids, plasma glucose, insulin, and GLP-1 during enteral dextrose infusion (75gm over 2 hours) were measured. GE and enteral dextrose infusion were, respectively, evaluated in 44 (27 controls and 17 patients with functional dyspepsia or nausea) and 42 (28 controls, 14 patients) participants; of these, 51 participants consented to assessment of SNPs. Four functional SNPs were studied: rs6923761 and rs1042044 at GLP-1 receptor, rs7903146 (TCF7L2), and rs1800857 (CCK receptor). KEY RESULTS Gastric emptying was normal in 38, rapid in 4, and delayed in two participants; 38 had normal, and four had impaired glucose tolerance. The T allele at rs7903146 (TCF7L2) was non-significantly associated (P = .14) with faster GE. The associations between SNPs and demographic variables, GE thalf , glucose tolerance and plasma GLP1 levels were not significant. CONCLUSIONS & INFERENCES There is a trend toward an association between faster GE and the diabetes-associated allele at rs7903146 in TCF7L2. However, these SNPs were not associated with plasma glucose or GLP1 concentrations during enteral dextrose infusion.
Collapse
Affiliation(s)
| | | | - Marcello Laurenti
- Mayo School of Graduate Medical Education, Division of Internal Medicine
| | | | | | | | | | | |
Collapse
|
75
|
Fabris C, Ozaslan B, Breton MD. Continuous Glucose Monitors and Activity Trackers to Inform Insulin Dosing in Type 1 Diabetes: The University of Virginia Contribution. SENSORS 2019; 19:s19245386. [PMID: 31817678 PMCID: PMC6961036 DOI: 10.3390/s19245386] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/31/2019] [Revised: 11/19/2019] [Accepted: 11/21/2019] [Indexed: 01/11/2023]
Abstract
Objective: Suboptimal insulin dosing in type 1 diabetes (T1D) is frequently associated with time-varying insulin requirements driven by various psycho-behavioral and physiological factors influencing insulin sensitivity (IS). Among these, physical activity has been widely recognized as a trigger of altered IS both during and following the exercise effort, but limited indication is available for the management of structured and (even more) unstructured activity in T1D. In this work, we present two methods to inform insulin dosing with biosignals from wearable sensors to improve glycemic control in individuals with T1D. Research Design and Methods: Continuous glucose monitors (CGM) and activity trackers are leveraged by the methods. The first method uses CGM records to estimate IS in real time and adjust the insulin dose according to a person’s insulin needs; the second method uses step count data to inform the bolus calculation with the residual glucose-lowering effects of recently performed (structured or unstructured) physical activity. The methods were tested in silico within the University of Virginia/Padova T1D Simulator. A standard bolus calculator and the proposed “smart” systems were deployed in the control of one meal in presence of increased/decreased IS (Study 1) and following a 1-hour exercise bout (Study 2). Postprandial glycemic control was assessed in terms of time spent in different glycemic ranges and low/high blood glucose indices (LBGI/HBGI), and compared between the dosing strategies. Results: In Study 1, the CGM-informed system allowed to reduce exposure to hypoglycemia in presence of increased IS (percent time < 70 mg/dL: 6.1% versus 9.9%; LBGI: 1.9 versus 3.2) and exposure to hyperglycemia in presence of decreased IS (percent time > 180 mg/dL: 14.6% versus 18.3%; HBGI: 3.0 versus 3.9), tending toward optimal control. In Study 2, the step count-informed system allowed to reduce hypoglycemia (percent time < 70 mg/dL: 3.9% versus 13.4%; LBGI: 1.7 versus 3.2) at the cost of a minor increase in exposure to hyperglycemia (percent time > 180 mg/dL: 11.9% versus 7.5%; HBGI: 2.4 versus 1.5). Conclusions: We presented and validated in silico two methods for the smart dosing of prandial insulin in T1D. If seen within an ensemble, the two algorithms provide alternatives to individuals with T1D for improving insulin dosing accommodating a large variety of treatment options. Future work will be devoted to test the safety and efficacy of the methods in free-living conditions.
Collapse
|
76
|
Toffanin C, Aiello EM, Cobelli C, Magni L. Hypoglycemia Prevention via Personalized Glucose-Insulin Models Identified in Free-Living Conditions. J Diabetes Sci Technol 2019; 13:1008-1016. [PMID: 31645119 PMCID: PMC6835187 DOI: 10.1177/1932296819880864] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND The objective of this research is to show the effectiveness of individualized hypoglycemia predictive alerts (IHPAs) based on patient-tailored glucose-insulin models (PTMs) for different subjects. Interpatient variability calls for PTMs that have been identified from data collected in free-living conditions during a one-month trial. METHODS A new impulse-response (IR) identification technique has been applied to free-living data in order to identify PTMs that are able to predict the future glucose trends and prevent hypoglycemia events. Impulse response has been applied to seven patients with type 1 diabetes (T1D) of the University of Amsterdam Medical Centre. Individualized hypoglycemia predictive alert has been designed for each patient thanks to the good prediction capabilities of PTMs. RESULTS The PTMs performance is evaluated in terms of index of fitting (FIT), coefficient of determination, and Pearson's correlation coefficient with a population FIT of 63.74%. The IHPAs are evaluated on seven patients with T1D with the aim of predicting in advance (between 45 and 10 minutes) the unavoidable hypoglycemia events; these systems show better performance in terms of sensitivity, precision, and accuracy with respect to previously published results. CONCLUSION The proposed work shows the successful results obtained applying the IR to an entire set of patients, participants of a one-month trial. Individualized hypoglycemia predictive alerts are evaluated in terms of hypoglycemia prevention: the use of a PTM allows to detect 84.67% of the hypoglycemia events occurred during a one-month trial on average with less than 0.4% of false alarms. The promising prediction capabilities of PTMs can be a key ingredient for new generations of individualized model predictive control for artificial pancreas.
Collapse
Affiliation(s)
- Chiara Toffanin
- Department of Electrical, Computer and Biomedical Engineering, University of Pavia, Italy
- Chiara Toffanin, Department of Electrical, Computer and Biomedical Engineering, University of Pavia, via Ferrata 3, Pavia, Lombardy 27100, Italy.
| | - Eleonora Maria Aiello
- Department of Electrical, Computer and Biomedical Engineering, University of Pavia, Italy
| | - Claudio Cobelli
- Department of Information Engineering, University of Padova, Italy
| | - Lalo Magni
- Department of Civil Engineering and Architecture, University of Pavia, Italy
| |
Collapse
|
77
|
Ladwa M, Hakim O, Amiel SA, Goff LM. A Systematic Review of Beta Cell Function in Adults of Black African Ethnicity. J Diabetes Res 2019; 2019:7891359. [PMID: 31781667 PMCID: PMC6855028 DOI: 10.1155/2019/7891359] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2019] [Revised: 07/16/2019] [Accepted: 08/11/2019] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Understanding ethnic differences in beta cell function has important implications for preventative and therapeutic strategies in populations at high risk of type 2 diabetes (T2D). The existing literature, largely drawn from work in children and adolescents, suggests that beta cell function in black African (BA) populations is upregulated when compared to white Europeans (WE). METHODS A systematic literature search was undertaken in June 2018 to identify comparative studies of beta cell function between adults (>age 18 years) of indigenous/diasporic BA and WE ethnicity. All categories of glucose tolerance and all methodologies of assessing beta cell function in vivo were included. RESULTS 41 studies were identified for inclusion into a qualitative synthesis. The majority were studies in African American populations (n = 30) with normal glucose tolerance (NGT)/nondiabetes (n = 25), using intravenous glucose stimulation techniques (n = 27). There were fewer studies in populations defined as only impaired fasting glucose/impaired glucose tolerance (IFG/IGT) (n = 3) or only T2D (n = 3). Although BA broadly exhibited greater peripheral insulin responses than WE, the relatively small number of studies which measured C-peptide to differentiate between beta cell insulin secretion and hepatic insulin extraction (n = 14) had highly variable findings. In exclusively IGT or T2D cohorts, beta cell insulin secretion was found to be lower in BA compared to WE. CONCLUSIONS There is inconsistent evidence for upregulated beta cell function in BA adults, and they may in fact exhibit greater deficits in insulin secretory function as glucose intolerance develops.
