101
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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.
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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
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102
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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.
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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.
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103
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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.
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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
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104
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Morrison DJ, Kowalski GM, Grespan E, Mari A, Bruce CR, Wadley GD. Measurement of postprandial glucose fluxes in response to acute and chronic endurance exercise in healthy humans. Am J Physiol Endocrinol Metab 2018; 314:E503-E511. [PMID: 29351488 DOI: 10.1152/ajpendo.00316.2017] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
The effect of endurance exercise on enhancing insulin sensitivity and glucose flux has been well established with techniques such as the hyperinsulinemic clamp. Although informative, such techniques do not emulate the physiological postprandial state, and it remains unclear how exercise improves postprandial glycaemia. Accordingly, combining mixed-meal tolerance testing and the triple-stable isotope glucose tracer approach, glucose fluxes [rates of meal glucose appearance (Ra), disposal (Rd), and endogenous glucose production (EGP)] were determined following acute endurance exercise (1 h cycling; ~70% V̇o2max) and 4 wk of endurance training (cycling 5 days/wk). Training was associated with a modest increase in V̇o2max (~7%, P < 0.001). Postprandial glucose and insulin responses were reduced to the same extent following acute and chronic training. Interestingly, this was not accompanied by changes to rates of meal Ra, Rd, or degree of EGP suppression. Glucose clearance (Rd relative to prevailing glucose) was, however, enhanced with acute and chronic exercise. Furthermore, the duration of EGP suppression was shorter with acute and chronic exercise, with EGP returning toward fasting levels more rapidly than pretraining conditions. These findings suggest that endurance exercise influences the efficiency of the glucoregulatory system, where pretraining rates of glucose disposal and production were achieved at lower glucose and insulin levels. Notably, there was no influence of chronic training over and above that of a single exercise bout, providing further evidence that glucoregulatory benefits of endurance exercise are largely attributed to the residual effects of the last exercise bout.
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Affiliation(s)
- Dale J Morrison
- Deakin University, Geelong, Australia, Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Burwood, Australia
| | - Greg M Kowalski
- Deakin University, Geelong, Australia, Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Burwood, Australia
| | | | - Andrea Mari
- CNR Institute of Neuroscience , Padua , Italy
| | - Clinton R Bruce
- Deakin University, Geelong, Australia, Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Burwood, Australia
| | - Glenn D Wadley
- Deakin University, Geelong, Australia, Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Burwood, Australia
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105
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Purnell JQ, Johnson GS, Wahed AS, Dalla Man C, Piccinini F, Cobelli C, Prigeon RL, Goodpaster BH, Kelley DE, Staten MA, Foster-Schubert KE, Cummings DE, Flum DR, Courcoulas AP, Havel PJ, Wolfe BM. Prospective evaluation of insulin and incretin dynamics in obese adults with and without diabetes for 2 years after Roux-en-Y gastric bypass. Diabetologia 2018; 61:1142-1154. [PMID: 29428999 PMCID: PMC6634312 DOI: 10.1007/s00125-018-4553-y] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2017] [Accepted: 11/22/2017] [Indexed: 01/20/2023]
Abstract
AIMS/HYPOTHESIS In this prospective case-control study we tested the hypothesis that, while long-term improvements in insulin sensitivity (SI) accompanying weight loss after Roux-en-Y gastric bypass (RYGB) would be similar in obese individuals with and without type 2 diabetes mellitus, stimulated-islet-cell insulin responses would differ, increasing (recovering) in those with diabetes but decreasing in those without. We investigated whether these changes would occur in conjunction with favourable alterations in meal-related gut hormone secretion and insulin processing. METHODS Forty participants with type 2 diabetes and 22 participants without diabetes from the Longitudinal Assessment of Bariatric Surgery (LABS-2) study were enrolled in a separate, longitudinal cohort (LABS-3 Diabetes) to examine the mechanisms of postsurgical diabetes improvement. Study procedures included measures of SI, islet secretory response and gastrointestinal hormone secretion after both intravenous glucose (frequently-sampled IVGTT [FSIVGTT]) and a mixed meal (MM) prior to and up to 24 months after RYGB. RESULTS Postoperatively, weight loss and SI-FSIVGTT improvement was similar in both groups, whereas the acute insulin response to glucose (AIRglu) decreased in the non-diabetic participants and increased in the participants with type 2 diabetes. The resulting disposition indices (DIFSIVGTT) increased by three- to ninefold in both groups. In contrast, during the MM, total insulin responsiveness did not significantly change in either group despite durable increases of up to eightfold in postprandial glucagon-like peptide 1 levels, and SI-MM and DIMM increased only in the diabetes group. Peak postprandial glucagon levels increased in both groups. CONCLUSIONS/INTERPRETATION For up to 2 years following RYGB, obese participants without diabetes showed improvements in DI that approach population norms. Those with type 2 diabetes recovered islet-cell insulin secretion response yet continued to manifest abnormal insulin processing, with DI values that remained well below population norms. These data suggest that, rather than waiting for lifestyle or medical failure, RYGB is ideally considered before, or as soon as possible after, onset of type 2 diabetes. TRIAL REGISTRATION ClinicalTrials.gov NCT00433810.
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Affiliation(s)
- Jonathan Q Purnell
- Department of Medicine, The Knight Cardiovascular Institute, Mailcode MDYMI, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Portland, OR, 97239, USA.
| | - Geoffrey S Johnson
- Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
| | - Abdus S Wahed
- Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
| | - Chiara Dalla Man
- Department of Information Engineering, University of Padova, Padova, Italy
| | | | - Claudio Cobelli
- Department of Information Engineering, University of Padova, Padova, Italy
| | | | - Bret H Goodpaster
- Translational Research Institute for Metabolism and Diabetes, Sanford-Burnham Institute, Orlando, FL, USA
| | | | - Myrlene A Staten
- National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), Bethesda, MD, USA
| | | | - David E Cummings
- Department of Medicine, University of Washington, Seattle, WA, USA
| | - David R Flum
- Department of Surgery, University of Washington, Seattle, WA, USA
| | | | - Peter J Havel
- Departments of Molecular Biosciences and Nutrition, University of California, Davis, Davis, CA, USA
| | - Bruce M Wolfe
- Department of Surgery, Oregon Health & Science University, Portland, OR, USA
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106
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Increase in hepatic and decrease in peripheral insulin clearance characterize abnormal temporal patterns of serum insulin in diabetic subjects. NPJ Syst Biol Appl 2018; 4:14. [PMID: 29560274 PMCID: PMC5852153 DOI: 10.1038/s41540-018-0051-6] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2017] [Revised: 02/12/2018] [Accepted: 02/12/2018] [Indexed: 12/14/2022] Open
Abstract
Insulin plays a central role in glucose homeostasis, and impairment of insulin action causes glucose intolerance and leads to type 2 diabetes mellitus (T2DM). A decrease in the transient peak and sustained increase of circulating insulin following an infusion of glucose accompany T2DM pathogenesis. However, the mechanism underlying this abnormal temporal pattern of circulating insulin concentration remains unknown. Here we show that changes in opposite direction of hepatic and peripheral insulin clearance characterize this abnormal temporal pattern of circulating insulin concentration observed in T2DM. We developed a mathematical model using a hyperglycemic and hyperinsulinemic-euglycemic clamp in 111 subjects, including healthy normoglycemic and diabetic subjects. The hepatic and peripheral insulin clearance significantly increase and decrease, respectively, from healthy to borderline type and T2DM. The increased hepatic insulin clearance reduces the amplitude of circulating insulin concentration, whereas the decreased peripheral insulin clearance changes the temporal patterns of circulating insulin concentration from transient to sustained. These results provide further insight into the pathogenesis of T2DM, and thus may contribute to develop better treatment of this condition. Type 2 diabetes mellitus (T2DM) is one of the fastest growing public health problems, characterized by chronic hyperglycemia with the failure of glucose homeostasis. Evaluating alteration in biological functions regulating circulating glucose concentration is complicated due to the mutual relation between circulating glucose and insulin. A team led by Wataru Ogawa at Kobe University designed clinical experiments for breaking such feedback relations, and a team led by Shinya Kuroda at University of Tokyo developed mathematical models for specifically quantifying the functions from the clinical data. The estimated model parameters revealed the significant increase in hepatic and decrease in peripheral insulin clearance, which occur before and after insulin delivery into systemic circulation, respectively, from healthy to T2DM subjects. Model analysis suggested these insulin clearances centrally regulate the dynamics of circulating insulin concentration in the glucose-insulin regulatory system.
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107
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Varghese RT, Man CD, Laurenti MC, Piccinini F, Sharma A, Shah M, Bailey KR, Rizza RA, Cobelli C, Vella A. Performance of individually measured vs population-based C-peptide kinetics to assess β-cell function in the presence and absence of acute insulin resistance. Diabetes Obes Metab 2018; 20:549-555. [PMID: 28862812 PMCID: PMC5946313 DOI: 10.1111/dom.13106] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2017] [Revised: 08/22/2017] [Accepted: 08/29/2017] [Indexed: 01/07/2023]
Abstract
AIMS To compare the performance of population-based kinetics with that of directly measured C-peptide kinetics when used to calculate β-cell responsivity indices, and to study people with and without acute insulin resistance to ensure that population-based kinetics apply to all conditions where β-cell function is measured. METHODS Somatostatin was used to inhibit endogenous insulin secretion in 56 people without diabetes. Subsequently, a C-peptide bolus was administered and the changing concentrations were used to calculate individual kinetic measures of C-peptide clearance. In addition, the participants were studied on 2 occasions in random order using an oral glucose tolerance test (OGTT). On one occasion, free fatty acid elevation, to cause insulin resistance, was achieved by infusion of Intralipid + heparin. The Disposition Index (DI) was then estimated by the oral minimal model using either population-based or individual C-peptide kinetics. RESULTS There were marked differences in the exchange variables (k 12 and k 21 ) of the model describing C-peptide kinetics, but smaller differences in the fractional clearance; that is, the irreversible loss from the accessible compartment (k 01 ), obtained from population-based estimates compared with experimental measurement. Because it is predominantly influenced by k 01 , DI estimated using individual kinetics correlated well with DI estimated using population-based kinetics. CONCLUSIONS These data support the use of population-based measures of C-peptide kinetics to estimate β-cell function during an OGTT.
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Affiliation(s)
- Ron T. Varghese
- Division of Endocrinology, Diabetes & Metabolism, Mayo Clinic, 200 1 St SW, 5-194 Joseph, Rochester, Minnesota USA
| | - Chiara Dalla Man
- Department of Information Engineering, Universita’ di Padova, Via Gradenigo 6B, Padova, Italy
| | - Marcello C. Laurenti
- Department of Information Engineering, Universita’ di Padova, Via Gradenigo 6B, Padova, Italy
| | - Francesca Piccinini
- Department of Information Engineering, Universita’ di Padova, Via Gradenigo 6B, Padova, Italy
| | - Anu Sharma
- Division of Endocrinology, Diabetes & Metabolism, Mayo Clinic, 200 1 St SW, 5-194 Joseph, Rochester, Minnesota USA
| | - Meera Shah
- Division of Endocrinology, Diabetes & Metabolism, Mayo Clinic, 200 1 St SW, 5-194 Joseph, Rochester, Minnesota USA
| | - Kent R. Bailey
- Division of Biomedical Statistics and Informatics, Mayo Clinic, 200 1 St SW, Rochester, Minnesota USA
| | - Robert A. Rizza
- Division of Endocrinology, Diabetes & Metabolism, Mayo Clinic, 200 1 St SW, 5-194 Joseph, Rochester, Minnesota USA
| | - Claudio Cobelli
- Department of Information Engineering, Universita’ di Padova, Via Gradenigo 6B, Padova, Italy
| | - Adrian Vella
- Division of Endocrinology, Diabetes & Metabolism, Mayo Clinic, 200 1 St SW, 5-194 Joseph, Rochester, Minnesota USA
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Chen ME, Chandramouli AG, Considine RV, Hannon TS, Mather KJ. Comparison of β-Cell Function Between Overweight/Obese Adults and Adolescents Across the Spectrum of Glycemia. Diabetes Care 2018; 41:318-325. [PMID: 29183909 PMCID: PMC5780051 DOI: 10.2337/dc17-1373] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2017] [Accepted: 10/25/2017] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Type 2 diabetes is a growing health problem among both adults and adolescents. To better understand the differences in the pathogenesis of diabetes between these groups, we examined differences in β-cell function along the spectrum of glucose tolerance. RESEARCH DESIGN AND METHODS We evaluated 89 adults and 50 adolescents with normal glucose tolerance (NGT), dysglycemia, or type 2 diabetes. Oral glucose tolerance test results were used for C-peptide and insulin/glucose minimal modeling. Model-derived and direct measures of insulin secretion and insulin sensitivity were compared across glycemic stages and between age-groups at each stage. RESULTS In adolescents with dysglycemia, there was marked insulin resistance (insulin sensitivity index: adolescents, median [interquartile range] 1.8 [1.1-2.4] × 10-4; adults, 5.0 [2.3-9.9]; P = 0.01). The nature of β-cell dysfunction across stages of dysglycemia differed between the groups. We observed higher levels of secretion among adolescents than adults (total insulin secretion: NGT, 143 [103-284] × 10-9/min adolescent vs. 106 [71-127], P = 0.001); adults showed stepwise impairments in static insulin secretion (NGT, 7.5 [4.0-10.3] × 10-9/min; dysglycemia, 5.0 [2.3-9.9]; type 2 diabetes, 0.7 [0.1-2.45]; P = 0.003), whereas adolescents showed diabetes-related impairment in dynamic secretion (NGT, 1,905 [1,630-3,913] × 10-9; dysglycemia, 2,703 [1,323-3,637]; type 2 diabetes, 1,189 [269-1,410]; P = 0.001). CONCLUSIONS Adults and adolescents differ in the underlying defects leading to dysglycemia, and in the nature of β-cell dysfunction across stages of dysglycemia. These results may suggest different approaches to diabetes prevention in youths versus adults.
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Affiliation(s)
- Melinda E Chen
- Department of Pediatrics, Indiana University School of Medicine and Riley Hospital for Children, Indianapolis, IN
| | | | - Robert V Considine
- Department of Medicine, Indiana University School of Medicine, Indianapolis, IN
| | - Tamara S Hannon
- Department of Pediatrics, Indiana University School of Medicine and Riley Hospital for Children, Indianapolis, IN
| | - Kieren J Mather
- Department of Medicine, Indiana University School of Medicine, Indianapolis, IN
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Affiliation(s)
- Claudio Cobelli
- Department of Information Engineering, University of Padova , Padova, Italy
| | - Andrea Facchinetti
- Department of Information Engineering, University of Padova , Padova, Italy
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Sharma A, Varghese RT, Shah M, Man CD, Cobelli C, Rizza RA, Bailey KR, Vella A. Impaired Insulin Action Is Associated With Increased Glucagon Concentrations in Nondiabetic Humans. J Clin Endocrinol Metab 2018; 103:314-319. [PMID: 29126197 PMCID: PMC5761487 DOI: 10.1210/jc.2017-01197] [Citation(s) in RCA: 19] [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: 05/25/2017] [Accepted: 11/01/2017] [Indexed: 01/18/2023]
Abstract
Context Abnormal glucagon concentrations contribute to hyperglycemia, but the mechanisms of α-cell dysfunction in prediabetes are unclear. Objective We sought to determine the relative contributions of insulin secretion and action to α-cell dysfunction in nondiabetic participants across the spectrum of glucose tolerance. Design This was a cross-sectional study. A subset of participants (n = 120) was studied in the presence and absence of free fatty acid (FFA) elevation, achieved by infusion of Intralipid (Baxter Healthcare, Deerfield, IL) plus heparin, to cause insulin resistance. Setting An inpatient clinical research unit at an academic medical center. Participants A total of 310 nondiabetic persons participated in this study. Interventions Participants underwent a seven-sample oral glucose tolerance test. Subsequently, 120 participants were studied on two occasions. On one day, infusion of Intralipid plus heparin raised FFA. On the other day, participants received glycerol as a control. Main Outcome Measure(s) We examined the relationship of glucagon concentration with indices of insulin action after adjusting for the effects of age, sex, and weight. Subsequently, we sought to determine whether an acute decrease in insulin action, produced by FFA elevation, altered glucagon concentrations in nondiabetic participants. Results Fasting glucagon concentrations correlated positively with fasting insulin and C-peptide concentrations and inversely with insulin action. Fasting glucagon was not associated with any index of β-cell function in response to an oral challenge. As expected, FFA elevation decreased insulin action and also raised glucagon concentrations. Conclusions In nondiabetic participants, glucagon secretion was altered by changes in insulin action.
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Affiliation(s)
- Anu Sharma
- Division of Endocrinology, Diabetes & Metabolism, Mayo Clinic College of Medicine, Rochester, Minnesota 55905
| | - Ron T. Varghese
- Division of Endocrinology, Diabetes & Metabolism, Mayo Clinic College of Medicine, Rochester, Minnesota 55905
| | - Meera Shah
- Division of Endocrinology, Diabetes & Metabolism, Mayo Clinic College of Medicine, Rochester, Minnesota 55905
| | - Chiara Dalla Man
- Department of Information Engineering, Università di Padova, 35131 Padova, Italy
| | - Claudio Cobelli
- Department of Information Engineering, Università di Padova, 35131 Padova, Italy
| | - Robert A. Rizza
- Division of Endocrinology, Diabetes & Metabolism, Mayo Clinic College of Medicine, Rochester, Minnesota 55905
| | - Kent R. Bailey
- Biomedical Statistics and Informatics, Mayo Clinic College of Medicine, Rochester, Minnesota 55905
| | - Adrian Vella
- Division of Endocrinology, Diabetes & Metabolism, Mayo Clinic College of Medicine, Rochester, Minnesota 55905
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Hannon TS, Kahn SE, Utzschneider KM, Buchanan TA, Nadeau KJ, Zeitler PS, Ehrmann DA, Arslanian SA, Caprio S, Edelstein SL, Savage PJ, Mather KJ. Review of methods for measuring β-cell function: Design considerations from the Restoring Insulin Secretion (RISE) Consortium. Diabetes Obes Metab 2018; 20:14-24. [PMID: 28493515 PMCID: PMC6095472 DOI: 10.1111/dom.13005] [Citation(s) in RCA: 62] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2017] [Revised: 05/04/2017] [Accepted: 05/06/2017] [Indexed: 01/09/2023]
Abstract
The Restoring Insulin Secretion (RISE) study was initiated to evaluate interventions to slow or reverse the progression of β-cell failure in type 2 diabetes (T2D). To design the RISE study, we undertook an evaluation of methods for measurement of β-cell function and changes in β-cell function in response to interventions. In the present paper, we review approaches for measurement of β-cell function, focusing on methodologic and feasibility considerations. Methodologic considerations included: (1) the utility of each technique for evaluating key aspects of β-cell function (first- and second-phase insulin secretion, maximum insulin secretion, glucose sensitivity, incretin effects) and (2) tactics for incorporating a measurement of insulin sensitivity in order to adjust insulin secretion measures for insulin sensitivity appropriately. Of particular concern were the capacity to measure β-cell function accurately in those with poor function, as is seen in established T2D, and the capacity of each method for demonstrating treatment-induced changes in β-cell function. Feasibility considerations included: staff burden, including time and required methodological expertise; participant burden, including time and number of study visits; and ease of standardizing methods across a multicentre consortium. After this evaluation, we selected a 2-day measurement procedure, combining a 3-hour 75-g oral glucose tolerance test and a 2-stage hyperglycaemic clamp procedure, augmented with arginine.
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Affiliation(s)
- Tamara S Hannon
- Departments of Pediatrics (T. S. H.) and Medicine (K. J. M.), Indiana University School of Medicine, Indianapolis, Indiana
| | - Steven E Kahn
- VA Puget Sound Health Care System and Department of Medicine, University of Washington, Seattle, Washington
| | - Kristina M Utzschneider
- VA Puget Sound Health Care System and Department of Medicine, University of Washington, Seattle, Washington
| | - Thomas A Buchanan
- University of Southern California Keck School of Medicine/Kaiser Permanente Southern California, Department of Medicine, Los Angeles, California
| | - Kristen J Nadeau
- University of Colorado Denver/Children's Hospital Colorado, Department of Pediatrics, Denver, Colorado
| | - Philip S Zeitler
- University of Colorado Denver/Children's Hospital Colorado, Department of Pediatrics, Denver, Colorado
| | | | - Silva A Arslanian
- Children's Hospital of Pittsburgh, University of Pittsburgh Medical Center, Department of Pediatrics, Pittsburgh, Pennsylvania
| | - Sonia Caprio
- Department of Pediatrics, Yale University, New Haven, Connecticut
| | - Sharon L Edelstein
- George Washington University Biostatistics Center (RISE Coordinating Center), Rockville, Maryland
| | - Peter J Savage
- National Institute of Diabetes, Digestive and Kidney Diseases, Bethesda, Maryland
| | - Kieren J Mather
- Departments of Pediatrics (T. S. H.) and Medicine (K. J. M.), Indiana University School of Medicine, Indianapolis, Indiana
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Lee YM, Ha CM, Kim SA, Thoudam T, Yoon YR, Kim DJ, Kim HC, Moon HB, Park S, Lee IK, Lee DH. Low-Dose Persistent Organic Pollutants Impair Insulin Secretory Function of Pancreatic β-Cells: Human and In Vitro Evidence. Diabetes 2017; 66:2669-2680. [PMID: 28720696 DOI: 10.2337/db17-0188] [Citation(s) in RCA: 49] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2017] [Accepted: 07/13/2017] [Indexed: 11/13/2022]
Abstract
Low-dose persistent organic pollutants (POPs), especially organochlorine pesticides (OCPs) and polychlorinated biphenyls (PCBs), have emerged as a new risk factor for type 2 diabetes. We evaluated whether chronic exposure to low-dose POPs affects insulin secretory function of β-cells in humans and in vitro cells. Serum concentrations of OCPs and PCBs were measured in 200 adults without diabetes. Mathematical model-based insulin secretion indices were estimated by using a 2-h seven-sample oral glucose tolerance test. Insulin secretion by INS-1E β-cells was measured after 48 h of treatment with three OCPs or one PCB mixture. Static second-phase insulin secretion significantly decreased with increasing serum concentrations of OCPs. Adjusted means were 63.2, 39.3, 44.1, 39.3, 39.7, and 22.3 across six categories of a summary measure of OCPs (Ptrend = 0.02). Dynamic first-phase insulin secretion remarkably decreased with increasing concentrations of OCPs among only insulin-sensitive individuals (Ptrend = 0.02); the insulin levels among individuals with high OCPs were ∼30% of those with low OCPs. Compared with OCPs, PCBs showed weaker associations. The decreased insulin secretion by INS-1E β-cells was observed for even 1 pmol/L OCP. The data from human and in vitro cell experiments suggest that chronic exposure to low-dose POPs, especially OCPs, can induce pancreatic β-cell dysfunction.
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Affiliation(s)
- Yu-Mi Lee
- Department of Preventive Medicine, School of Medicine, Kyungpook National University, Daegu, Republic of Korea
| | - Chae-Myeong Ha
- Department of Biomedical Science, Graduate School, Kyungpook National University, Daegu, Republic of Korea
- BK21 Plus KNU Biomedical Convergence Program, Department of Biomedical Science, Kyungpook National University, Daegu, Republic of Korea
| | - Se-A Kim
- Department of Biomedical Science, Graduate School, Kyungpook National University, Daegu, Republic of Korea
- BK21 Plus KNU Biomedical Convergence Program, Department of Biomedical Science, Kyungpook National University, Daegu, Republic of Korea
| | - Themis Thoudam
- Department of Biomedical Science, Graduate School, Kyungpook National University, Daegu, Republic of Korea
- BK21 Plus KNU Biomedical Convergence Program, Department of Biomedical Science, Kyungpook National University, Daegu, Republic of Korea
| | - Young-Ran Yoon
- BK21 Plus KNU Biomedical Convergence Program, Department of Biomedical Science, Kyungpook National University, Daegu, Republic of Korea
- Department of Biomedical Science, School of Medicine, Kyungpook National University and Hospital, Daegu, Republic of Korea
| | - Dae-Jung Kim
- Department of Endocrinology and Metabolism, Ajou University School of Medicine, Suwon, Republic of Korea
| | - Hyeon-Chang Kim
- Department of Preventive Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Hyo-Bang Moon
- Department of Environmental Marine Sciences, College of Science and Technology, Hanyang University, Ansan, Republic of Korea
| | - Sungmi Park
- Leading-edge Research Center for Drug Discovery and Development for Diabetes and Metabolic Disease, Kyungpook National University, Daegu, Republic of Korea
| | - In-Kyu Lee
- BK21 Plus KNU Biomedical Convergence Program, Department of Biomedical Science, Kyungpook National University, Daegu, Republic of Korea
- Leading-edge Research Center for Drug Discovery and Development for Diabetes and Metabolic Disease, Kyungpook National University, Daegu, Republic of Korea
- Department of Internal Medicine, School of Medicine, Kyungpook National University, Daegu, Republic of Korea
| | - Duk-Hee Lee
- Department of Preventive Medicine, School of Medicine, Kyungpook National University, Daegu, Republic of Korea
- BK21 Plus KNU Biomedical Convergence Program, Department of Biomedical Science, Kyungpook National University, Daegu, Republic of Korea
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113
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Vella A. The Currency of Science. Metab Syndr Relat Disord 2017; 15:385-386. [PMID: 28922059 DOI: 10.1089/met.2017.0130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Adrian Vella
- Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Mayo Clinic , Rochester, Minnesota
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114
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Sharma A, Vella A. Obstacles to Translating Genotype-Phenotype Correlates in Metabolic Disease. Physiology (Bethesda) 2017; 32:42-50. [PMID: 27927804 DOI: 10.1152/physiol.00009.2016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
Type 2 diabetes mellitus is a polygenic disease with a variable phenotype. Many genetic associations have been described; however, understanding their underlying pathophysiological role in Type 2 diabetes mellitus is important for development of future therapeutic targets. Here, we review the physiological mechanisms of diabetes-associated variants that affect glycemia.
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Affiliation(s)
- Anu Sharma
- Department of Endocrinology, Diabetes and Nutrition, Mayo Clinic, Rochester, Minnesota
| | - Adrian Vella
- Department of Endocrinology, Diabetes and Nutrition, Mayo Clinic, Rochester, Minnesota
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115
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Sharma A, Laurenti MC, Dalla Man C, Varghese RT, Cobelli C, Rizza RA, Matveyenko A, Vella A. Glucose metabolism during rotational shift-work in healthcare workers. Diabetologia 2017; 60:1483-1490. [PMID: 28551698 PMCID: PMC5860643 DOI: 10.1007/s00125-017-4317-0] [Citation(s) in RCA: 63] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2017] [Accepted: 04/26/2017] [Indexed: 01/05/2023]
Abstract
AIMS/HYPOTHESIS Shift-work is associated with circadian rhythm disruption and an increased risk of obesity and type 2 diabetes. We sought to determine the effect of rotational shift-work on glucose metabolism in humans. METHODS We studied 12 otherwise healthy nurses performing rotational shift-work using a randomised crossover study design. On each occasion, participants underwent an isotope-labelled mixed meal test during a simulated day shift and a simulated night shift, enabling simultaneous measurement of glucose flux and beta cell function using the oral minimal model. We sought to determine differences in fasting and postprandial glucose metabolism during the day shift vs the night shift. RESULTS Postprandial glycaemic excursion was higher during the night shift (381±33 vs 580±48 mmol/l per 5 h, p<0.01). The time to peak insulin and C-peptide and nadir glucagon suppression in response to meal ingestion was also delayed during the night shift. While insulin action did not differ between study days, the beta cell responsivity to glucose (59±5 vs 44±4 × 10-9 min-1; p<0.001) and disposition index were decreased during the night shift. CONCLUSIONS/INTERPRETATION Impaired beta cell function during the night shift may result from normal circadian variation, the effect of rotational shift-work or a combination of both. As a consequence, higher postprandial glucose concentrations are observed during the night shift.