Collapse
Affiliation(s)
- M. Ladwa
- Diabetes Research Group, Department of Diabetes, School of Life Course Sciences, Faculty of Life Sciences & Medicine, King's College London, London, UK
| | - O. Hakim
- Diabetes Research Group, Department of Diabetes, School of Life Course Sciences, Faculty of Life Sciences & Medicine, King's College London, London, UK
| | - S. A. Amiel
- Diabetes Research Group, Department of Diabetes, School of Life Course Sciences, Faculty of Life Sciences & Medicine, King's College London, London, UK
| | - L. M. Goff
- Diabetes Research Group, Department of Diabetes, School of Life Course Sciences, Faculty of Life Sciences & Medicine, King's College London, London, UK
| |
Collapse
|
78
|
Abstract
Patients with psychotic disorders are at high risk for type 2 diabetes mellitus, and there is increasing evidence that patients display glucose metabolism abnormalities before significant antipsychotic medication exposure. In the present study, we examined insulin action by quantifying insulin sensitivity in first-episode psychosis (FEP) patients and unaffected siblings, compared to healthy individuals, using a physiological-based model and comprehensive assessment battery. Twenty-two unaffected siblings, 18 FEP patients, and 15 healthy unrelated controls were evaluated using a 2-h oral glucose tolerance test (OGTT), with 7 samples of plasma glucose and serum insulin concentration measurements. Insulin sensitivity was quantified using the oral minimal model method. Lipid, leptin, free fatty acids, and inflammatory marker levels were also measured. Anthropometric, nutrient, and activity assessments were conducted; total body composition and fat distribution were determined using whole-body dual-energy X-ray absorptiometry. Insulin sensitivity significantly differed among groups (F = 6.01 and 0.004), with patients and siblings showing lower insulin sensitivity, compared to controls (P = 0.006 and 0.002, respectively). Body mass index, visceral adipose tissue area (cm2), lipids, leptin, free fatty acids, inflammatory markers, and activity ratings were not significantly different among groups. There was a significant difference in nutrient intake with lower total kilocalories/kilogram body weight in patients, compared to siblings and controls. Overall, the findings suggest that familial abnormal glucose metabolism or a primary insulin signaling pathway abnormality is related to risk for psychosis, independent of disease expression and treatment effects. Future studies should examine underlying biological mechanisms of insulin signaling abnormalities in psychotic disorders.
Collapse
|
79
|
Basu R, Schiavon M, Petterson XM, Hinshaw L, Slama M, Carter R, Man CD, Cobelli C, Basu A. A novel natural tracer method to measure complex carbohydrate metabolism. Am J Physiol Endocrinol Metab 2019; 317:E483-E493. [PMID: 31265327 PMCID: PMC6766609 DOI: 10.1152/ajpendo.00133.2019] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
While the triple tracer isotope dilution method has enabled accurate estimation of carbohydrate turnover after a mixed meal, use of the simple carbohydrate glucose as the carbohydrate source limits its translational applicability to everyday meals that typically contain complex carbohydrates. Hence, utilizing the natural enrichment of [13C]polysaccharide in commercially available grains, we devised a novel tracer method to measure postprandial complex carbohydrate turnover and indices of insulin action and β-cell function and compared the parameters to those obtained after a simple carbohydrate containing mixed meal. We studied healthy volunteers after either rice (n = 8) or sorghum (n = 8) and glucose (n = 16) containing mixed meals and modified the triple tracer technique to calculate carbohydrate turnover. All meals were matched for calories and macronutrient composition. Rates of meal glucose appearance (2,658 ± 736 vs. 4,487 ± 909 μM·kg-1·2 h-1), endogenous glucose production (-835 ± 283 vs. -1,123 ± 323 μM·kg-1·2 h-1) and glucose disappearance (1,829 ± 807 vs. 3,606 ± 839 μM·kg-1·2 h-1) differed (P < 0.01) between complex and simple carbohydrate containing meals, respectively. Interestingly, there were significant increase in indices of insulin sensitivity (32.5 ± 3.5 vs. 25.6 ± 3.2 10-5 (dl·kg-1·min-2)/pM, P = 0.006) and β-cell responsivity (disposition index: 1,817 ± 234 vs. 1,236 ± 159 10-14 (dl·kg-1·min-2)/pM, P < 0.005) with complex than simple carbohydrate meals. We present a novel triple tracer approach to estimate postprandial turnover of complex carbohydrate containing mixed meals. We also report higher insulin sensitivity and β-cell responsivity with complex than with simple carbohydrates in mixed meals of identical calorie and macronutrient compositions in healthy adults.
Collapse
Affiliation(s)
- Rita Basu
- Division of Endocrinology, University of Virginia, Charlottesville, Virginia
| | - Michele Schiavon
- Department of Information Engineering, University of Padova, Padova, Italy
| | - Xuan-Mai Petterson
- Endocrine Research Unit, Division of Endocrinology and Metabolism, Mayo Clinic, Rochester, Minnesota
| | - Ling Hinshaw
- Endocrine Research Unit, Division of Endocrinology and Metabolism, Mayo Clinic, Rochester, Minnesota
| | - Michael Slama
- Endocrine Research Unit, Division of Endocrinology and Metabolism, Mayo Clinic, Rochester, Minnesota
| | - Rickey Carter
- Department of Health Sciences Research, Mayo Clinic, Jacksonville, Florida
| | - Chiara Dalla Man
- Department of Information Engineering, University of Padova, Padova, Italy
| | - Claudio Cobelli
- Department of Information Engineering, University of Padova, Padova, Italy
| | - Ananda Basu
- Division of Endocrinology, University of Virginia, Charlottesville, Virginia
| |
Collapse
|
80
|
Nath A, Deb D, Dey R, Das S. Blood glucose regulation in type 1 diabetic patients: an adaptive parametric compensation control-based approach. IET Syst Biol 2019; 12:219-225. [PMID: 30259867 PMCID: PMC8687408 DOI: 10.1049/iet-syb.2017.0093] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Here, a direct adaptive control strategy with parametric compensation is adopted for an uncertain non‐linear model representing blood glucose regulation in type 1 diabetes mellitus patients. The uncertain parameters of the model are updated by appropriate design of adaptation laws using the Lyapunov method. The closed‐loop response of the plasma glucose concentration as well as external insulin infusion rate is analysed for a wide range of variation of the model parameters through extensive simulation studies. The result indicates that the proposed adaptive control scheme avoids severe hypoglycaemia and gives satisfactory performance under parametric uncertainty highlighting its ability to address the issue of inter‐patient variability.
Collapse
Affiliation(s)
- Anirudh Nath
- Electrical Engineering Department, National Institute of Technology, Silchar 788010, Assam, India.
| | - Dipankar Deb
- Electrical Engineering Department, Institute of Infrastructure Technology Research and Management, Ahmedabad 380026, Gujarat, India
| | - Rajeeb Dey
- Electrical Engineering Department, National Institute of Technology, Silchar 788010, Assam, India
| | - Sipon Das
- Electrical Engineering Department, National Institute of Technology, Silchar 788010, Assam, India
| |
Collapse
|
81
|
Galderisi A, Giannini C, Van Name M, Caprio S. Fructose Consumption Contributes to Hyperinsulinemia in Adolescents With Obesity Through a GLP-1-Mediated Mechanism. J Clin Endocrinol Metab 2019; 104:3481-3490. [PMID: 30938760 PMCID: PMC6599430 DOI: 10.1210/jc.2019-00161] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2019] [Accepted: 03/26/2019] [Indexed: 01/03/2023]
Abstract
CONTEXT The consumption of high-fructose beverages is associated with a higher risk for obesity and diabetes. Fructose can stimulate glucagon-like peptide 1 (GLP-1) secretion in lean adults, in the absence of any anorexic effect. OBJECTIVE We hypothesized that the ingestion of glucose and fructose may differentially stimulate GLP-1 and insulin response in lean adolescents and adolescents with obesity. DESIGN We studied 14 lean adolescents [four females; 15.9 ± 1.6 years of age; body mass index (BMI), 21.8 ± 2.2 kg/m2] and 23 adolescents with obesity (five females; 15.1 ± 1.6 years of age; BMI, 34.5 ± 4.6 kg/m2). Participants underwent a baseline oral glucose tolerance test to determine their glucose tolerance and estimate insulin sensitivity and β-cell function [oral disposition index (oDIcpep)]. Eligible subjects received, in a double-blind, crossover design, 75 g of glucose or fructose. Plasma was obtained every 10 minutes for 60 minutes for the measures of glucose, insulin, and GLP-1 (radioimmunoassay) and glucose-dependent insulinotropic polypeptide (GIP; ELISA). Incremental glucose and hormone levels were compared between lean individuals and those with obesity by a linear mixed model. The relationship between GLP-1 increment and oDIcpep was evaluated by regression analysis. RESULTS Following the fructose challenge, plasma glucose excursions were similar in both groups, yet the adolescents with obesity exhibited a greater insulin (P < 0.001) and GLP-1 (P < 0.001) increase than did their lean peers. Changes in GIP were similar in both groups. After glucose ingestion, the GLP-1 response (P < 0.001) was higher in the lean group. The GLP-1 increment during 60 minutes from fructose drink was correlated with a lower oDIcpep (r2 = 0.22, P = 0.009). CONCLUSION Fructose, but not glucose, ingestion elicits a higher GLP-1 and insulin response in adolescents with obesity than in lean adolescents. Fructose consumption may contribute to the hyperinsulinemic phenotype of adolescent obesity through a GLP-1-mediated mechanism.