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Affiliation(s)
- Anu Sharma
- Endocrine Research Unit, Department of Endocrinology, Diabetes and Nutrition, Mayo Clinic College of Medicine, 200 First St SW, 5-194 Joseph, Rochester, MN, 55905, USA
| | | | - Chiara Dalla Man
- Department of Information Engineering, University of Padua, Padua, Italy
| | - Ron T Varghese
- Endocrine Research Unit, Department of Endocrinology, Diabetes and Nutrition, Mayo Clinic College of Medicine, 200 First St SW, 5-194 Joseph, Rochester, MN, 55905, USA
| | - Claudio Cobelli
- Department of Information Engineering, University of Padua, Padua, Italy
| | - Robert A Rizza
- Endocrine Research Unit, Department of Endocrinology, Diabetes and Nutrition, Mayo Clinic College of Medicine, 200 First St SW, 5-194 Joseph, Rochester, MN, 55905, USA
| | - Aleksey Matveyenko
- Department of Physiology and Biomedical Engineering, Mayo Clinic, Rochester, MN, USA
| | - Adrian Vella
- Endocrine Research Unit, Department of Endocrinology, Diabetes and Nutrition, Mayo Clinic College of Medicine, 200 First St SW, 5-194 Joseph, Rochester, MN, 55905, USA.
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116
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Cropano C, Santoro N, Groop L, Dalla Man C, Cobelli C, Galderisi A, Kursawe R, Pierpont B, Goffredo M, Caprio S. The rs7903146 Variant in the TCF7L2 Gene Increases the Risk of Prediabetes/Type 2 Diabetes in Obese Adolescents by Impairing β-Cell Function and Hepatic Insulin Sensitivity. Diabetes Care 2017; 40:1082-1089. [PMID: 28611053 PMCID: PMC5521977 DOI: 10.2337/dc17-0290] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2017] [Accepted: 05/06/2017] [Indexed: 02/03/2023]
Abstract
OBJECTIVE In this study, we aimed to explore the mechanism by which TCF7L2 rs7903146 risk allele confers susceptibility to impaired glucose tolerance (IGT) or type 2 diabetes (T2D) in obese adolescents. RESEARCH DESIGN AND METHODS The rs7903146 variant in the TCF7L2 gene was genotyped in a multiethnic cohort of 955 youths. All subjects underwent an oral glucose tolerance test with the use of the Oral Minimal Model to assess insulin secretion, and 33 subjects underwent a hyperinsulinemic-euglycemic clamp. In 307 subjects, a follow-up oral glucose tolerance test was repeated after 3.11 ± 2.36 years. RESULTS The TCF7L2 rs7903146 risk allele was associated with higher 2-h glucose levels in Caucasians (P = 0.006) and African Americans (P = 0.009), and a trend was seen also in Hispanics (P = 0.072). Also, the T allele was associated with decreased β-cell responsivity and IGT (P < 0.05). Suppression of endogenous hepatic glucose production was lower in subjects with the risk variant (P = 0.006). Finally, the odds of showing IGT/T2D at follow-up were higher in subjects carrying the minor allele (odds ratio 2.224; 95% CI 1.370-3.612; P = 0.0012). CONCLUSIONS The rs7903146 variant in the TCF7L2 gene increases the risk of IGT/T2D in obese adolescents by impairing β-cell function, and hepatic insulin sensitivity predicts the development of IGT/T2D over time.
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Affiliation(s)
- Catrina Cropano
- Division of Pediatric Endocrinology, Department of Pediatrics, Yale University School of Medicine, New Haven, CT
| | - Nicola Santoro
- Division of Pediatric Endocrinology, Department of Pediatrics, Yale University School of Medicine, New Haven, CT
| | - Leif Groop
- Department of Clinical Sciences, Diabetes and Endocrinology, Lund University, Malmo, Sweden.,Lund University Diabetes Center, Lund University, Malmo, Sweden
| | - Chiara Dalla Man
- Department of Information Engineering, University of Padua, Padua, Italy
| | - Claudio Cobelli
- Department of Information Engineering, University of Padua, Padua, Italy
| | - Alfonso Galderisi
- Division of Pediatric Endocrinology, Department of Pediatrics, Yale University School of Medicine, New Haven, CT
| | | | - Bridget Pierpont
- Division of Pediatric Endocrinology, Department of Pediatrics, Yale University School of Medicine, New Haven, CT
| | - Martina Goffredo
- Division of Pediatric Endocrinology, Department of Pediatrics, Yale University School of Medicine, New Haven, CT
| | - Sonia Caprio
- Division of Pediatric Endocrinology, Department of Pediatrics, Yale University School of Medicine, New Haven, CT
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117
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Schrauwen-Hinderling VB, Carpentier AC. Molecular imaging of postprandial metabolism. J Appl Physiol (1985) 2017; 124:504-511. [PMID: 28495844 DOI: 10.1152/japplphysiol.00212.2017] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
Disordered postprandial metabolism of energy substrates is one of the main defining features of prediabetes and contributes to the development of several chronic diseases associated with obesity, such as type 2 diabetes and cardiovascular diseases. Postprandial energy metabolism has been studied using classical isotopic tracer approaches that are limited by poor access to splanchnic metabolism and highly dynamic and complex exchanges of energy substrates involving multiple organs and systems. Advances in noninvasive molecular imaging modalities, such as PET and MRI/magnetic resonance spectroscopy (MRS), have recently allowed important advances in our understanding of postprandial energy metabolism in humans. The present review describes some of these recent advances, with particular focus on glucose and fatty acid metabolism in the postprandial state, and discusses current gaps in knowledge and new perspectives of application of PET and MRI/MRS for the investigation and treatment of human metabolic diseases.
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Affiliation(s)
- Vera B Schrauwen-Hinderling
- Department of Radiology and Human Biology and Human Movement Sciences, Maastricht University Medical Center , Maastricht , The Netherlands
| | - André C Carpentier
- Department of Medicine, Centre de Recherche du Centre Hospitalier Universitaire de Sherbrooke, Université de Sherbrooke , Sherbrooke, Québec , Canada
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118
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Goede SL, de Galan BE, Leow MKS. Personalized glucose-insulin model based on signal analysis. J Theor Biol 2017; 419:333-342. [PMID: 28039012 DOI: 10.1016/j.jtbi.2016.12.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2016] [Revised: 12/04/2016] [Accepted: 12/26/2016] [Indexed: 10/20/2022]
Abstract
Glucose plasma measurements for diabetes patients are generally presented as a glucose concentration-time profile with 15-60min time scale intervals. This limited resolution obscures detailed dynamic events of glucose appearance and metabolism. Measurement intervals of 15min or more could contribute to imperfections in present diabetes treatment. High resolution data from mixed meal tolerance tests (MMTT) for 24 type 1 and type 2 diabetes patients were used in our present modeling. We introduce a model based on the physiological properties of transport, storage and utilization. This logistic approach follows the principles of electrical network analysis and signal processing theory. The method mimics the physiological equivalent of the glucose homeostasis comprising the meal ingestion, absorption via the gastrointestinal tract (GIT) to the endocrine nexus between the liver, pancreatic alpha and beta cells. This model demystifies the metabolic 'black box' by enabling in silico simulations and fitting of individual responses to clinical data. Five-minute intervals MMTT data measured from diabetic subjects result in two independent model parameters that characterize the complete glucose system response at a personalized level. From the individual data measurements, we obtain a model which can be analyzed with a standard electrical network simulator for diagnostics and treatment optimization. The insulin dosing time scale can be accurately adjusted to match the individual requirements of characterized diabetic patients without the physical burden of treatment.
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Affiliation(s)
- Simon L Goede
- Systems Research, Oterlekerweg 4, 1841 GP Stompetoren, The Netherlands.
| | - Bastiaan E de Galan
- Department of General Internal Medicine of Radboud University Nijmegen Medical Centre, Postbus 9101, 6500 HB Nijmegen, The Netherlands.
| | - Melvin Khee Shing Leow
- Dept of Endocrinology, Tan Tock Seng Hospital, Singapore 308433, Office of Clinical Sciences, Duke-NUS Graduate Medical School, Singapore Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore.
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119
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Versteeg RI, Stenvers DJ, Visintainer D, Linnenbank A, Tanck MW, Zwanenburg G, Smilde AK, Fliers E, Kalsbeek A, Serlie MJ, la Fleur SE, Bisschop PH. Acute Effects of Morning Light on Plasma Glucose and Triglycerides in Healthy Men and Men with Type 2 Diabetes. J Biol Rhythms 2017; 32:130-142. [PMID: 28470119 PMCID: PMC5423535 DOI: 10.1177/0748730417693480] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Ambient light intensity is signaled directly to hypothalamic areas that regulate energy metabolism. Observational studies have shown associations between ambient light intensity and plasma glucose and lipid levels, but human data on the acute metabolic effects of light are scarce. Since light is the main signal indicating the onset of the diurnal phase of physical activity and food intake in humans, we hypothesized that bright light would affect glucose and lipid metabolism. Therefore, we determined the acute effects of bright light on plasma glucose and lipid concentrations in 2 randomized crossover trials: (1) in 8 healthy lean men and (2) in 8 obese men with type 2 diabetes. From 0730 h, subjects were exposed to either bright light (4000 lux) or dim light (10 lux) for 5 h. After 1 h of light exposure, subjects consumed a 600-kcal mixed meal. Primary endpoints were fasting and postprandial plasma glucose levels. In healthy men, bright light did not affect fasting or postprandial plasma glucose levels. However, bright light increased fasting and postprandial plasma triglycerides. In men with type 2 diabetes, bright light increased fasting and postprandial glucose levels. In men with type 2 diabetes, bright light did not affect fasting triglyceride levels but increased postprandial triglyceride levels. We show that ambient light intensity acutely affects human plasma glucose and triglyceride levels. Our findings warrant further research into the consequences of the metabolic effects of light for the diagnosis and prevention of hyperglycemia and dyslipidemia.
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Affiliation(s)
- Ruth I Versteeg
- Department of Endocrinology and Metabolism, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Dirk J Stenvers
- Department of Endocrinology and Metabolism, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Dana Visintainer
- Department of Endocrinology and Metabolism, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Andre Linnenbank
- Department of Experimental Cardiology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Michael W Tanck
- Department of Clinical Epidemiology, Biostatistics and Bioinformatics, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Gooitzen Zwanenburg
- Biosystem Data Analysis Group, University of Amsterdam, Amsterdam, The Netherlands
| | - Age K Smilde
- Biosystem Data Analysis Group, University of Amsterdam, Amsterdam, The Netherlands
| | - Eric Fliers
- Department of Endocrinology and Metabolism, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Andries Kalsbeek
- Department of Endocrinology and Metabolism, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.,Hypothalamic Integration Mechanisms, Netherlands Institute for Neuroscience, Royal Netherlands Academy of Arts and Sciences, Amsterdam, The Netherlands
| | - Mireille J Serlie
- Department of Endocrinology and Metabolism, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Susanne E la Fleur
- Department of Endocrinology and Metabolism, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Peter H Bisschop
- Department of Endocrinology and Metabolism, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
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120
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Hodson K, Dalla Man C, Smith FE, Barnes A, McParlin C, Cobelli C, Robson SC, Araújo-Soares V, Taylor R. Liver triacylglycerol content and gestational diabetes: effects of moderate energy restriction. Diabetologia 2017; 60:306-313. [PMID: 27817155 PMCID: PMC6518369 DOI: 10.1007/s00125-016-4143-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2016] [Accepted: 09/26/2016] [Indexed: 12/17/2022]
Abstract
AIMS/HYPOTHESIS Women with a history of gestational diabetes mellitus (GDM) have raised liver triacylglycerol. Restriction of energy intake in type 2 diabetes can normalise glucose control and liver triacylglycerol concentration but it is not known whether similar benefits could be achieved in GDM. The aim of this work was to examine liver triacylglycerol accumulation in women with GDM and the effect of modest energy restriction. METHODS Sixteen women with GDM followed a 4 week diet (5 MJ [1200 kcal]/day). Liver triacylglycerol, before and after diet and postpartum, was measured by magnetic resonance. Insulin secretion and sensitivity were assessed before and after diet. Twenty-six women who underwent standard antenatal care for GDM (matched for age, BMI, parity and ethnicity) were used as a comparator group. RESULTS Fourteen women, who completed the study, achieved a weight loss of 1.6 ± 1.7 kg over the 4 week dietary period. Mean weight change was -0.4 kg/week in the study group vs +0.3 kg/week in the comparator group (p = 0.002). Liver triacylglycerol level was normal but decreased following diet (3.7% [interquartile range, IQR 1.2-6.1%] vs 1.8% [IQR 0.7-3.1%], p = 0.004). There was no change in insulin sensitivity or production. Insulin was required in six comparator women vs none in the study group (eight vs two required metformin). Blood glucose control was similar for both groups. The hypo-energetic diet was well accepted. CONCLUSIONS/INTERPRETATION Liver triacylglycerol in women with GDM was not elevated, unlike observations in non-pregnant women with a history of GDM. A 4 week hypo-energetic diet resulted in weight loss, reduced liver triacylglycerol and minimised pharmacotherapy. The underlying pathophysiology of glucose metabolism appeared unchanged.