Collapse
Affiliation(s)
- Alfonso Galderisi
- Department of Pediatrics, Pediatrics Endocrinology and Diabetes Section, Yale School of Medicine, New Haven, Connecticut
- Department of Woman’s and Child’s Health, University of Padova, Padova, Italy
| | - Cosimo Giannini
- Department of Pediatrics, Pediatrics Endocrinology and Diabetes Section, Yale School of Medicine, New Haven, Connecticut
| | - Michelle Van Name
- Department of Pediatrics, Pediatrics Endocrinology and Diabetes Section, Yale School of Medicine, New Haven, Connecticut
| | - Sonia Caprio
- Department of Pediatrics, Pediatrics Endocrinology and Diabetes Section, Yale School of Medicine, New Haven, Connecticut
- Correspondence and Reprint Requests: Sonia Caprio, MD, Division of Pediatric Endocrinology, Department of Pediatrics, Yale University School of Medicine, 333 Cedar Street, New Haven, Connecticut 06520. E-mail:
| |
Collapse
|
82
|
Ethnic distinctions in the pathophysiology of type 2 diabetes: a focus on black African-Caribbean populations. Proc Nutr Soc 2019; 79:184-193. [PMID: 31307560 DOI: 10.1017/s0029665119001034] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Type 2 diabetes (T2D) is a global public health priority, particularly for populations of black African-Caribbean ethnicity, who suffer disproportionately high rates of the disease. While the mechanisms underlying the development of T2D are well documented, there is growing evidence describing distinctions among black African-Caribbean populations. In the present paper, we review the evidence describing the impact of black African-Caribbean ethnicity on T2D pathophysiology. Ethnic differences were first recognised through evidence that metabolic syndrome diagnostic criteria fail to detect T2D risk in black populations due to less central obesity and dyslipidaemia. Subsequently more detailed investigations have recognised other mechanistic differences, particularly lower visceral and hepatic fat accumulation and a distinctly hyperinsulinaemic response to glucose stimulation. While epidemiological studies have reported exaggerated insulin resistance in black populations, more detailed and direct measures of insulin sensitivity have provided evidence that insulin sensitivity is not markedly different to other ethnic groups and does not explain the hyperinsulinaemia that is exhibited. These findings lead us to hypothesise that ectopic fat does not play a pivotal role in driving insulin resistance in black populations. Furthermore, we hypothesise that hyperinsulinaemia is driven by lower rates of hepatic insulin clearance rather than heightened insulin resistance and is a primary defect rather than occurring in compensation for insulin resistance. These hypotheses are being investigated in our ongoing South London Diabetes and Ethnicity Phenotyping study, which will enable a more detailed understanding of ethnic distinctions in the pathophysiology of T2D between men of black African and white European ethnicity.
Collapse
|
83
|
Improved quantification of muscle insulin sensitivity using oral glucose tolerance test data: the MISI Calculator. Sci Rep 2019; 9:9388. [PMID: 31253846 PMCID: PMC6598992 DOI: 10.1038/s41598-019-45858-w] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2018] [Accepted: 06/12/2019] [Indexed: 12/12/2022] Open
Abstract
The Muscle Insulin Sensitivity Index (MISI) has been developed to estimate muscle-specific insulin sensitivity based on oral glucose tolerance test (OGTT) data. To date, the score has been implemented with considerable variation in literature and initial positive evaluations were not reproduced in subsequent studies. In this study, we investigate the computation of MISI on oral OGTT data with differing sampling schedules and aim to standardise and improve its calculation. Seven time point OGTT data for 2631 individuals from the Maastricht Study and seven time point OGTT data combined with a hyperinsulinemic-euglycaemic clamp for 71 individuals from the PRESERVE Study were used to evaluate the performance of MISI. MISI was computed on subsets of OGTT data representing four and five time point sampling schedules to determine minimal requirements for accurate computation of the score. A modified MISI computed on cubic splines of the measured data, resulting in improved identification of glucose peak and nadir, was compared with the original method yielding an increased correlation (ρ = 0.576) with the clamp measurement of peripheral insulin sensitivity as compared to the original method (ρ = 0.513). Finally, a standalone MISI calculator was developed allowing for a standardised method of calculation using both the original and improved methods.
Collapse
|
84
|
Ruan Y, Willemsen RH, Wilinska ME, Tauschmann M, Dunger DB, Hovorka R. Mixed-meal tolerance test to assess residual beta-cell secretion: Beyond the area-under-curve of plasma C-peptide concentration. Pediatr Diabetes 2019; 20:282-285. [PMID: 30652426 PMCID: PMC6487945 DOI: 10.1111/pedi.12816] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2018] [Revised: 12/09/2018] [Accepted: 12/18/2018] [Indexed: 02/02/2023] Open
Abstract
AIMS Residual beta-cell secretion in type 1 diabetes is commonly assessed by area-under-curve of plasma C-peptide concentration (AUCCpep ) following mixed-meal tolerance test (MMTT). We aimed to investigate alternative measures of beta-cell responsiveness. METHODS We analyzed data from 32 youth (age 7 to 17 years) undergoing MMTT within 6 months of type 1 diabetes diagnosis. We related AUCCpep with (a) validated mechanistic index of postprandial beta-cell responsiveness MI accounting for glucose level during MMTT, and (b) pragmatic marker calculated as baseline plasma C-peptide concentration corrected for baseline plasma glucose concentration. RESULTS Postprandial responsiveness MI was correlated with age and BMI SDS (Rs = 0.66 and 0.44, P < 0.01 and P < 0.05) and was more correlated with glycated hemoglobin than AUCCpep (Rs = 0.79, P = 0.04). The pragmatic marker was highly correlated with AUCCpep (Rs = 0.94, P < 0.01). CONCLUSIONS Postprandial responsiveness MI may be more relevant to glucose control than AUCCpep . Baseline C-peptide corrected for baseline glucose appears to be a suitable surrogate of AUCCpep if MMTT is not performed.