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Affiliation(s)
- Kenneth Hodson
- Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, UK.
- Royal Victoria Infirmary, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK.
- Newcastle Magnetic Resonance Centre, Newcastle University Campus for Ageing and Vitality, Newcastle upon Tyne, NE4 5PL, UK.
| | - Chiara Dalla Man
- Department of Information Engineering, University of Padova, Padova, Italy
| | - Fiona E Smith
- Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, UK
- Newcastle Magnetic Resonance Centre, Newcastle University Campus for Ageing and Vitality, Newcastle upon Tyne, NE4 5PL, UK
| | - Alison Barnes
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
| | - Catherine McParlin
- Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, UK
- Royal Victoria Infirmary, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Claudio Cobelli
- Department of Information Engineering, University of Padova, Padova, Italy
| | - Stephen C Robson
- Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, UK
- Royal Victoria Infirmary, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Vera Araújo-Soares
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
| | - Roy Taylor
- Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, UK
- Royal Victoria Infirmary, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
- Newcastle Magnetic Resonance Centre, Newcastle University Campus for Ageing and Vitality, Newcastle upon Tyne, NE4 5PL, UK
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121
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Klement J, Ott V, Rapp K, Brede S, Piccinini F, Cobelli C, Lehnert H, Hallschmid M. Oxytocin Improves β-Cell Responsivity and Glucose Tolerance in Healthy Men. Diabetes 2017; 66:264-271. [PMID: 27554476 DOI: 10.2337/db16-0569] [Citation(s) in RCA: 50] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2016] [Accepted: 08/18/2016] [Indexed: 11/13/2022]
Abstract
In addition to its pivotal role in psychosocial behavior, the hypothalamic neuropeptide oxytocin contributes to metabolic control by suppressing eating behavior. Its involvement in glucose homeostasis is less clear, although pilot experiments suggest that oxytocin improves glucose homeostasis. We assessed the effect of intranasal oxytocin (24 IU) administered to 29 healthy, fasted male subjects on glucose homeostasis measured by means of an oral glucose tolerance test. Parameters of glucose metabolism were analyzed according to the oral minimal model. Oxytocin attenuated the peak excursion of plasma glucose and augmented the early increases in insulin and C-peptide concentrations in response to the glucose challenge, while slightly blunting insulin and C-peptide peaks. Oral minimal model analyses revealed that oxytocin compared with placebo induced a pronounced increase in β-cell responsivity (PHItotal) that was largely due to an enhanced dynamic response (PHId), and a more than twofold improvement in glucose tolerance (disposition index). Adrenocorticotropic hormone (ACTH), cortisol, glucagon, and nonesterified fatty acid (NEFA) concentrations were not or were only marginally affected. These results indicate that oxytocin plays a significant role in the acute regulation of glucose metabolism in healthy humans and render the oxytocin system a potential target of antidiabetic treatment.
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Affiliation(s)
- Johanna Klement
- Department of Internal Medicine I, University of Lübeck, Lübeck, Germany
| | - Volker Ott
- Department of Internal Medicine I, University of Lübeck, Lübeck, Germany
| | - Kristina Rapp
- Department of Internal Medicine I, University of Lübeck, Lübeck, Germany
| | - Swantje Brede
- Department of Internal Medicine I, University of Lübeck, Lübeck, Germany
| | | | - Claudio Cobelli
- Department of Information Engineering, University of Padua, Padua, Italy
| | - Hendrik Lehnert
- Department of Internal Medicine I, University of Lübeck, 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
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122
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Newhouse LP, Joyner MJ, Curry TB, Laurenti MC, Man CD, Cobelli C, Vella A, Limberg JK. Three hours of intermittent hypoxia increases circulating glucose levels in healthy adults. Physiol Rep 2017; 5:5/1/e13106. [PMID: 28087818 PMCID: PMC5256164 DOI: 10.14814/phy2.13106] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2016] [Revised: 12/08/2016] [Accepted: 12/08/2016] [Indexed: 01/10/2023] Open
Abstract
An independent association exists between sleep apnea and diabetes. Animal models suggest exposure to intermittent hypoxia, a consequence of sleep apnea, results in altered glucose metabolism and fasting hyperglycemia. However, it is unknown if acute exposure to intermittent hypoxia increases glucose concentrations in nondiabetic humans. We hypothesized plasma glucose would be increased from baseline following 3 h of intermittent hypoxia in healthy humans independent of any effect on insulin sensitivity. Eight (7M/1F, 21–34 years) healthy subjects completed two study visits randomized to 3 h of intermittent hypoxia or continuous normoxia, followed by an oral glucose tolerance test. Intermittent hypoxia consisted of 25 hypoxic events per hour where oxygen saturation (SpO2) was significantly reduced (Normoxia: 97 ± 1%, Hypoxia: 90 ± 2%, P < 0.01). Venous plasma glucose concentrations were measured on both visits before and after the 3 h protocol. No changes in plasma glucose were observed from baseline after 3 h of continuous normoxia (5.1 ± 0.2 vs. 5.1 ± 0.1 mmol/L, P > 0.05). In contrast, circulating glucose concentrations were increased after 3 h of intermittent hypoxia when compared to baseline (5.0 ± 0.2 vs. 5.3 ± 0.2 mmol/L, P = 0.01). There were no detectable changes in insulin sensitivity following intermittent hypoxia when compared to continuous normoxia, as assessed by the oral glucose tolerance test (P > 0.05). Circulating glucose is increased after 3 h of intermittent hypoxia in healthy humans, independent of any lasting changes in insulin sensitivity. These novel findings could explain, in part, the high prevalence of diabetes in patients with sleep apnea and warrant future studies to identify underlying mechanisms.
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Affiliation(s)
| | | | - Timothy B Curry
- Department of Anesthesiology, Mayo Clinic, Rochester, Minnesota
| | | | - Chiara Dalla Man
- Department of Information Engineering, University of Padua, Padua, Italy
| | - Claudio Cobelli
- Department of Information Engineering, University of Padua, Padua, Italy
| | - Adrian Vella
- Department of Endocrinology, Mayo Clinic, Rochester, Minnesota
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Cobelli C, Vella A. Exocrine and Endocrine Interactions in Cystic Fibrosis: A Potential Key to Understanding Insulin Secretion in Health and Disease? Diabetes 2017; 66:20-22. [PMID: 27999103 PMCID: PMC5204318 DOI: 10.2337/dbi16-0049] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Affiliation(s)
- Claudio Cobelli
- Department of Information Engineering, University of Padova, Padova, Italy
| | - Adrian Vella
- Division of Endocrinology, Metabolism, Diabetes, Nutrition, and Internal Medicine, Mayo Clinic, Rochester, MN
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Mansell EJ, Docherty PD, Chase JG. Shedding light on grey noise in diabetes modelling. Biomed Signal Process Control 2017. [DOI: 10.1016/j.bspc.2016.06.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
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125
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Wilbaux M, Wölnerhanssen BK, Meyer-Gerspach AC, Beglinger C, Pfister M. Characterizing the dynamic interaction among gastric emptying, glucose absorption, and glycemic control in nondiabetic obese adults. Am J Physiol Regul Integr Comp Physiol 2016; 312:R314-R323. [PMID: 27974316 DOI: 10.1152/ajpregu.00369.2016] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2016] [Revised: 12/12/2016] [Accepted: 12/12/2016] [Indexed: 01/21/2023]
Abstract
The effects of altered gastric emptying on glucose absorption and kinetics are not well understood in nondiabetic obese adults. The aim of this work was to develop a physiology-based model that can characterize and compare interactions among gastric emptying, glucose absorption, and glycemic control in nondiabetic obese and lean healthy adults. Dynamic glucose, insulin, and gastric emptying (measured with breath test) data from 12 nondiabetic obese and 12 lean healthy adults were available until 180 min after an oral glucose tolerance test (OGTT) with 10, 25, and 75 g of glucose. A physiology-based model was developed to characterize glucose kinetics applying nonlinear mixed-effects modeling with NONMEM7.3. Glucose kinetics after OGTT was described by a one-compartment model with an effect compartment to describe delayed insulin effects on glucose clearance. After the interactions between individual gastric emptying and glucose absorption profiles were accounted for, the glucose absorption rate was found to be similar in nondiabetic obese and lean controls. Baseline glucose concentration was estimated to be only marginally higher in nondiabetic obese subjects (4.9 vs. 5.2 mmol/l), whereas insulin-dependent glucose clearance in nondiabetic obese subjects was found to be cut in half compared with lean controls (0.052 vs. 0.029 l/min) and the insulin concentration associated with 50% of insulin-dependent glucose elimination rate was approximately twofold higher in nondiabetic obese subjects compared with lean controls (7.1 vs. 15.3 μU/ml). Physiology-based models can characterize and compare the dynamic interaction among gastric emptying, glucose absorption and glycemic control in populations of interest such as lean healthy and nondiabetic obese adults.
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Affiliation(s)
- Mélanie Wilbaux
- Pediatric Pharmacology and Pharmacometrics, University of Basel Children's Hospital, Basel, Switzerland;
| | - Bettina K Wölnerhanssen
- Department of Biomedicine, Division of Gastroenterology and Hepatology, University Hospital of Basel, Basel, Switzerland; and
| | - Anne Christin Meyer-Gerspach
- Department of Biomedicine, Division of Gastroenterology and Hepatology, University Hospital of Basel, Basel, Switzerland; and
| | - Christoph Beglinger
- Department of Biomedicine, Division of Gastroenterology and Hepatology, University Hospital of Basel, Basel, Switzerland; and
| | - Marc Pfister
- Pediatric Pharmacology and Pharmacometrics, University of Basel Children's Hospital, Basel, Switzerland.,Quantitative Solutions LP, Menlo Park, Calfornia
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126
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Varghese RT, Dalla Man C, Sharma A, Viegas I, Barosa C, Marques C, Shah M, Miles JM, Rizza RA, Jones JG, Cobelli C, Vella A. Mechanisms Underlying the Pathogenesis of Isolated Impaired Glucose Tolerance in Humans. J Clin Endocrinol Metab 2016; 101:4816-4824. [PMID: 27603902 PMCID: PMC5155694 DOI: 10.1210/jc.2016-1998] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
CONTEXT Prediabetes is a heterogeneous disorder classified on the basis of fasting glucose concentrations and 2-hour glucose tolerance. OBJECTIVE We sought to determine the relative contributions of insulin secretion and action to the pathogenesis of isolated impaired glucose tolerance (IGT). DESIGN The study consisted of an oral glucose tolerance test and a euglycemic clamp performed in two cohorts matched for anthropometric characteristics and fasting glucose but discordant for glucose tolerance. SETTING An inpatient clinical research unit at an academic medical center. PATIENTS OR OTHER PARTICIPANTS Twenty-five subjects who had normal fasting glucose (NFG) and normal glucose tolerance (NGT) and 19 NFG/IGT subjects participated in this study. INTERVENTION(S) Subjects underwent a seven-sample oral glucose tolerance test and a 4-hour euglycemic, hyperinsulinemic clamp on separate occasions. Glucose turnover during the clamp was measured using tracers, and endogenous hormone secretion was inhibited by somatostatin. MAIN OUTCOME MEASURES We sought to determine whether hepatic glucose metabolism, specifically the contribution of gluconeogenesis to endogenous glucose production, differed between subjects with NFG/NGT and those with NFG/IGT. RESULTS Endogenous glucose production did not differ between groups before or during the clamp. Insulin-stimulated glucose disappearance was lower in NFG/IGT (24.6 ± 2.2 vs 35.0 ± 3.6 μmol/kg/min; P = .03). The disposition index was decreased in NFG/IGT (681 ± 102 vs 2231 ± 413 × 10-14 dL/kg/min2 per pmol/L; P < .001). CONCLUSIONS We conclude that innate defects in the regulation of glycogenolysis and gluconeogenesis do not contribute to NFG/IGT. However, insulin-stimulated glucose disposal is impaired, exacerbating defects in β-cell function.
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Affiliation(s)
- Ron T Varghese
- Division of Endocrinology, Diabetes, and Metabolism (R.T.V., A.S., M.S., J.M.M., R.A.R., A.V.), Mayo Clinic College of Medicine, Rochester, Minnesota 55905; Department of Information Engineering (C.D.M., C.C.), Universitá di Padova, 35122 Padova, Italy; Center for Neurosciences and Cell Biology (I.V., C.B., C.M., J.G.J.), University of Coimbra, 3000-370 Coimbra, Portugal; and APDP-Portuguese Diabetes Association (J.G.J.), 1250-203 Lisbon, Portugal
| | - Chiara Dalla Man
- Division of Endocrinology, Diabetes, and Metabolism (R.T.V., A.S., M.S., J.M.M., R.A.R., A.V.), Mayo Clinic College of Medicine, Rochester, Minnesota 55905; Department of Information Engineering (C.D.M., C.C.), Universitá di Padova, 35122 Padova, Italy; Center for Neurosciences and Cell Biology (I.V., C.B., C.M., J.G.J.), University of Coimbra, 3000-370 Coimbra, Portugal; and APDP-Portuguese Diabetes Association (J.G.J.), 1250-203 Lisbon, Portugal
| | - Anu Sharma
- Division of Endocrinology, Diabetes, and Metabolism (R.T.V., A.S., M.S., J.M.M., R.A.R., A.V.), Mayo Clinic College of Medicine, Rochester, Minnesota 55905; Department of Information Engineering (C.D.M., C.C.), Universitá di Padova, 35122 Padova, Italy; Center for Neurosciences and Cell Biology (I.V., C.B., C.M., J.G.J.), University of Coimbra, 3000-370 Coimbra, Portugal; and APDP-Portuguese Diabetes Association (J.G.J.), 1250-203 Lisbon, Portugal
| | - Ivan Viegas
- Division of Endocrinology, Diabetes, and Metabolism (R.T.V., A.S., M.S., J.M.M., R.A.R., A.V.), Mayo Clinic College of Medicine, Rochester, Minnesota 55905; Department of Information Engineering (C.D.M., C.C.), Universitá di Padova, 35122 Padova, Italy; Center for Neurosciences and Cell Biology (I.V., C.B., C.M., J.G.J.), University of Coimbra, 3000-370 Coimbra, Portugal; and APDP-Portuguese Diabetes Association (J.G.J.), 1250-203 Lisbon, Portugal
| | - Cristina Barosa
- Division of Endocrinology, Diabetes, and Metabolism (R.T.V., A.S., M.S., J.M.M., R.A.R., A.V.), Mayo Clinic College of Medicine, Rochester, Minnesota 55905; Department of Information Engineering (C.D.M., C.C.), Universitá di Padova, 35122 Padova, Italy; Center for Neurosciences and Cell Biology (I.V., C.B., C.M., J.G.J.), University of Coimbra, 3000-370 Coimbra, Portugal; and APDP-Portuguese Diabetes Association (J.G.J.), 1250-203 Lisbon, Portugal
| | - Catia Marques
- Division of Endocrinology, Diabetes, and Metabolism (R.T.V., A.S., M.S., J.M.M., R.A.R., A.V.), Mayo Clinic College of Medicine, Rochester, Minnesota 55905; Department of Information Engineering (C.D.M., C.C.), Universitá di Padova, 35122 Padova, Italy; Center for Neurosciences and Cell Biology (I.V., C.B., C.M., J.G.J.), University of Coimbra, 3000-370 Coimbra, Portugal; and APDP-Portuguese Diabetes Association (J.G.J.), 1250-203 Lisbon, Portugal
| | - Meera Shah
- Division of Endocrinology, Diabetes, and Metabolism (R.T.V., A.S., M.S., J.M.M., R.A.R., A.V.), Mayo Clinic College of Medicine, Rochester, Minnesota 55905; Department of Information Engineering (C.D.M., C.C.), Universitá di Padova, 35122 Padova, Italy; Center for Neurosciences and Cell Biology (I.V., C.B., C.M., J.G.J.), University of Coimbra, 3000-370 Coimbra, Portugal; and APDP-Portuguese Diabetes Association (J.G.J.), 1250-203 Lisbon, Portugal
| | - John M Miles
- Division of Endocrinology, Diabetes, and Metabolism (R.T.V., A.S., M.S., J.M.M., R.A.R., A.V.), Mayo Clinic College of Medicine, Rochester, Minnesota 55905; Department of Information Engineering (C.D.M., C.C.), Universitá di Padova, 35122 Padova, Italy; Center for Neurosciences and Cell Biology (I.V., C.B., C.M., J.G.J.), University of Coimbra, 3000-370 Coimbra, Portugal; and APDP-Portuguese Diabetes Association (J.G.J.), 1250-203 Lisbon, Portugal
| | - Robert A Rizza
- Division of Endocrinology, Diabetes, and Metabolism (R.T.V., A.S., M.S., J.M.M., R.A.R., A.V.), Mayo Clinic College of Medicine, Rochester, Minnesota 55905; Department of Information Engineering (C.D.M., C.C.), Universitá di Padova, 35122 Padova, Italy; Center for Neurosciences and Cell Biology (I.V., C.B., C.M., J.G.J.), University of Coimbra, 3000-370 Coimbra, Portugal; and APDP-Portuguese Diabetes Association (J.G.J.), 1250-203 Lisbon, Portugal
| | - John G Jones
- Division of Endocrinology, Diabetes, and Metabolism (R.T.V., A.S., M.S., J.M.M., R.A.R., A.V.), Mayo Clinic College of Medicine, Rochester, Minnesota 55905; Department of Information Engineering (C.D.M., C.C.), Universitá di Padova, 35122 Padova, Italy; Center for Neurosciences and Cell Biology (I.V., C.B., C.M., J.G.J.), University of Coimbra, 3000-370 Coimbra, Portugal; and APDP-Portuguese Diabetes Association (J.G.J.), 1250-203 Lisbon, Portugal
| | - Claudio Cobelli
- Division of Endocrinology, Diabetes, and Metabolism (R.T.V., A.S., M.S., J.M.M., R.A.R., A.V.), Mayo Clinic College of Medicine, Rochester, Minnesota 55905; Department of Information Engineering (C.D.M., C.C.), Universitá di Padova, 35122 Padova, Italy; Center for Neurosciences and Cell Biology (I.V., C.B., C.M., J.G.J.), University of Coimbra, 3000-370 Coimbra, Portugal; and APDP-Portuguese Diabetes Association (J.G.J.), 1250-203 Lisbon, Portugal
| | - Adrian Vella
- Division of Endocrinology, Diabetes, and Metabolism (R.T.V., A.S., M.S., J.M.M., R.A.R., A.V.), Mayo Clinic College of Medicine, Rochester, Minnesota 55905; Department of Information Engineering (C.D.M., C.C.), Universitá di Padova, 35122 Padova, Italy; Center for Neurosciences and Cell Biology (I.V., C.B., C.M., J.G.J.), University of Coimbra, 3000-370 Coimbra, Portugal; and APDP-Portuguese Diabetes Association (J.G.J.), 1250-203 Lisbon, Portugal
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127
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Marchetti L, Reali F, Dauriz M, Brangani C, Boselli L, Ceradini G, Bonora E, Bonadonna RC, Priami C. A Novel Insulin/Glucose Model after a Mixed-Meal Test in Patients with Type 1 Diabetes on Insulin Pump Therapy. Sci Rep 2016; 6:36029. [PMID: 27824066 PMCID: PMC5099899 DOI: 10.1038/srep36029] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2016] [Accepted: 10/10/2016] [Indexed: 11/30/2022] Open
Abstract
Current closed-loop insulin delivery methods stem from sophisticated models of the glucose-insulin (G/I) system, mostly based on complex studies employing glucose tracer technology. We tested the performance of a new minimal model (GLUKINSLOOP 2.0) of the G/I system to characterize the glucose and insulin dynamics during multiple mixed meal tests (MMT) of different sizes in patients with type 1 diabetes (T1D) on insulin pump therapy (continuous subcutaneous insulin infusion, CSII). The GLUKINSLOOP 2.0 identified the G/I system, provided a close fit of the G/I time-courses and showed acceptable reproducibility of the G/I system parameters in repeated studies of identical and double-sized MMTs. This model can provide a fairly good and reproducible description of the G/I system in T1D patients on CSII, and it may be applied to create a bank of “virtual” patients. Our results might be relevant at improving the architecture of upcoming closed-loop CSII systems.
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Affiliation(s)
- Luca Marchetti
- The Microsoft Research - University of Trento Centre for Computational and Systems Biology (COSBI), Rovereto (TN), Italy
| | - Federico Reali
- The Microsoft Research - University of Trento Centre for Computational and Systems Biology (COSBI), Rovereto (TN), Italy.,Department of Mathematics, University of Trento, Trento, Italy
| | - Marco Dauriz
- Department of Medicine, Section of Endocrinology, University of Verona School of Medicine, Verona, Italy
| | - Corinna Brangani
- Department of Medicine, Section of Endocrinology, University of Verona School of Medicine, Verona, Italy
| | - Linda Boselli
- Department of Medicine, Section of Endocrinology, University of Verona School of Medicine, Verona, Italy
| | - Giulia Ceradini
- Department of Medicine, Section of Endocrinology, University of Verona School of Medicine, Verona, Italy
| | - Enzo Bonora
- Department of Medicine, Section of Endocrinology, University of Verona School of Medicine, Verona, Italy.,Division of Endocrinology and Metabolic Diseases, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - Riccardo C Bonadonna
- Department of Clinical and Experimental Medicine, University of Parma, Parma, Italy.,Division of Endocrinology, Azienda Ospedaliera Universitaria of Parma, Italy
| | - Corrado Priami
- The Microsoft Research - University of Trento Centre for Computational and Systems Biology (COSBI), Rovereto (TN), Italy.,Department of Mathematics, University of Trento, Trento, Italy
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128
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Vettoretti M, Facchinetti A, Sparacino G, Cobelli C. Predicting Insulin Treatment Scenarios with the Net Effect Method: Domain of Validity. Diabetes Technol Ther 2016; 18:694-704. [PMID: 27860496 DOI: 10.1089/dia.2016.0148] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
BACKGROUND A simulation methodology based on the net effect, a signal estimated from continuous glucose monitoring (CGM) and insulin data accounting for sources of glucose variability, for example, meals and exercise, has been proposed. This method has been recently used to "replay" real-life treatment scenarios and determine the minimal level of CGM sensor accuracy required for nonadjunctive use. Given the potential of the net effect method, it is important to assess its domain of validity. METHODS The UVA/Padova type 1 diabetes simulator is used to generate glucose and insulin data. The net effect signal is estimated and used to predict the glucose profiles resulting from the following therapy modifications: (1) basal insulin increase/decrease, (2) bolus reduction to prevent hypoglycemia, (3) bolus addition after CGM hyperalarms, (4) hypotreatment addition after CGM hypoalarms. Results of the net effect method are compared with the reference provided by the UVA/Padova simulator. RESULTS The net effect method (1) well predicts the effect of small basal insulin adjustments (±10%), but overestimates time in hypo/hyperglycemia for larger adjustments (±50%); (2) underestimates the bolus reduction required to prevent hypoglycemia; (3) underestimates time in hyperglycemia when introducing correction boluses; and (4) overestimates time in hypoglycemia when introducing hypotreatments. CONCLUSIONS The net effect method is reliable for small adjustments of basal insulin, while outside this domain of validity it can provide inaccurate results.
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Affiliation(s)
- Martina Vettoretti
- Department of Information Engineering, University of Padova , Padova, Italy
| | - Andrea Facchinetti
- Department of Information Engineering, University of Padova , Padova, Italy
| | - Giovanni Sparacino
- Department of Information Engineering, University of Padova , Padova, Italy
| | - Claudio Cobelli
- Department of Information Engineering, University of Padova , Padova, Italy
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129
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Shankar SS, Vella A, Raymond RH, Staten MA, Calle RA, Bergman RN, Cao C, Chen D, Cobelli C, Dalla Man C, Deeg M, Dong JQ, Lee DS, Polidori D, Robertson RP, Ruetten H, Stefanovski D, Vassileva MT, Weir GC, Fryburg DA. Standardized Mixed-Meal Tolerance and Arginine Stimulation Tests Provide Reproducible and Complementary Measures of β-Cell Function: Results From the Foundation for the National Institutes of Health Biomarkers Consortium Investigative Series. Diabetes Care 2016; 39:1602-13. [PMID: 27407117 PMCID: PMC5001146 DOI: 10.2337/dc15-0931] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2016] [Accepted: 06/15/2016] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Standardized, reproducible, and feasible quantification of β-cell function (BCF) is necessary for the evaluation of interventions to improve insulin secretion and important for comparison across studies. We therefore characterized the responses to, and reproducibility of, standardized methods of in vivo BCF across different glucose tolerance states. RESEARCH DESIGN AND METHODS Participants classified as having normal glucose tolerance (NGT; n = 23), prediabetes (PDM; n = 17), and type 2 diabetes mellitus (T2DM; n = 22) underwent two standardized mixed-meal tolerance tests (MMTT) and two standardized arginine stimulation tests (AST) in a test-retest paradigm and one frequently sampled intravenous glucose tolerance test (FSIGT). RESULTS From the MMTT, insulin secretion in T2DM was >86% lower compared with NGT or PDM (P < 0.001). Insulin sensitivity (Si) decreased from NGT to PDM (∼50%) to T2DM (93% lower [P < 0.001]). In the AST, insulin secretory response to arginine at basal glucose and during hyperglycemia was lower in T2DM compared with NGT and PDM (>58%; all P < 0.001). FSIGT showed decreases in both insulin secretion and Si across populations (P < 0.001), although Si did not differ significantly between PDM and T2DM populations. Reproducibility was generally good for the MMTT, with intraclass correlation coefficients (ICCs) ranging from ∼0.3 to ∼0.8 depending on population and variable. Reproducibility for the AST was very good, with ICC values >0.8 across all variables and populations. CONCLUSIONS Standardized MMTT and AST provide reproducible and complementary measures of BCF with characteristics favorable for longitudinal interventional trials use.
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Affiliation(s)
- Sudha S Shankar
- Lilly Research Laboratories, Eli Lilly and Company, Indianapolis, IN
| | - Adrian Vella
- Division of Endocrinology, Diabetes & Metabolism, Mayo Clinic College of Medicine, Rochester, MN
| | | | - Myrlene A Staten
- Kelly Government Solutions for National Institute of Diabetes and Digestive and Kidney Diseases, Rockville, MD
| | | | - Richard N Bergman
- Cedars-Sinai Diabetes and Obesity Research Institute, Los Angeles, CA
| | - Charlie Cao
- Takeda Development Center Americas, Deerfield, IL
| | | | - Claudio Cobelli
- Department of Information Engineering, University of Padova, Padova, Italy
| | - Chiara Dalla Man
- Department of Information Engineering, University of Padova, Padova, Italy
| | - Mark Deeg
- Lilly Research Laboratories, Eli Lilly and Company, Indianapolis, IN
| | | | | | | | - R Paul Robertson
- Pacific Northwest Diabetes Research Institute, Seattle, WA Division of Endocrinology, Departments of Medicine and Pharmacology, University of Washington, Seattle, WA
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130
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Lim MH, Oh TJ, Choi K, Lee JC, Cho YM, Kim S. Application of the Oral Minimal Model to Korean Subjects with Normal Glucose Tolerance and Type 2 Diabetes Mellitus. Diabetes Metab J 2016; 40:308-17. [PMID: 27273909 PMCID: PMC4995186 DOI: 10.4093/dmj.2016.40.4.308] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2015] [Accepted: 08/28/2015] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND The oral minimal model is a simple, useful tool for the assessment of β-cell function and insulin sensitivity across the spectrum of glucose tolerance, including normal glucose tolerance (NGT), prediabetes, and type 2 diabetes mellitus (T2DM) in humans. METHODS Plasma glucose, insulin, and C-peptide levels were measured during a 180-minute, 75-g oral glucose tolerance test in 24 Korean subjects with NGT (n=10) and T2DM (n=14). The parameters in the computational model were estimated, and the indexes for insulin sensitivity and β-cell function were compared between the NGT and T2DM groups. RESULTS The insulin sensitivity index was lower in the T2DM group than the NGT group. The basal index of β-cell responsivity, basal hepatic insulin extraction ratio, and post-glucose challenge hepatic insulin extraction ratio were not different between the NGT and T2DM groups. The dynamic, static, and total β-cell responsivity indexes were significantly lower in the T2DM group than the NGT group. The dynamic, static, and total disposition indexes were also significantly lower in the T2DM group than the NGT group. CONCLUSION The oral minimal model can be reproducibly applied to evaluate β-cell function and insulin sensitivity in Koreans.