Collapse
Affiliation(s)
- Yue Ruan
- Wellcome Trust‐MRC Institute of Metabolic ScienceUniversity of CambridgeCambridgeUK
- Oxford Centre for Diabetes, Endocrinology and MetabolismUniversity of OxfordOxfordUK
| | | | - Malgorzata E. Wilinska
- Wellcome Trust‐MRC Institute of Metabolic ScienceUniversity of CambridgeCambridgeUK
- Department of PaediatricsUniversity of CambridgeCambridgeUK
| | - Martin Tauschmann
- Wellcome Trust‐MRC Institute of Metabolic ScienceUniversity of CambridgeCambridgeUK
- Department of PaediatricsUniversity of CambridgeCambridgeUK
| | - David B. Dunger
- Wellcome Trust‐MRC Institute of Metabolic ScienceUniversity of CambridgeCambridgeUK
- Department of PaediatricsUniversity of CambridgeCambridgeUK
| | - Roman Hovorka
- Wellcome Trust‐MRC Institute of Metabolic ScienceUniversity of CambridgeCambridgeUK
- Department of PaediatricsUniversity of CambridgeCambridgeUK
| |
Collapse
|
85
|
Laurenti MC, Vella A, Varghese RT, Andrews JC, Sharma A, Kittah NE, Rizza RA, Matveyenko A, De Nicolao G, Cobelli C, Dalla Man C. Assessment of pulsatile insulin secretion derived from peripheral plasma C-peptide concentrations by nonparametric stochastic deconvolution. Am J Physiol Endocrinol Metab 2019; 316:E687-E694. [PMID: 30807214 PMCID: PMC6580177 DOI: 10.1152/ajpendo.00519.2018] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
The characteristics of pulsatile insulin secretion are important determinants of type 2 diabetes pathophysiology, but they are understudied due to the difficulties in measuring pulsatile insulin secretion noninvasively. Deconvolution of either peripheral C-peptide or insulin concentrations offers an appealing alternative to hepatic vein catheterization. However, to do so, there are a series of methodological challenges to overcome. C-peptide has a relatively long half-life and accumulates in the circulation. On the other hand, peripheral insulin concentrations reflect relatively fast clearance and hepatic extraction as it leaves the portal circulation to enter the systemic circulation. We propose a method based on nonparametric stochastic deconvolution of C-peptide concentrations, using individually determined C-peptide kinetics, to overcome these limitations. The use of C-peptide (instead of insulin) concentrations allows estimation of portal (and not post-hepatic) insulin pulses, whereas nonparametric stochastic deconvolution allows evaluation of pulsatile signals without any a priori assumptions of pulse shape and occurrence. The only assumption required is the degree of smoothness of the (unknown) secretion rate. We tested this method first on simulated data and then on 29 nondiabetic subjects studied during euglycemia and hyperglycemia and compared our estimates with the profiles obtained from hepatic vein insulin concentrations. This method produced satisfactory results both in the ability to fit the data and in providing reliable estimates of pulsatile secretion, in agreement with hepatic vein measurements. In conclusion, the proposed method enables reliable and noninvasive measurement of pulsatile insulin secretion. Future studies will be needed to validate this method in people with type 2 diabetes.
Collapse
Affiliation(s)
- Marcello C Laurenti
- Division of Endocrinology, Diabetes and Metabolism, Mayo Clinic , Rochester, Minnesota
- Department of Information Engineering, University of Padua , Padua , Italy
| | - Adrian Vella
- Division of Endocrinology, Diabetes and Metabolism, Mayo Clinic , Rochester, Minnesota
| | - Ron T Varghese
- Division of Endocrinology, Diabetes and Metabolism, Mayo Clinic , Rochester, Minnesota
| | - James C Andrews
- Vascular and Interventional Radiology, Mayo Clinic , Rochester, Minnesota
| | - Anu Sharma
- Division of Endocrinology, Diabetes and Metabolism, Mayo Clinic , Rochester, Minnesota
| | - Nana Esi Kittah
- Division of Endocrinology, Diabetes and Metabolism, Mayo Clinic , Rochester, Minnesota
| | - Robert A Rizza
- Division of Endocrinology, Diabetes and Metabolism, Mayo Clinic , Rochester, Minnesota
| | - Aleksey Matveyenko
- Division of Endocrinology, Diabetes and Metabolism, Mayo Clinic , Rochester, Minnesota
- Physiology and Biomedical Engineering, Mayo Clinic , Rochester, Minnesota
| | - Giuseppe De Nicolao
- Department of Computer Engineering and Systems Science, University of Pavia , Pavia , Italy
| | - Claudio Cobelli
- Department of Information Engineering, University of Padua , Padua , Italy
| | - Chiara Dalla Man
- Department of Information Engineering, University of Padua , Padua , Italy
| |
Collapse
|
86
|
Viskochil R, Lyden K, Staudenmayer J, Keadle SK, Freedson PS, Braun B. Elevated insulin levels following 7 days of increased sedentary time are due to lower hepatic extraction and not higher insulin secretion. Appl Physiol Nutr Metab 2019; 44:1020-1023. [PMID: 30970217 DOI: 10.1139/apnm-2018-0802] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Higher insulin following sedentary behavior may be due to increased insulin secretion (IS), decreased hepatic insulin extraction (HIE), or a combination of both. Ten healthy adults completed glucose tolerance tests following 7 days of normal activity and 7 days of increased sitting. There were no differences in IS; however, HIE at 120 min after ingestion (85.4% ± 7.2% vs. 74.6% ± 6.6%, p < 0.05) and the area under the curve (73.6% ± 9.4% vs. 67.5% ± 11.3%, p < 0.05) were reduced following 7 days of increased sedentary time.
Collapse
Affiliation(s)
- Richard Viskochil
- Department of Kinesiology, University of Massachusetts, Amherst, MA 01003, USA
| | - Kate Lyden
- Department of Kinesiology, University of Massachusetts, Amherst, MA 01003, USA.,KAL Research and Consulting, Denver, CO 80202, USA
| | - John Staudenmayer
- Department of Mathematics and Statistics, University of Massachusetts, Amherst, MA 01003, USA
| | - Sarah K Keadle
- Department of Kinesiology, University of Massachusetts, Amherst, MA 01003, USA.,Department of Kinesiology and Public Health, California Polytechnic University, San Luis Obispo, CA 93407, USA
| | - Patty S Freedson
- Department of Kinesiology, University of Massachusetts, Amherst, MA 01003, USA
| | - Barry Braun
- Department of Kinesiology, University of Massachusetts, Amherst, MA 01003, USA.,Department of Health and Exercise Science, Colorado State University, Ft. Collins, CO 80523, USA
| |
Collapse
|
87
|
Shah M, Laurenti MC, Dalla Man C, Ma J, Cobelli C, Rizza RA, Vella A. Contribution of endogenous glucagon-like peptide-1 to changes in glucose metabolism and islet function in people with type 2 diabetes four weeks after Roux-en-Y gastric bypass (RYGB). Metabolism 2019; 93:10-17. [PMID: 30586575 PMCID: PMC6401231 DOI: 10.1016/j.metabol.2018.12.005] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2018] [Revised: 12/07/2018] [Accepted: 12/20/2018] [Indexed: 01/03/2023]
Abstract
UNLABELLED Glucagon-Like Peptide-1 (GLP-1) is an insulin secretagogue which is elevated after Roux-en-Y Gastric Bypass (RYGB). However, its contribution to glucose metabolism after RYGB remains uncertain. AIMS We tested the hypothesis that GLP-1 lowers postprandial glucose concentrations and improves β-cell function after RYGB. MATERIALS AND METHODS To address these questions we used a labeled mixed meal to assess glucose metabolism and islet function in 12 obese subjects with type 2 diabetes studied before and four weeks after RYGB. During the post-RYGB study subjects were randomly assigned to receive an infusion of either saline or Exendin-9,39 a competitive antagonist of GLP-1 at its receptor. Exendin-9,39 was infused at 300 pmol/kg/min for 6 h. All subjects underwent RYGB for medically-complicated obesity. RESULTS Exendin-9,39 resulted in increased integrated incremental postprandial glucose concentrations (181 ± 154 vs. 582 ± 129 mmol per 6 h, p = 0.02). In contrast, this was unchanged in the presence of saline (275 ± 88 vs. 315 ± 66 mmol per 6 h, p = 0.56) after RYGB. Exendin-9,39 also impaired β-cell responsivity to glucose but did not alter Disposition Index (DI). CONCLUSIONS These data indicate that the elevated GLP-1 concentrations that occur early after RYGB improve postprandial glucose tolerance by enhancing postprandial insulin secretion.