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Affiliation(s)
- Min Hyuk Lim
- Department of Biomedical Engineering, Seoul National University College of Medicine, Seoul, Korea
| | - Tae Jung Oh
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Karam Choi
- Interdisciplinary Program of Bioengineering, Seoul National University College of Engineering, Seoul, Korea
| | - Jung Chan Lee
- Department of Biomedical Engineering, Seoul National University College of Medicine, Seoul, Korea
| | - Young Min Cho
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea.
| | - Sungwan Kim
- Department of Biomedical Engineering, Seoul National University College of Medicine, Seoul, Korea.
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131
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Shaw ND, McHill AW, Schiavon M, Kangarloo T, Mankowski PW, Cobelli C, Klerman EB, Hall JE. Effect of Slow Wave Sleep Disruption on Metabolic Parameters in Adolescents. Sleep 2016; 39:1591-9. [PMID: 27166229 DOI: 10.5665/sleep.6028] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2015] [Accepted: 03/28/2016] [Indexed: 12/31/2022] Open
Abstract
STUDY OBJECTIVES Cross-sectional studies report a correlation between slow wave sleep (SWS) duration and insulin sensitivity (SI) in children and adults. Suppression of SWS causes insulin resistance in adults but effects in children are unknown. This study was designed to determine the effect of SWS fragmentation on SI in children. METHODS Fourteen pubertal children (11.3-14.1 y, body mass index 29(th) to 97(th) percentile) were randomized to sleep studies and mixed meal (MM) tolerance tests with and without SWS disruption. Beta-cell responsiveness (Φ) and SI were determined using oral minimal modeling. RESULTS During the disruption night, auditory stimuli (68.1 ± 10.7/night; mean ± standard error) decreased SWS by 40.0 ± 8.0%. SWS fragmentation did not affect fasting glucose (non-disrupted 76.9 ± 2.3 versus disrupted 80.6 ± 2.1 mg/dL), insulin (9.2 ± 1.6 versus 10.4 ± 2.0 μIU/mL), or C-peptide (1.9 ± 0.2 versus 1.9 ± 0.1 ng/mL) levels and did not impair SI (12.9 ± 2.3 versus 10.1 ± 1.6 10(-4) dL/kg/min per μIU/mL) or Φ (73.4 ± 7.8 versus 74.4 ± 8.4 10(-9) min(-1)) to a MM challenge. Only the subjects in the most insulin-sensitive tertile demonstrated a consistent decrease in SI after SWS disruption. CONCLUSION Pubertal children across a range of body mass indices may be resistant to the adverse metabolic effects of acute SWS disruption. Only those subjects with high SI (i.e., having the greatest "metabolic reserve") demonstrated a consistent decrease in SI. These results suggest that adolescents may have a unique ability to adapt to metabolic stressors, such as acute SWS disruption, to maintain euglycemia. Additional studies are necessary to confirm that this resiliency is maintained in settings of chronic SWS disruption.
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Affiliation(s)
- Natalie D Shaw
- Reproductive Endocrine Unit, Department of Medicine, Massachusetts General Hospital, Boston, MA.,Clinical Research Branch, National Institute of Environmental Health Sciences (NIEHS), Research Triangle Park, NC
| | - Andrew W McHill
- Division of Sleep and Circadian Disorders, The Brigham and Women's Hospital, Boston MA.,Division of Sleep Medicine, Harvard Medical School, Boston MA
| | - Michele Schiavon
- Department of Information Engineering, University of Padova, Padova, Italy
| | - Tairmae Kangarloo
- Reproductive Endocrine Unit, Department of Medicine, Massachusetts General Hospital, Boston, MA
| | - Piotr W Mankowski
- Division of Sleep and Circadian Disorders, The Brigham and Women's Hospital, Boston MA.,Division of Sleep Medicine, Harvard Medical School, Boston MA
| | - Claudio Cobelli
- Department of Information Engineering, University of Padova, Padova, Italy
| | - Elizabeth B Klerman
- Division of Sleep and Circadian Disorders, The Brigham and Women's Hospital, Boston MA.,Division of Sleep Medicine, Harvard Medical School, Boston MA
| | - Janet E Hall
- Reproductive Endocrine Unit, Department of Medicine, Massachusetts General Hospital, Boston, MA.,Clinical Research Branch, National Institute of Environmental Health Sciences (NIEHS), Research Triangle Park, NC
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132
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Siebel AL, Trinh SK, Formosa MF, Mundra PA, Natoli AK, Reddy-Luthmoodoo M, Huynh K, Khan AA, Carey AL, van Hall G, Cobelli C, Dalla-Man C, Otvos JD, Rye KA, Johansson J, Gordon A, Wong NCW, Sviridov D, Barter P, Duffy SJ, Meikle PJ, Kingwell BA. Effects of the BET-inhibitor, RVX-208 on the HDL lipidome and glucose metabolism in individuals with prediabetes: A randomized controlled trial. Metabolism 2016; 65:904-14. [PMID: 27173469 DOI: 10.1016/j.metabol.2016.03.002] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2015] [Revised: 02/18/2016] [Accepted: 03/03/2016] [Indexed: 12/14/2022]
Abstract
AIMS High-density lipoprotein (HDL) and apolipoprotein A-I (apoA-I) can modulate glucose metabolism through multiple mechanisms. This study determined the effects of a novel bromodomain and extra-terminal (BET) inhibitor (RVX-208) and putative apoA-I inducer on lipid species contained within HDL (HDL lipidome) and glucose metabolism. MATERIALS AND METHODS Twenty unmedicated males with prediabetes received 100mg b.i.d. RVX-208 and placebo for 29-33days separated by a wash-out period in a randomized, cross-over design trial. Plasma HDL-cholesterol and apoA-I were assessed as well as lipoprotein particle size and distribution using NMR spectroscopy. An oral glucose tolerance test (OGTT) protocol with oral and infused stable isotope tracers was employed to assess postprandial plasma glucose, indices of insulin secretion and insulin sensitivity, glucose kinetics and lipolysis. Whole plasma and HDL lipid profiles were measured using mass spectrometry. RESULTS RVX-208 treatment for 4weeks increased 6 sphingolipid and 4 phospholipid classes in the HDL lipidome (p≤0.05 versus placebo), but did not change conventional clinical lipid measures. The concentration of medium-sized HDL particles increased by 11% (P=0.01) and small-sized HDL particles decreased by 10% (P=0.04) after RVX-208 treatment. In response to a glucose load, after RVX-208 treatment, plasma glucose peaked at a similar level to placebo, but 30min later with a more sustained elevation (treatment effect, P=0.003). There was a reduction and delay in total (P=0.001) and oral (P=0.003) glucose rates of appearance in plasma and suppression of endogenous glucose production (P=0.014) after RVX-208 treatment. The rate of glucose disappearance was also lower following RVX-208 (P=0.016), with no effect on glucose oxidation or total glucose disposal. CONCLUSIONS RVX-208 increased 10 lipid classes in the plasma HDL fraction, without altering the concentrations of either apoA-I or HDL-cholesterol (HDL-C). RVX-208 delayed and reduced oral glucose absorption and endogenous glucose production, with plasma glucose maintained via reduced peripheral glucose disposal. If sustained, these effects may protect against the development of type 2 diabetes.
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Affiliation(s)
- Andrew L Siebel
- Baker IDI Heart and Diabetes Institute, Melbourne, Australia
| | - Si Khiang Trinh
- Baker IDI Heart and Diabetes Institute, Melbourne, Australia
| | | | | | - Alaina K Natoli
- Baker IDI Heart and Diabetes Institute, Melbourne, Australia
| | | | - Kevin Huynh
- Baker IDI Heart and Diabetes Institute, Melbourne, Australia
| | - Anmar A Khan
- Baker IDI Heart and Diabetes Institute, Melbourne, Australia
| | - Andrew L Carey
- Baker IDI Heart and Diabetes Institute, Melbourne, Australia
| | - Gerrit van Hall
- Department of Biomedical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Claudio Cobelli
- Department of Information Engineering, University of Padova, Padova, Italy
| | - Chiara Dalla-Man
- Department of Information Engineering, University of Padova, Padova, Italy
| | | | - Kerry-Anne Rye
- School of Medical Sciences, Faculty of Medicine, University of New South Wales, Sydney, Australia
| | | | | | | | - Dmitri Sviridov
- Baker IDI Heart and Diabetes Institute, Melbourne, Australia
| | - Philip Barter
- School of Medical Sciences, Faculty of Medicine, University of New South Wales, Sydney, Australia
| | | | - Peter J Meikle
- Baker IDI Heart and Diabetes Institute, Melbourne, Australia
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133
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Shankar SS, Shankar RR, Mixson LA, Miller DL, Chung C, Cilissen C, Beals CR, Stoch SA, Steinberg HO, Kelley DE. Linearity of β-cell response across the metabolic spectrum and to pharmacology: insights from a graded glucose infusion-based investigation series. Am J Physiol Endocrinol Metab 2016; 310:E865-73. [PMID: 27072496 DOI: 10.1152/ajpendo.00527.2015] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2015] [Accepted: 04/05/2016] [Indexed: 11/22/2022]
Abstract
The graded glucose infusion (GGI) examines insulin secretory response patterns to continuously escalating glycemia. The current study series sought to more fully appraise its performance characteristics. Key questions addressed were comparison of the GGI to the hyperglycemic clamp (HGC), comparison of insulin secretory response patterns across three volunteer populations known to differ in β-cell function (healthy nonobese, obese nondiabetic, and type 2 diabetic), and characterization of effects of known insulin secretagogues in the context of a GGI. Insulin secretory response was measured as changes in insulin, C-peptide, insulin secretion rates (ISR), and ratio of ISR to prevailing glucose (ISR/G). The GGI correlated well with the HGC (r = 0.72 for ISR/G, P < 0.01). The insulin secretory response in type 2 diabetes (T2DM) was significantly blunted (P < 0.001), whereas it was significantly increased in obese nondiabetics compared with healthy nonobese (P < 0.001). Finally, robust (P < 0.001 over placebo) pharmacological effects were observed in T2DM and healthy nonobese volunteers. Collectively, the findings of this investigational series bolster confidence that the GGI has solid attributes for assessing insulin secretory response to glucose across populations and pharmacology. Notably, the coupling of insulin secretory response to glycemic changes was distinctly and uniformly linear across populations and in the context of insulin secretagogues. (Clinical Trial Registration Nos. NCT00782418, NCT01055340, NCT01373450).
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Affiliation(s)
| | | | | | | | | | | | - Chan R Beals
- Merck & Company, Inc., Kenilworth, New Jersey; and
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134
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Konopka AR, Esponda RR, Robinson MM, Johnson ML, Carter RE, Schiavon M, Cobelli C, Wondisford FE, Lanza IR, Nair KS. Hyperglucagonemia Mitigates the Effect of Metformin on Glucose Production in Prediabetes. Cell Rep 2016; 15:1394-1400. [PMID: 27160898 DOI: 10.1016/j.celrep.2016.04.024] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2015] [Revised: 02/17/2016] [Accepted: 04/01/2016] [Indexed: 12/11/2022] Open
Abstract
The therapeutic mechanism of metformin action remains incompletely understood. Whether metformin inhibits glucagon-stimulated endogenous glucose production (EGP), as in preclinical studies, is unclear in humans. To test this hypothesis, we studied nine prediabetic individuals using a randomized, placebo-controlled, double-blinded, crossover study design. Metformin increased glucose tolerance, insulin sensitivity, and plasma glucagon. Metformin did not alter average basal EGP, although individual variability in EGP correlated with plasma glucagon. Metformin increased basal EGP in individuals with severe hyperglucagonemia (>150 pg/ml). Decreased fasting glucose after metformin treatment appears to increase glucagon to stimulate EGP and prevent further declines in glucose. Similarly, intravenous glucagon infusion elevated plasma glucagon (>150 pg/ml) and stimulated a greater increase in EGP during metformin therapy. Metformin also counteracted the protein-catabolic effect of glucagon. Collectively, these data indicate that metformin does not inhibit glucagon-stimulated EGP, but hyperglucagonemia may decrease the ability of the metformin to lower EGP in prediabetic individuals.