Collapse
Affiliation(s)
- Meera Shah
- Division of Endocrinology, Diabetes & Metabolism, Mayo Clinic College of Medicine, 200 First Street SW, Rochester, MN 55905, USA.
| | - Marcello C Laurenti
- Department of Information Engineering, University of Padua, Via Gradenigo 6A, Padua 35131, Italy.
| | - Chiara Dalla Man
- Department of Information Engineering, University of Padua, Via Gradenigo 6A, Padua 35131, Italy.
| | - Jing Ma
- Division of Endocrinology, Diabetes & Metabolism, Mayo Clinic College of Medicine, 200 First Street SW, Rochester, MN 55905, USA.
| | - Claudio Cobelli
- Department of Information Engineering, University of Padua, Via Gradenigo 6A, Padua 35131, Italy.
| | - Robert A Rizza
- Division of Endocrinology, Diabetes & Metabolism, Mayo Clinic College of Medicine, 200 First Street SW, Rochester, MN 55905, USA.
| | - Adrian Vella
- Division of Endocrinology, Diabetes & Metabolism, Mayo Clinic College of Medicine, 200 First Street SW, Rochester, MN 55905, USA.
| |
Collapse
|
88
|
Dunn JP, Abumrad NN, Patterson BW, Kessler RM, Tamboli RA. Brief communication: β-cell function influences dopamine receptor availability. PLoS One 2019; 14:e0212738. [PMID: 30849082 PMCID: PMC6407783 DOI: 10.1371/journal.pone.0212738] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2017] [Accepted: 02/10/2019] [Indexed: 11/19/2022] Open
Abstract
We aim to identify physiologic regulators of dopamine (DA) signaling in obesity but previously did not find a compelling relationship with insulin sensitivity measured by oral-minimal model (OMM) and DA subtype 2 and 3 receptor (D2/3R) binding potential (BPND). Reduced disposition index (DI), a β-cell function metric that can also be calculated by OMM, was shown to predict a negative reward behavior that occurs in states of lower endogenous DA. We hypothesized that reduced DI would occur with higher D2/3R BPND, reflecting lower endogenous DA. Participants completed PET scanning, with a displaceable radioligand to measure D2/3R BPND, and a 5-hour oral glucose tolerance test to measure DI by OMM. We studied 26 age-similar females without (n = 8) and with obesity (n = 18) (22 vs 39 kg/m2). Reduced DI predicted increased striatal D2/3R BPND independent of BMI. By accounting for β-cell function, we were able to determine that the state of insulin and glucose metabolism is pertinent to striatal D2/3R BPND in obesity. Clinical Trial Registration Number: NCT00802204.
Collapse
Affiliation(s)
- Julia P. Dunn
- Department of Medicine, Vanderbilt University School of Medicine, Nashville, Tennessee, United States of America
- Department of Medicine, Washington University School of Medicine, St. Louis, Missouri, United States of America
- Veterans Administration St. Louis Health Care System, St. Louis, Missouri, United States of America
- * E-mail:
| | - Naji N. Abumrad
- Department of Surgery, Vanderbilt University School of Medicine, Nashville, Tennessee, United States of America
| | - Bruce W. Patterson
- Department of Medicine, Washington University School of Medicine, St. Louis, Missouri, United States of America
| | - Robert M. Kessler
- Department of Radiology, Vanderbilt University School of Medicine, Nashville, Tennessee, United States of America
| | - Robyn A. Tamboli
- Department of Surgery, Vanderbilt University School of Medicine, Nashville, Tennessee, United States of America
| |
Collapse
|
89
|
Brede S, Fehr S, Dalla-Man C, Cobelli C, Lehnert H, Hallschmid M, Klement J. Intranasal oxytocin fails to acutely improve glucose metabolism in obese men. Diabetes Obes Metab 2019; 21:424-428. [PMID: 30203536 DOI: 10.1111/dom.13527] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2018] [Revised: 08/27/2018] [Accepted: 09/05/2018] [Indexed: 01/22/2023]
Abstract
The hypothalamic neuropeptide oxytocin not only modulates psychosocial function, but also contributes to metabolic regulation. We have recently shown that intranasal oxytocin acutely improves beta-cell responsivity and glucose tolerance in normal-weight men. In the present experiment, we investigated the acute glucoregulatory impact of oxytocin in obese men with impaired insulin sensitivity. Fifteen obese healthy men with an average body mass index of 35 kg/m2 and an average body fat content of 33% received a single intranasal dose (24 IU) of oxytocin before undergoing an oral glucose tolerance test. Results were analysed according to the oral minimal model and compared with our findings in normal-weight participants. In contrast to the results in normal-weight subjects, oxytocin did not blunt postprandial glucose and insulin excursions in obese men, and moreover failed to enhance beta-cell responsivity and glucose tolerance. These results indicate that pronounced obesity may be associated with a certain degree of resistance to the glucoregulatory impact of exogenous oxytocin, and underlines the need for further investigations into the potential of oxytocin to improve glucose homeostasis in the clinical context.
Collapse
Affiliation(s)
- Swantje Brede
- Department of Internal Medicine I, University of Lübeck, Lübeck, Germany
| | - Sebastian Fehr
- Department of Internal Medicine I, University of Lübeck, Lübeck, Germany
| | - Chiara Dalla-Man
- Department of Information Engineering, University of Padova, Padova, Italy
| | - Claudio Cobelli
- Department of Information Engineering, University of Padova, Padova, Italy
| | - Hendrik Lehnert
- Department of Internal Medicine I, University of Lübeck, Lübeck, Germany
- German Center for Diabetes Research (DZD), Lübeck, Germany
| | - Manfred Hallschmid
- Department of Medical Psychology and Behavioural Neurobiology, University of Tübingen, Tübingen, Germany
- German Center for Diabetes Research (DZD), Tübingen, Germany
- Institute for Diabetes Research and Metabolic Diseases of the Helmholtz Center Munich at the University of Tübingen (IDM), Tübingen, Germany
| | - Johanna Klement
- Department of Internal Medicine I, University of Lübeck, Lübeck, Germany
| |
Collapse
|
90
|
Staal OM, Salid S, Fougner A, Stavdahl O. Kalman Smoothing for Objective and Automatic Preprocessing of Glucose Data. IEEE J Biomed Health Inform 2019; 23:218-226. [DOI: 10.1109/jbhi.2018.2811706] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
|
91
|
de Goede P, Foppen E, Ritsema WIGR, Korpel NL, Yi CX, Kalsbeek A. Time-Restricted Feeding Improves Glucose Tolerance in Rats, but Only When in Line With the Circadian Timing System. Front Endocrinol (Lausanne) 2019; 10:554. [PMID: 31496992 PMCID: PMC6712481 DOI: 10.3389/fendo.2019.00554] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2019] [Accepted: 07/29/2019] [Indexed: 12/25/2022] Open
Abstract
Epidemiological studies indicate that shift-workers have an increased risk of type 2 diabetes mellitus (T2DM). Glucose tolerance and insulin sensitivity both are dependent on the circadian timing system (i.e., the time-of-day) and fasting duration, in rodents as well as humans. Therefore, question is whether manipulation of the circadian timing system, for example by changing the timing of feeding and fasting, is a potential preventive treatment for T2DM. Time-restricted feeding (TRF) is well-known to have profound effects on various metabolic measures, including glucose metabolism. However, experiments that directly measure the effects of TRF on glucose tolerance and/or insulin sensitivity at different time points throughout the 24 h cycle are lacking. Here we show, in rats, that TRF in line with the circadian timing system (i.e., feeding during the active phase) improves glucose tolerance during intravenous glucose tolerance tests (ivGTT) in the active phase, as lower insulin levels were observed with similar levels of glucose clearance. However, this was not the case during the inactive phase in which more insulin was released but only a slightly faster glucose clearance was observed. Contrasting, TRF out of sync with the circadian timing system (i.e., feeding during the inactive phase) worsened glucose tolerance, although only marginally, likely because of adaptation to the 4 week TRF regimen. Our results show that TRF can improve glucose metabolism, but strict adherence to the time-restricted feeding period is necessary, as outside the regular eating hours glucose tolerance is worsened.
Collapse
Affiliation(s)
- Paul de Goede
- Laboratory of Endocrinology, Amsterdam University Medical Center, Amsterdam Gastroenterology & Metabolism, University of Amsterdam, Amsterdam, Netherlands
- Hypothalamic Integration Mechanisms Group, Netherlands Institute for Neuroscience (NIN), An Institute of the Royal Netherlands Academy of Arts and Sciences, Amsterdam, Netherlands
| | - Ewout Foppen
- Laboratory of Endocrinology, Amsterdam University Medical Center, Amsterdam Gastroenterology & Metabolism, University of Amsterdam, Amsterdam, Netherlands
- Hypothalamic Integration Mechanisms Group, Netherlands Institute for Neuroscience (NIN), An Institute of the Royal Netherlands Academy of Arts and Sciences, Amsterdam, Netherlands
| | - Wayne I. G. R. Ritsema
- Laboratory of Endocrinology, Amsterdam University Medical Center, Amsterdam Gastroenterology & Metabolism, University of Amsterdam, Amsterdam, Netherlands
- Hypothalamic Integration Mechanisms Group, Netherlands Institute for Neuroscience (NIN), An Institute of the Royal Netherlands Academy of Arts and Sciences, Amsterdam, Netherlands
| | - Nikita L. Korpel
- Laboratory of Endocrinology, Amsterdam University Medical Center, Amsterdam Gastroenterology & Metabolism, University of Amsterdam, Amsterdam, Netherlands
- Hypothalamic Integration Mechanisms Group, Netherlands Institute for Neuroscience (NIN), An Institute of the Royal Netherlands Academy of Arts and Sciences, Amsterdam, Netherlands
| | - Chun-Xia Yi
- Laboratory of Endocrinology, Amsterdam University Medical Center, Amsterdam Gastroenterology & Metabolism, University of Amsterdam, Amsterdam, Netherlands
- Department of Endocrinology and Metabolism, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, Netherlands
| | - Andries Kalsbeek
- Laboratory of Endocrinology, Amsterdam University Medical Center, Amsterdam Gastroenterology & Metabolism, University of Amsterdam, Amsterdam, Netherlands
- Hypothalamic Integration Mechanisms Group, Netherlands Institute for Neuroscience (NIN), An Institute of the Royal Netherlands Academy of Arts and Sciences, Amsterdam, Netherlands
- Department of Endocrinology and Metabolism, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, Netherlands
- *Correspondence: Andries Kalsbeek
| |
Collapse
|
92
|
Adams JD, Treiber G, Hurtado MD, Laurenti MC, Dalla Man C, Cobelli C, Rizza RA, Vella A. Increased Rates of Meal Absorption Do Not Explain Elevated 1-Hour Glucose in Subjects With Normal Glucose Tolerance. J Endocr Soc 2018; 3:135-145. [PMID: 30591957 PMCID: PMC6302905 DOI: 10.1210/js.2018-00222] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2018] [Accepted: 11/16/2018] [Indexed: 01/12/2023] Open
Abstract
Context In subjects with normal fasting glucose (NFG) and normal glucose tolerance (NGT), glucose concentrations >155 mg/dL 1 hour after 75 g of oral glucose predict increased risk of progression to diabetes. Recently, it has been suggested that the mechanism underlying this abnormality is increased gut absorption of glucose. Objective We sought to determine the rate of systemic appearance of meal-derived glucose in subjects classified by their 1-hour glucose after a 75-g oral glucose challenge. Design This was a cross-sectional study. Participating subjects underwent a 75-g oral glucose challenge and a labeled mixed meal test. Setting An inpatient clinical research unit at an academic medical center. Participants Thirty-six subjects with NFG/NGT participated in this study. Interventions Subjects underwent an oral glucose tolerance test. Subsequently, they underwent a labeled mixed meal to measure fasting and postprandial glucose metabolism. Main Outcome Measures We examined β-cell function and the rate of meal appearance (Meal Ra) in NFG/NGT subjects. Subsequently, we examined the relationship of peak postchallenge glucose with Meal Ra and indices of β-cell function. Results Peak glucose concentrations correlated inversely with β-cell function. No relationship of Meal Ra with peak postchallenge glucose concentrations was observed. Conclusion In subjects with NFG/NGT, elevated 1-hour peak postchallenge glucose concentrations reflect impaired β-cell function rather than increased systemic meal appearance.
Collapse
Affiliation(s)
- J D Adams
- Division of Endocrinology, Diabetes, and Metabolism, Mayo Clinic, Rochester, Minnesota
| | - Gerlies Treiber
- Department of Internal Medicine, Division of Endocrinology and Diabetology, Medical University of Graz, Graz, Austria
| | - Maria Daniela Hurtado
- Division of Endocrinology, Diabetes, and Metabolism, Mayo Clinic, Rochester, Minnesota
| | - Marcello C Laurenti
- Department of Information Engineering, Università di Padova, 36131 Padova, Italy
| | - Chiara Dalla Man
- Department of Information Engineering, Università di Padova, 36131 Padova, Italy
| | - Claudio Cobelli
- Department of Information Engineering, Università di Padova, 36131 Padova, Italy
| | - Robert A Rizza
- Division of Endocrinology, Diabetes, and Metabolism, Mayo Clinic, Rochester, Minnesota
| | - Adrian Vella
- Division of Endocrinology, Diabetes, and Metabolism, Mayo Clinic, Rochester, Minnesota
| |
Collapse
|
93
|
Qian J, Man CD, Morris CJ, Cobelli C, Scheer FAJL. Differential effects of the circadian system and circadian misalignment on insulin sensitivity and insulin secretion in humans. Diabetes Obes Metab 2018; 20:2481-2485. [PMID: 29862620 PMCID: PMC6167165 DOI: 10.1111/dom.13391] [Citation(s) in RCA: 80] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2018] [Revised: 05/23/2018] [Accepted: 05/27/2018] [Indexed: 01/22/2023]
Abstract
Glucose tolerance is lower at night and higher in the morning. Shift workers, who often eat at night and experience circadian misalignment (i.e. misalignment between the central circadian pacemaker and the environmental/behavioural cycles), have an increased risk of type 2 diabetes. To determine the separate and relative impacts of the circadian system, behavioural/environmental cycles, and their interaction (i.e. circadian misalignment) on insulin sensitivity and β-cell function, the oral minimal model was used to quantitatively assess the major determinants of glucose control in 14 healthy adults using a randomized, cross-over design with two 8-day laboratory protocols. Both protocols involved 3 baseline inpatient days with habitual sleep/wake cycles, followed by 4 inpatient days with the same nocturnal bedtime (circadian alignment) or with 12-hour inverted behavioural/environmental cycles (circadian misalignment). The data showed that circadian phase and circadian misalignment affect glucose tolerance through different mechanisms. While the circadian system reduces glucose tolerance in the biological evening compared to the biological morning mainly by decreasing both dynamic and static β-cell responsivity, circadian misalignment reduced glucose tolerance mainly by lowering insulin sensitivity, not by affecting β-cell function.
Collapse
Affiliation(s)
- Jingyi Qian
- Medical Chronobiology Program, Division of Sleep and Circadian Disorders, Departments of Medicine and Neurology, Brigham and Women's Hospital, Boston, MA 02115; Division of Sleep Medicine, Department of Medicine, Harvard Medical School, Boston, MA 02115
| | - Chiara Dalla Man
- Department of Information Engineering, University of Padova, Padova, Italy
| | - Christopher J. Morris
- Medical Chronobiology Program, Division of Sleep and Circadian Disorders, Departments of Medicine and Neurology, Brigham and Women's Hospital, Boston, MA 02115; Division of Sleep Medicine, Department of Medicine, Harvard Medical School, Boston, MA 02115
| | - Claudio Cobelli
- Department of Information Engineering, University of Padova, Padova, Italy
| | - Frank AJL Scheer
- Medical Chronobiology Program, Division of Sleep and Circadian Disorders, Departments of Medicine and Neurology, Brigham and Women's Hospital, Boston, MA 02115; Division of Sleep Medicine, Department of Medicine, Harvard Medical School, Boston, MA 02115
| |
Collapse
|
94
|
Ruetten H, Gebauer M, Raymond RH, Calle RA, Cobelli C, Ghosh A, Robertson RP, Shankar SS, Staten MA, Stefanovski D, Vella A, Wright K, Fryburg DA. Mixed Meal and Intravenous L-Arginine Tests Both Stimulate Incretin Release Across Glucose Tolerance in Man: Lack of Correlation with β Cell Function. Metab Syndr Relat Disord 2018; 16:406-415. [PMID: 30117761 DOI: 10.1089/met.2018.0022] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND The aims of this study were to 1. define the responses of glucagon-like peptide-1 (GLP-1), glucose-dependent insulinotropic polypeptide (GIP), glucagon, and peptide YY (PYY) to an oral meal and to intravenous L-arginine; and 2. examine correlation of enteroendocrine hormones with insulin secretion. We hypothesized a relationship between circulating incretin concentrations and insulin secretion. METHODS Subjects with normal glucose tolerance (NGT, n = 23), prediabetes (PDM, n = 17), or with type 2 diabetes (T2DM, n = 22) were studied twice, following a mixed test meal (470 kCal) (mixed meal tolerance test [MMTT]) or intravenous L-arginine (arginine maximal stimulation test [AST], 5 g). GLP-1 (total and active), PYY, GIP, glucagon, and β cell function were measured before and following each stimulus. RESULTS Baseline enteroendocrine hormones differed across the glucose tolerance (GT) spectrum, T2DM generally >NGT and PDM. In response to MMTT, total and active GLP-1, GIP, glucagon, and PYY increased in all populations. The incremental area-under-the-curve (0-120 min) of analytes like total GLP-1 were often higher in T2DM compared with NGT and PDM (35-51%; P < 0.05). At baseline glucose, L-arginine increased total and active GLP-1 and glucagon concentrations in all GT populations (all P < 0.05). As expected, the MMTT and AST provoked differential glucose, insulin, and C-peptide responses across GT populations. Baseline or stimulated enteroendocrine hormone concentrations did not consistently correlate with either measure of β cell function. CONCLUSIONS/INTERPRETATION Both MMTT and AST resulted in insulin and enteroendocrine hormone responses across GT populations without consistent correlation between release of incretins and insulin, which is in line with other published research. If a defect is in the enteroendocrine/β cell axis, it is probably reduced response to rather than diminished secretion of enteroendocrine hormones.