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Affiliation(s)
- Adam R Konopka
- Division of Endocrinology, Mayo Clinic, Rochester, MN 55905, USA
| | | | | | | | - Rickey E Carter
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN 55905, USA
| | - Michele Schiavon
- Department of Information Engineering, University of Padova, 35131 Padova, Italy
| | - Claudio Cobelli
- Department of Information Engineering, University of Padova, 35131 Padova, Italy
| | - Fredric E Wondisford
- Department of Medicine, Rutgers-Robert Wood Johnson Medical School, New Brunswick, NJ 08901, USA
| | - Ian R Lanza
- Division of Endocrinology, Mayo Clinic, Rochester, MN 55905, USA
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135
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Kovatchev B, Cobelli C. Glucose Variability: Timing, Risk Analysis, and Relationship to Hypoglycemia in Diabetes. Diabetes Care 2016; 39:502-10. [PMID: 27208366 PMCID: PMC4806774 DOI: 10.2337/dc15-2035] [Citation(s) in RCA: 157] [Impact Index Per Article: 19.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2015] [Accepted: 01/21/2016] [Indexed: 02/03/2023]
Abstract
Glucose control, glucose variability (GV), and risk for hypoglycemia are intimately related, and it is now evident that GV is important in both the physiology and pathophysiology of diabetes. However, its quantitative assessment is complex because blood glucose (BG) fluctuations are characterized by both amplitude and timing. Additional numerical complications arise from the asymmetry of the BG scale. In this Perspective, we focus on the acute manifestations of GV, particularly on hypoglycemia, and review measures assessing the amplitude of GV from routine self-monitored BG data, as well as its timing from continuous glucose monitoring (CGM) data. With availability of CGM, the latter is not only possible but also a requirement-we can now assess rapid glucose fluctuations in real time and relate their speed and magnitude to clinically relevant outcomes. Our primary message is that diabetes control is all about optimization and balance between two key markers-frequency of hypoglycemia and HbA1c reflecting average BG and primarily driven by the extent of hyperglycemia. GV is a primary barrier to this optimization, including to automated technologies such as the "artificial pancreas." Thus, it is time to standardize GV measurement and thereby streamline the assessment of its two most important components-amplitude and timing.
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Affiliation(s)
- Boris Kovatchev
- Center for Diabetes Technology, University of Virginia, Charlottesville, VA
| | - Claudio Cobelli
- Department of Information Engineering, University of Padova, Padova, Italy
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136
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Sharma NK, Sajuthi SP, Chou JW, Calles-Escandon J, Demons J, Rogers S, Ma L, Palmer ND, McWilliams DR, Beal J, Comeau ME, Cherry K, Hawkins GA, Menon L, Kouba E, Davis D, Burris M, Byerly SJ, Easter L, Bowden DW, Freedman BI, Langefeld CD, Das SK. Tissue-Specific and Genetic Regulation of Insulin Sensitivity-Associated Transcripts in African Americans. J Clin Endocrinol Metab 2016; 101:1455-68. [PMID: 26789776 PMCID: PMC4880154 DOI: 10.1210/jc.2015-3336] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Integrative multiomics analyses of adipose and muscle tissue transcripts, S, and genotypes revealed novel genetic regulatory mechanisms of insulin resistance in African Americans.
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Affiliation(s)
- Neeraj K Sharma
- Department of Internal Medicine (N.K.S., J.C.-E., J.D., S.R., L.Ma., K.C., L.Me., E.K., D.D., B.I.F., S.K.D.), Center for Public Health Genomics (N.K.S., S.P.S., J.W.C., L.Ma., N.D.P., D.R.M., M.C., G.A.H., B.I.F., C.D.L., S.K.D.), Department of Biostatistical Sciences, Division of Public Health Sciences (S.P.S., J.W.C., D.R.M., J.B., M.C., C.D.L.), Department of Biochemistry (N.D.P., D.W.B.), Center for Diabetes Research and Center for Genomics and Personalized Medicine Research (N.D.P., G.A.H., D.W.B., B.I.F.), and Clinical Research Unit, Biomedical Research Services and Administration (M.B., S.J.B., L.E.), Wake Forest School of Medicine, Winston-Salem, North Carolina 27157
| | - Satria P Sajuthi
- Department of Internal Medicine (N.K.S., J.C.-E., J.D., S.R., L.Ma., K.C., L.Me., E.K., D.D., B.I.F., S.K.D.), Center for Public Health Genomics (N.K.S., S.P.S., J.W.C., L.Ma., N.D.P., D.R.M., M.C., G.A.H., B.I.F., C.D.L., S.K.D.), Department of Biostatistical Sciences, Division of Public Health Sciences (S.P.S., J.W.C., D.R.M., J.B., M.C., C.D.L.), Department of Biochemistry (N.D.P., D.W.B.), Center for Diabetes Research and Center for Genomics and Personalized Medicine Research (N.D.P., G.A.H., D.W.B., B.I.F.), and Clinical Research Unit, Biomedical Research Services and Administration (M.B., S.J.B., L.E.), Wake Forest School of Medicine, Winston-Salem, North Carolina 27157
| | - Jeff W Chou
- Department of Internal Medicine (N.K.S., J.C.-E., J.D., S.R., L.Ma., K.C., L.Me., E.K., D.D., B.I.F., S.K.D.), Center for Public Health Genomics (N.K.S., S.P.S., J.W.C., L.Ma., N.D.P., D.R.M., M.C., G.A.H., B.I.F., C.D.L., S.K.D.), Department of Biostatistical Sciences, Division of Public Health Sciences (S.P.S., J.W.C., D.R.M., J.B., M.C., C.D.L.), Department of Biochemistry (N.D.P., D.W.B.), Center for Diabetes Research and Center for Genomics and Personalized Medicine Research (N.D.P., G.A.H., D.W.B., B.I.F.), and Clinical Research Unit, Biomedical Research Services and Administration (M.B., S.J.B., L.E.), Wake Forest School of Medicine, Winston-Salem, North Carolina 27157
| | - Jorge Calles-Escandon
- Department of Internal Medicine (N.K.S., J.C.-E., J.D., S.R., L.Ma., K.C., L.Me., E.K., D.D., B.I.F., S.K.D.), Center for Public Health Genomics (N.K.S., S.P.S., J.W.C., L.Ma., N.D.P., D.R.M., M.C., G.A.H., B.I.F., C.D.L., S.K.D.), Department of Biostatistical Sciences, Division of Public Health Sciences (S.P.S., J.W.C., D.R.M., J.B., M.C., C.D.L.), Department of Biochemistry (N.D.P., D.W.B.), Center for Diabetes Research and Center for Genomics and Personalized Medicine Research (N.D.P., G.A.H., D.W.B., B.I.F.), and Clinical Research Unit, Biomedical Research Services and Administration (M.B., S.J.B., L.E.), Wake Forest School of Medicine, Winston-Salem, North Carolina 27157
| | - Jamehl Demons
- Department of Internal Medicine (N.K.S., J.C.-E., J.D., S.R., L.Ma., K.C., L.Me., E.K., D.D., B.I.F., S.K.D.), Center for Public Health Genomics (N.K.S., S.P.S., J.W.C., L.Ma., N.D.P., D.R.M., M.C., G.A.H., B.I.F., C.D.L., S.K.D.), Department of Biostatistical Sciences, Division of Public Health Sciences (S.P.S., J.W.C., D.R.M., J.B., M.C., C.D.L.), Department of Biochemistry (N.D.P., D.W.B.), Center for Diabetes Research and Center for Genomics and Personalized Medicine Research (N.D.P., G.A.H., D.W.B., B.I.F.), and Clinical Research Unit, Biomedical Research Services and Administration (M.B., S.J.B., L.E.), Wake Forest School of Medicine, Winston-Salem, North Carolina 27157
| | - Samantha Rogers
- Department of Internal Medicine (N.K.S., J.C.-E., J.D., S.R., L.Ma., K.C., L.Me., E.K., D.D., B.I.F., S.K.D.), Center for Public Health Genomics (N.K.S., S.P.S., J.W.C., L.Ma., N.D.P., D.R.M., M.C., G.A.H., B.I.F., C.D.L., S.K.D.), Department of Biostatistical Sciences, Division of Public Health Sciences (S.P.S., J.W.C., D.R.M., J.B., M.C., C.D.L.), Department of Biochemistry (N.D.P., D.W.B.), Center for Diabetes Research and Center for Genomics and Personalized Medicine Research (N.D.P., G.A.H., D.W.B., B.I.F.), and Clinical Research Unit, Biomedical Research Services and Administration (M.B., S.J.B., L.E.), Wake Forest School of Medicine, Winston-Salem, North Carolina 27157
| | - Lijun Ma
- Department of Internal Medicine (N.K.S., J.C.-E., J.D., S.R., L.Ma., K.C., L.Me., E.K., D.D., B.I.F., S.K.D.), Center for Public Health Genomics (N.K.S., S.P.S., J.W.C., L.Ma., N.D.P., D.R.M., M.C., G.A.H., B.I.F., C.D.L., S.K.D.), Department of Biostatistical Sciences, Division of Public Health Sciences (S.P.S., J.W.C., D.R.M., J.B., M.C., C.D.L.), Department of Biochemistry (N.D.P., D.W.B.), Center for Diabetes Research and Center for Genomics and Personalized Medicine Research (N.D.P., G.A.H., D.W.B., B.I.F.), and Clinical Research Unit, Biomedical Research Services and Administration (M.B., S.J.B., L.E.), Wake Forest School of Medicine, Winston-Salem, North Carolina 27157
| | - Nicholette D Palmer
- Department of Internal Medicine (N.K.S., J.C.-E., J.D., S.R., L.Ma., K.C., L.Me., E.K., D.D., B.I.F., S.K.D.), Center for Public Health Genomics (N.K.S., S.P.S., J.W.C., L.Ma., N.D.P., D.R.M., M.C., G.A.H., B.I.F., C.D.L., S.K.D.), Department of Biostatistical Sciences, Division of Public Health Sciences (S.P.S., J.W.C., D.R.M., J.B., M.C., C.D.L.), Department of Biochemistry (N.D.P., D.W.B.), Center for Diabetes Research and Center for Genomics and Personalized Medicine Research (N.D.P., G.A.H., D.W.B., B.I.F.), and Clinical Research Unit, Biomedical Research Services and Administration (M.B., S.J.B., L.E.), Wake Forest School of Medicine, Winston-Salem, North Carolina 27157
| | - David R McWilliams
- Department of Internal Medicine (N.K.S., J.C.-E., J.D., S.R., L.Ma., K.C., L.Me., E.K., D.D., B.I.F., S.K.D.), Center for Public Health Genomics (N.K.S., S.P.S., J.W.C., L.Ma., N.D.P., D.R.M., M.C., G.A.H., B.I.F., C.D.L., S.K.D.), Department of Biostatistical Sciences, Division of Public Health Sciences (S.P.S., J.W.C., D.R.M., J.B., M.C., C.D.L.), Department of Biochemistry (N.D.P., D.W.B.), Center for Diabetes Research and Center for Genomics and Personalized Medicine Research (N.D.P., G.A.H., D.W.B., B.I.F.), and Clinical Research Unit, Biomedical Research Services and Administration (M.B., S.J.B., L.E.), Wake Forest School of Medicine, Winston-Salem, North Carolina 27157
| | - John Beal
- Department of Internal Medicine (N.K.S., J.C.-E., J.D., S.R., L.Ma., K.C., L.Me., E.K., D.D., B.I.F., S.K.D.), Center for Public Health Genomics (N.K.S., S.P.S., J.W.C., L.Ma., N.D.P., D.R.M., M.C., G.A.H., B.I.F., C.D.L., S.K.D.), Department of Biostatistical Sciences, Division of Public Health Sciences (S.P.S., J.W.C., D.R.M., J.B., M.C., C.D.L.), Department of Biochemistry (N.D.P., D.W.B.), Center for Diabetes Research and Center for Genomics and Personalized Medicine Research (N.D.P., G.A.H., D.W.B., B.I.F.), and Clinical Research Unit, Biomedical Research Services and Administration (M.B., S.J.B., L.E.), Wake Forest School of Medicine, Winston-Salem, North Carolina 27157
| | - Mary E Comeau
- Department of Internal Medicine (N.K.S., J.C.-E., J.D., S.R., L.Ma., K.C., L.Me., E.K., D.D., B.I.F., S.K.D.), Center for Public Health Genomics (N.K.S., S.P.S., J.W.C., L.Ma., N.D.P., D.R.M., M.C., G.A.H., B.I.F., C.D.L., S.K.D.), Department of Biostatistical Sciences, Division of Public Health Sciences (S.P.S., J.W.C., D.R.M., J.B., M.C., C.D.L.), Department of Biochemistry (N.D.P., D.W.B.), Center for Diabetes Research and Center for Genomics and Personalized Medicine Research (N.D.P., G.A.H., D.W.B., B.I.F.), and Clinical Research Unit, Biomedical Research Services and Administration (M.B., S.J.B., L.E.), Wake Forest School of Medicine, Winston-Salem, North Carolina 27157
| | - Kristina Cherry
- Department of Internal Medicine (N.K.S., J.C.-E., J.D., S.R., L.Ma., K.C., L.Me., E.K., D.D., B.I.F., S.K.D.), Center for Public Health Genomics (N.K.S., S.P.S., J.W.C., L.Ma., N.D.P., D.R.M., M.C., G.A.H., B.I.F., C.D.L., S.K.D.), Department of Biostatistical Sciences, Division of Public Health Sciences (S.P.S., J.W.C., D.R.M., J.B., M.C., C.D.L.), Department of Biochemistry (N.D.P., D.W.B.), Center for Diabetes Research and Center for Genomics and Personalized Medicine Research (N.D.P., G.A.H., D.W.B., B.I.F.), and Clinical Research Unit, Biomedical Research Services and Administration (M.B., S.J.B., L.E.), Wake Forest School of Medicine, Winston-Salem, North Carolina 27157
| | - Gregory A Hawkins