Collapse
Affiliation(s)
| | | | | | | | - Claudio Cobelli
- 4 Department of Information Engineering, University of Padova , Padova, Italy
| | - Atalanta Ghosh
- 5 Janssen Research and Development , Raritan, New Jersey
| | - R Paul Robertson
- 6 Pacific Northwest Diabetes Institute, University of Washington , Seattle, Washington
| | - Sudha S Shankar
- 7 Lilly Research Laboratories, Lilly Corporate Center , Indianapolis, Indiana
| | | | - Darko Stefanovski
- 9 School of Veterinary Medicine, University of Pennsylvania , Philadelphia, Pennsylvania
| | - Adrian Vella
- 10 Division of Endocrinology, Mayo Clinic and Foundation , Rochester, Minnesota
| | - Kathryn Wright
- 11 Wright Biomarker Consulting , Gales Ferry, Connecticut
| | | | | |
Collapse
|
95
|
Shankar SS, Lee DS, Raymond RH, Calle RA, Cobelli C, Ghosh A, Robertson RP, Ruetten H, Staten MA, Stefanovski D, Vella A, Whitaker S, Fryburg DA. Outpatient versus inpatient mixed meal tolerance and arginine stimulation testing yields comparable measures of variability for assessment of beta cell function. Contemp Clin Trials Commun 2018; 10:94-99. [PMID: 30023442 PMCID: PMC6047312 DOI: 10.1016/j.conctc.2018.03.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2017] [Revised: 03/19/2018] [Accepted: 03/26/2018] [Indexed: 11/24/2022] Open
Abstract
Standard practice to minimize variability in beta cell function (BCF) measurement is to test in inpatient (IP) settings. IP testing strains trial subjects, investigators, and budgets. Outpatient (OP) testing may be a solution although there are few reports on OP BCF testing variability. We compared variability metrics between OP and IP from a standardized mixed meal tolerance test (MMTT) and arginine stimulation test (AST) in two separate type 2 diabetes (T2DM) cohorts (OP, n = 20; IP n = 22) in test-retest design. MMTT variables included: insulin sensitivity (Si); beta cell responsivity (Φtot); and disposition index (DItot = Si* Φtot) following 470 kCal meal. AST variables included: acute insulin response to arginine (AIRarg) and during hyperglycemia (AIRargMAX). Results Baseline characteristics were well-matched. Between and within subject variance for each parameter across cohorts, and intraclass correlation coefficients (ICC-a measure of reproducibility) across parameters were generally comparable for OP to IP. Table summarizes the ICC results for each key parameter and cohort.Test/Parameter | Outpatient (95% CI) | Inpatient (95% CI) |
---|
MMTT: Si | 0.49(0,0.69) | 0.28(0,0.60) | MMTT: Φtot | 0.65(0.16,0.89) | 0.81(0.44,0.93) | MMTT: DI | 0.67(0,0.83) | 0.36(0,0.69) |
| AST: AIR Arg | 0.96(0.88,0.98) | 0.84(0.59,0.94) | AST: AIR Arg Max | 0.97(0.90,0.99) | 0.95(0.86,0.97) | AST: ISR | 0.93(0.77,0.97) | 0.93(0.82,0.96) |
In conclusion, the variability (reproducibility) of BCF measures from standardized MMTT and AST is comparable between OP and IP settings. These observations have significant implications for complexity and cost of metabolic studies.
Collapse
Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | - David A. Fryburg
- ROI BioPharma Consulting, United States
- Corresponding author. 14 Alexander Drive, East Lyme, CT 06333, United States.
| | | |
Collapse
|
96
|
Adams JD, Vella A. What Can Diabetes-Associated Genetic Variation in TCF7L2 Teach Us About the Pathogenesis of Type 2 Diabetes? Metab Syndr Relat Disord 2018; 16:383-389. [PMID: 29993315 DOI: 10.1089/met.2018.0024] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Type 2 diabetes mellitus (T2DM) is a polygenic metabolic disorder characterized by hyperglycemia occurring as a result of impaired insulin secretion and/or insulin resistance. Among the various genetic factors associated with T2DM, a common genetic variant within the transcription factor 7-like 2 locus (TCF7L2) confers the greatest genetic risk for development of the disease. However, the mechanism(s) by which TCF7L2 predisposes to diabetes remain uncertain. Here we review the current literature pertaining to the potential mechanisms by which TCF7L2 confers risk of T2DM, using genetic variation as a probe to understand the pathogenesis of the disease.
Collapse
Affiliation(s)
- J D Adams
- Endocrine Research Unit, Department of Endocrinology, Diabetes and Nutrition, Mayo Clinic College of Medicine , Rochester, Minnesota
| | - Adrian Vella
- Endocrine Research Unit, Department of Endocrinology, Diabetes and Nutrition, Mayo Clinic College of Medicine , Rochester, Minnesota
| |
Collapse
|
97
|
Karanth S, Adams JD, Serrano MDLA, Quittner-Strom EB, Simcox J, Villanueva CJ, Ozcan L, Holland WL, Yost HJ, Vella A, Schlegel A. A Hepatocyte FOXN3-α Cell Glucagon Axis Regulates Fasting Glucose. Cell Rep 2018; 24:312-319. [PMID: 29996093 DOI: 10.1016/j.celrep.2018.06.039] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2018] [Revised: 05/07/2018] [Accepted: 06/08/2018] [Indexed: 01/26/2023] Open
Abstract
The common genetic variation at rs8004664 in the FOXN3 gene is independently and significantly associated with fasting blood glucose, but not insulin, in non-diabetic humans. Recently, we reported that primary hepatocytes from rs8004664 hyperglycemia risk allele carriers have increased FOXN3 transcript and protein levels and liver-limited overexpression of human FOXN3, a transcriptional repressor that had not been implicated in metabolic regulation previously, increases fasting blood glucose in zebrafish. Here, we find that injection of glucagon into mice and adult zebrafish decreases liver Foxn3 protein and transcript levels. Zebrafish foxn3 loss-of-function mutants have decreased fasting blood glucose, blood glucagon, liver gluconeogenic gene expression, and α cell mass. Conversely, liver-limited overexpression of foxn3 increases α cell mass. Supporting these genetic findings in model organisms, non-diabetic rs8004664 risk allele carriers have decreased suppression of glucagon during oral glucose tolerance testing. By reciprocally regulating each other, liver FOXN3 and glucagon control fasting glucose.
Collapse
Affiliation(s)
- Santhosh Karanth
- University of Utah Molecular Medicine Program, University of Utah School of Medicine, Salt Lake City, UT, USA; Department of Internal Medicine, Division of Endocrinology, Metabolism and Diabetes, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - J D Adams
- Department of Internal Medicine, Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Mayo Clinic College of Medicine, Rochester, MN, USA
| | - Maria de Los Angeles Serrano
- University of Utah Molecular Medicine Program, University of Utah School of Medicine, Salt Lake City, UT, USA; Department of Neurobiology and Anatomy, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Ezekiel B Quittner-Strom
- University of Utah Molecular Medicine Program, University of Utah School of Medicine, Salt Lake City, UT, USA; Department of Nutrition and Integrative Physiology, University of Utah College of Health, Salt Lake City, UT, USA
| | - Judith Simcox
- Department of Biochemistry, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Claudio J Villanueva
- Department of Biochemistry, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Lale Ozcan
- Department of Medicine, Division of Molecular Medicine, Columbia University Medical Center, New York, NY, USA
| | - William L Holland
- University of Utah Molecular Medicine Program, University of Utah School of Medicine, Salt Lake City, UT, USA; Department of Nutrition and Integrative Physiology, University of Utah College of Health, Salt Lake City, UT, USA; Department of Biochemistry, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - H Joseph Yost
- University of Utah Molecular Medicine Program, University of Utah School of Medicine, Salt Lake City, UT, USA; Department of Neurobiology and Anatomy, University of Utah School of Medicine, Salt Lake City, UT, USA; Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Adrian Vella
- Department of Internal Medicine, Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Mayo Clinic College of Medicine, Rochester, MN, USA
| | - Amnon Schlegel
- University of Utah Molecular Medicine Program, University of Utah School of Medicine, Salt Lake City, UT, USA; Department of Internal Medicine, Division of Endocrinology, Metabolism and Diabetes, University of Utah School of Medicine, Salt Lake City, UT, USA; Department of Nutrition and Integrative Physiology, University of Utah College of Health, Salt Lake City, UT, USA; Department of Biochemistry, University of Utah School of Medicine, Salt Lake City, UT, USA.
| |
Collapse
|
98
|
van Stee MF, de Graaf AA, Groen AK. Actions of metformin and statins on lipid and glucose metabolism and possible benefit of combination therapy. Cardiovasc Diabetol 2018; 17:94. [PMID: 29960584 PMCID: PMC6026339 DOI: 10.1186/s12933-018-0738-4] [Citation(s) in RCA: 92] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2018] [Accepted: 06/20/2018] [Indexed: 12/13/2022] Open
Abstract
Patients with diabetes type 2 have an increased risk for cardiovascular disease and commonly use combination therapy consisting of the anti-diabetic drug metformin and a cholesterol-lowering statin. However, both drugs act on glucose and lipid metabolism which could lead to adverse effects when used in combination as compared to monotherapy. In this review, the proposed molecular mechanisms of action of statin and metformin therapy in patients with diabetes and dyslipidemia are critically assessed, and a hypothesis for mechanisms underlying interactions between these drugs in combination therapy is developed.
Collapse
Affiliation(s)
- Mariël F. van Stee
- Netherlands Organisation for Applied Scientific Research (TNO), Zeist, The Netherlands
- Department of Laboratory Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Albert A. de Graaf
- Netherlands Organisation for Applied Scientific Research (TNO), Zeist, The Netherlands
| | - Albert K. Groen
- Amsterdam Diabetes Center and Department of Vascular Medicine, Academic Medical Center, Amsterdam, The Netherlands
- Department of Laboratory Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| |
Collapse
|
99
|
Chen ME, Aguirre RS, Hannon TS. Methods for Measuring Risk for Type 2 Diabetes in Youth: the Oral Glucose Tolerance Test (OGTT). Curr Diab Rep 2018; 18:51. [PMID: 29909550 DOI: 10.1007/s11892-018-1023-3] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
PURPOSE OF REVIEW The oral glucose tolerance test (OGTT) is used both in clinical practice and research to assess glucose tolerance. In addition, the OGTT is utilized for surrogate measures of insulin sensitivity and the insulin response to enteral glucose and has been widely applied in the evaluation of β-cell dysfunction in obesity, prediabetes, and type 2 diabetes. Here we review the use of the OGTT and the OGTT-derived indices for measurement of risk markers for type 2 diabetes in youth. RECENT FINDINGS Advantages of using the OGTT for measures of diabetes risk include its accessibility and the incorporation of physiological contributions of the gut-pancreas axis in the measures of insulin response to glucose. Mathematical modeling expands the potential gains from the OGTT in physiology and clinical research. Disadvantages include individual differences in the rate of glucose absorption that modify insulin responses, imperfect control of the glycemic stimulus, and poor intraindividual reproducibility. Available research suggests the OGTT provides valuable information about the development of impaired glycemic control and β-cell function in obese youth along the spectrum of glucose tolerance.
Collapse
Affiliation(s)
| | - Rebecca S Aguirre
- Indiana University School of Medicine, 705 Riley Hospital Drive, Room 5960, Indianapolis, IN, 46202, USA
| | - Tamara S Hannon
- Indiana University School of Medicine, 705 Riley Hospital Drive, Room 5960, Indianapolis, IN, 46202, USA.
| |
Collapse
|
100
|
Rozendaal YJW, Wang Y, Paalvast Y, Tambyrajah LL, Li Z, Willems van Dijk K, Rensen PCN, Kuivenhoven JA, Groen AK, Hilbers PAJ, van Riel NAW. In vivo and in silico dynamics of the development of Metabolic Syndrome. PLoS Comput Biol 2018; 14:e1006145. [PMID: 29879115 PMCID: PMC5991635 DOI: 10.1371/journal.pcbi.1006145] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2017] [Accepted: 04/13/2018] [Indexed: 12/16/2022] Open
Abstract
The Metabolic Syndrome (MetS) is a complex, multifactorial disorder that develops slowly over time presenting itself with large differences among MetS patients. We applied a systems biology approach to describe and predict the onset and progressive development of MetS, in a study that combined in vivo and in silico models. A new data-driven, physiological model (MINGLeD: Model INtegrating Glucose and Lipid Dynamics) was developed, describing glucose, lipid and cholesterol metabolism. Since classic kinetic models cannot describe slowly progressing disorders, a simulation method (ADAPT) was used to describe longitudinal dynamics and to predict metabolic concentrations and fluxes. This approach yielded a novel model that can describe long-term MetS development and progression. This model was integrated with longitudinal in vivo data that was obtained from male APOE*3-Leiden.CETP mice fed a high-fat, high-cholesterol diet for three months and that developed MetS as reflected by classical symptoms including obesity and glucose intolerance. Two distinct subgroups were identified: those who developed dyslipidemia, and those who did not. The combination of MINGLeD with ADAPT could correctly predict both phenotypes, without making any prior assumptions about changes in kinetic rates or metabolic regulation. Modeling and flux trajectory analysis revealed that differences in liver fluxes and dietary cholesterol absorption could explain this occurrence of the two different phenotypes. In individual mice with dyslipidemia dietary cholesterol absorption and hepatic turnover of metabolites, including lipid fluxes, were higher compared to those without dyslipidemia. Predicted differences were also observed in gene expression data, and consistent with the emergence of insulin resistance and hepatic steatosis, two well-known MetS co-morbidities. Whereas MINGLeD specifically models the metabolic derangements underlying MetS, the simulation method ADAPT is generic and can be applied to other diseases where dynamic modeling and longitudinal data are available.
Collapse
Affiliation(s)
- Yvonne J. W. Rozendaal
- Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands
| | - Yanan Wang
- Department of Pediatrics, Section Molecular Genetics, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
- Department of Medicine, Division of Endocrinology, Leiden University Medical Center, Leiden, The Netherlands
| | - Yared Paalvast
- Department of Pediatrics, Section Molecular Genetics, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Lauren L. Tambyrajah
- Department of Medicine, Division of Endocrinology, Leiden University Medical Center, Leiden, The Netherlands
| | - Zhuang Li
- Department of Medicine, Division of Endocrinology, Leiden University Medical Center, Leiden, The Netherlands
| | - Ko Willems van Dijk
- Department of Medicine, Division of Endocrinology, Leiden University Medical Center, Leiden, The Netherlands
- Einthoven Laboratory for Experimental Vascular Medicine, Leiden University Medical Center, Leiden, The Netherlands
- Department of Human Genetics, Leiden University Medical Center, Leiden, The Netherlands
| | - Patrick C. N. Rensen
- Department of Medicine, Division of Endocrinology, Leiden University Medical Center, Leiden, The Netherlands
- Einthoven Laboratory for Experimental Vascular Medicine, Leiden University Medical Center, Leiden, The Netherlands
| | - Jan A. Kuivenhoven
- Department of Pediatrics, Section Molecular Genetics, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Albert K. Groen
- Department of Pediatrics, Section Molecular Genetics, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
- Amsterdam Diabetes Center, Department of Vascular Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Peter A. J. Hilbers
- Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands
| | - Natal A. W. van Riel
- Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands
- Amsterdam Diabetes Center, Department of Vascular Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| |
Collapse
|