- Department of Internal Medicine (N.K.S., J.C.-E., J.D., S.R., L.Ma., K.C., L.Me., E.K., D.D., B.I.F., S.K.D.), Center for Public Health Genomics (N.K.S., S.P.S., J.W.C., L.Ma., N.D.P., D.R.M., M.C., G.A.H., B.I.F., C.D.L., S.K.D.), Department of Biostatistical Sciences, Division of Public Health Sciences (S.P.S., J.W.C., D.R.M., J.B., M.C., C.D.L.), Department of Biochemistry (N.D.P., D.W.B.), Center for Diabetes Research and Center for Genomics and Personalized Medicine Research (N.D.P., G.A.H., D.W.B., B.I.F.), and Clinical Research Unit, Biomedical Research Services and Administration (M.B., S.J.B., L.E.), Wake Forest School of Medicine, Winston-Salem, North Carolina 27157
| | - Lata Menon
- Department of Internal Medicine (N.K.S., J.C.-E., J.D., S.R., L.Ma., K.C., L.Me., E.K., D.D., B.I.F., S.K.D.), Center for Public Health Genomics (N.K.S., S.P.S., J.W.C., L.Ma., N.D.P., D.R.M., M.C., G.A.H., B.I.F., C.D.L., S.K.D.), Department of Biostatistical Sciences, Division of Public Health Sciences (S.P.S., J.W.C., D.R.M., J.B., M.C., C.D.L.), Department of Biochemistry (N.D.P., D.W.B.), Center for Diabetes Research and Center for Genomics and Personalized Medicine Research (N.D.P., G.A.H., D.W.B., B.I.F.), and Clinical Research Unit, Biomedical Research Services and Administration (M.B., S.J.B., L.E.), Wake Forest School of Medicine, Winston-Salem, North Carolina 27157
| | - Ethel Kouba
- Department of Internal Medicine (N.K.S., J.C.-E., J.D., S.R., L.Ma., K.C., L.Me., E.K., D.D., B.I.F., S.K.D.), Center for Public Health Genomics (N.K.S., S.P.S., J.W.C., L.Ma., N.D.P., D.R.M., M.C., G.A.H., B.I.F., C.D.L., S.K.D.), Department of Biostatistical Sciences, Division of Public Health Sciences (S.P.S., J.W.C., D.R.M., J.B., M.C., C.D.L.), Department of Biochemistry (N.D.P., D.W.B.), Center for Diabetes Research and Center for Genomics and Personalized Medicine Research (N.D.P., G.A.H., D.W.B., B.I.F.), and Clinical Research Unit, Biomedical Research Services and Administration (M.B., S.J.B., L.E.), Wake Forest School of Medicine, Winston-Salem, North Carolina 27157
| | - Donna Davis
- Department of Internal Medicine (N.K.S., J.C.-E., J.D., S.R., L.Ma., K.C., L.Me., E.K., D.D., B.I.F., S.K.D.), Center for Public Health Genomics (N.K.S., S.P.S., J.W.C., L.Ma., N.D.P., D.R.M., M.C., G.A.H., B.I.F., C.D.L., S.K.D.), Department of Biostatistical Sciences, Division of Public Health Sciences (S.P.S., J.W.C., D.R.M., J.B., M.C., C.D.L.), Department of Biochemistry (N.D.P., D.W.B.), Center for Diabetes Research and Center for Genomics and Personalized Medicine Research (N.D.P., G.A.H., D.W.B., B.I.F.), and Clinical Research Unit, Biomedical Research Services and Administration (M.B., S.J.B., L.E.), Wake Forest School of Medicine, Winston-Salem, North Carolina 27157
| | - Marcie Burris
- Department of Internal Medicine (N.K.S., J.C.-E., J.D., S.R., L.Ma., K.C., L.Me., E.K., D.D., B.I.F., S.K.D.), Center for Public Health Genomics (N.K.S., S.P.S., J.W.C., L.Ma., N.D.P., D.R.M., M.C., G.A.H., B.I.F., C.D.L., S.K.D.), Department of Biostatistical Sciences, Division of Public Health Sciences (S.P.S., J.W.C., D.R.M., J.B., M.C., C.D.L.), Department of Biochemistry (N.D.P., D.W.B.), Center for Diabetes Research and Center for Genomics and Personalized Medicine Research (N.D.P., G.A.H., D.W.B., B.I.F.), and Clinical Research Unit, Biomedical Research Services and Administration (M.B., S.J.B., L.E.), Wake Forest School of Medicine, Winston-Salem, North Carolina 27157
| | - Sara J Byerly
- Department of Internal Medicine (N.K.S., J.C.-E., J.D., S.R., L.Ma., K.C., L.Me., E.K., D.D., B.I.F., S.K.D.), Center for Public Health Genomics (N.K.S., S.P.S., J.W.C., L.Ma., N.D.P., D.R.M., M.C., G.A.H., B.I.F., C.D.L., S.K.D.), Department of Biostatistical Sciences, Division of Public Health Sciences (S.P.S., J.W.C., D.R.M., J.B., M.C., C.D.L.), Department of Biochemistry (N.D.P., D.W.B.), Center for Diabetes Research and Center for Genomics and Personalized Medicine Research (N.D.P., G.A.H., D.W.B., B.I.F.), and Clinical Research Unit, Biomedical Research Services and Administration (M.B., S.J.B., L.E.), Wake Forest School of Medicine, Winston-Salem, North Carolina 27157
| | - Linda Easter
- Department of Internal Medicine (N.K.S., J.C.-E., J.D., S.R., L.Ma., K.C., L.Me., E.K., D.D., B.I.F., S.K.D.), Center for Public Health Genomics (N.K.S., S.P.S., J.W.C., L.Ma., N.D.P., D.R.M., M.C., G.A.H., B.I.F., C.D.L., S.K.D.), Department of Biostatistical Sciences, Division of Public Health Sciences (S.P.S., J.W.C., D.R.M., J.B., M.C., C.D.L.), Department of Biochemistry (N.D.P., D.W.B.), Center for Diabetes Research and Center for Genomics and Personalized Medicine Research (N.D.P., G.A.H., D.W.B., B.I.F.), and Clinical Research Unit, Biomedical Research Services and Administration (M.B., S.J.B., L.E.), Wake Forest School of Medicine, Winston-Salem, North Carolina 27157
| | - Donald W Bowden
- Department of Internal Medicine (N.K.S., J.C.-E., J.D., S.R., L.Ma., K.C., L.Me., E.K., D.D., B.I.F., S.K.D.), Center for Public Health Genomics (N.K.S., S.P.S., J.W.C., L.Ma., N.D.P., D.R.M., M.C., G.A.H., B.I.F., C.D.L., S.K.D.), Department of Biostatistical Sciences, Division of Public Health Sciences (S.P.S., J.W.C., D.R.M., J.B., M.C., C.D.L.), Department of Biochemistry (N.D.P., D.W.B.), Center for Diabetes Research and Center for Genomics and Personalized Medicine Research (N.D.P., G.A.H., D.W.B., B.I.F.), and Clinical Research Unit, Biomedical Research Services and Administration (M.B., S.J.B., L.E.), Wake Forest School of Medicine, Winston-Salem, North Carolina 27157
| | - Barry I Freedman
- Department of Internal Medicine (N.K.S., J.C.-E., J.D., S.R., L.Ma., K.C., L.Me., E.K., D.D., B.I.F., S.K.D.), Center for Public Health Genomics (N.K.S., S.P.S., J.W.C., L.Ma., N.D.P., D.R.M., M.C., G.A.H., B.I.F., C.D.L., S.K.D.), Department of Biostatistical Sciences, Division of Public Health Sciences (S.P.S., J.W.C., D.R.M., J.B., M.C., C.D.L.), Department of Biochemistry (N.D.P., D.W.B.), Center for Diabetes Research and Center for Genomics and Personalized Medicine Research (N.D.P., G.A.H., D.W.B., B.I.F.), and Clinical Research Unit, Biomedical Research Services and Administration (M.B., S.J.B., L.E.), Wake Forest School of Medicine, Winston-Salem, North Carolina 27157
| | - Carl D Langefeld
- Department of Internal Medicine (N.K.S., J.C.-E., J.D., S.R., L.Ma., K.C., L.Me., E.K., D.D., B.I.F., S.K.D.), Center for Public Health Genomics (N.K.S., S.P.S., J.W.C., L.Ma., N.D.P., D.R.M., M.C., G.A.H., B.I.F., C.D.L., S.K.D.), Department of Biostatistical Sciences, Division of Public Health Sciences (S.P.S., J.W.C., D.R.M., J.B., M.C., C.D.L.), Department of Biochemistry (N.D.P., D.W.B.), Center for Diabetes Research and Center for Genomics and Personalized Medicine Research (N.D.P., G.A.H., D.W.B., B.I.F.), and Clinical Research Unit, Biomedical Research Services and Administration (M.B., S.J.B., L.E.), Wake Forest School of Medicine, Winston-Salem, North Carolina 27157
| | - Swapan K Das
- Department of Internal Medicine (N.K.S., J.C.-E., J.D., S.R., L.Ma., K.C., L.Me., E.K., D.D., B.I.F., S.K.D.), Center for Public Health Genomics (N.K.S., S.P.S., J.W.C., L.Ma., N.D.P., D.R.M., M.C., G.A.H., B.I.F., C.D.L., S.K.D.), Department of Biostatistical Sciences, Division of Public Health Sciences (S.P.S., J.W.C., D.R.M., J.B., M.C., C.D.L.), Department of Biochemistry (N.D.P., D.W.B.), Center for Diabetes Research and Center for Genomics and Personalized Medicine Research (N.D.P., G.A.H., D.W.B., B.I.F.), and Clinical Research Unit, Biomedical Research Services and Administration (M.B., S.J.B., L.E.), Wake Forest School of Medicine, Winston-Salem, North Carolina 27157
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137
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Shah M, Varghese RT, Miles JM, Piccinini F, Dalla Man C, Cobelli C, Bailey KR, Rizza RA, Vella A. TCF7L2 Genotype and α-Cell Function in Humans Without Diabetes. Diabetes 2016; 65:371-80. [PMID: 26525881 PMCID: PMC4747457 DOI: 10.2337/db15-1233] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2015] [Accepted: 10/26/2015] [Indexed: 12/20/2022]
Abstract
The diabetes-associated allele in TCF7L2 increases the rate of conversion to diabetes; however, the mechanism by which this occurs remains elusive. We hypothesized that the diabetes-associated allele in this locus (rs7903146) impairs insulin secretion and that this defect would be exacerbated by acute free fatty acid (FFA)-induced insulin resistance. We studied 120 individuals of whom one-half were homozygous for the diabetes-associated allele TT at rs7903146 and one-half were homozygous for the protective allele CC. After a screening examination during which glucose tolerance status was determined, subjects were studied on two occasions in random order while undergoing an oral challenge. During one study day, FFA was elevated by infusion of Intralipid plus heparin. On the other study day, subjects received the same amount of glycerol as present in the Intralipid infusion. β-Cell responsivity indices were estimated with the oral C-peptide minimal model. We report that β-cell responsivity was slightly impaired in the TT genotype group. Moreover, the hyperbolic relationship between insulin secretion and β-cell responsivity differed significantly between genotypes. Subjects also exhibited impaired suppression of glucagon after an oral challenge. These data imply that a genetic variant harbored within the TCF7L2 locus impairs glucose tolerance through effects on glucagon as well as on insulin secretion.
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Affiliation(s)
- Meera Shah
- Division of Endocrinology, Diabetes, Metabolism, and Nutrition Research, Mayo Clinic, Rochester, MN
| | - Ron T Varghese
- Division of Endocrinology, Diabetes, Metabolism, and Nutrition Research, Mayo Clinic, Rochester, MN
| | - John M Miles
- Division of Endocrinology, Diabetes, Metabolism, and Nutrition Research, Mayo Clinic, Rochester, MN
| | - Francesca Piccinini
- Department of Information Engineering, Università degli Studi di Padova, Padova, Italy
| | - Chiara Dalla Man
- Department of Information Engineering, Università degli Studi di Padova, Padova, Italy
| | - Claudio Cobelli
- Department of Information Engineering, Università degli Studi di Padova, Padova, Italy
| | - Kent R Bailey
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN
| | - Robert A Rizza
- Division of Endocrinology, Diabetes, Metabolism, and Nutrition Research, Mayo Clinic, Rochester, MN
| | - Adrian Vella
- Division of Endocrinology, Diabetes, Metabolism, and Nutrition Research, Mayo Clinic, Rochester, MN
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138
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RYNDERS COREYA, WELTMAN JUDYY, MALIN STEVENK, JIANG BOYI, BRETON MARC, BARRETT EUGENEJ, WELTMAN ARTHUR. Comparing Simple Insulin Sensitivity Indices to the Oral Minimal Model Postexercise. Med Sci Sports Exerc 2016; 48:66-72. [DOI: 10.1249/mss.0000000000000728] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
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139
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de Laat MA, McGree JM, Sillence MN. Equine hyperinsulinemia: investigation of the enteroinsular axis during insulin dysregulation. Am J Physiol Endocrinol Metab 2016; 310:E61-72. [PMID: 26530154 DOI: 10.1152/ajpendo.00362.2015] [Citation(s) in RCA: 85] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2015] [Accepted: 10/25/2015] [Indexed: 12/25/2022]
Abstract
Compared with some other species, insulin dysregulation in equids is poorly understood. However, hyperinsulinemia causes laminitis, a significant and often lethal disease affecting the pedal bone/hoof wall attachment site. Until recently, hyperinsulinemia has been considered a counterregulatory response to insulin resistance (IR), but there is growing evidence to support a gastrointestinal etiology. Incretin hormones released from the proximal intestine, glucagon-like peptide-1 (GLP-1) and glucose-dependent insulinotropic peptide, augment insulin secretion in several species but require investigation in horses. This study investigated peripheral and gut-derived factors impacting insulin secretion by comparing the response to intravenous (iv) and oral d-glucose. Oral and iv tests were performed in 22 ponies previously shown to be insulin dysregulated, of which only 15 were classified as IR (iv test). In a more detailed study, nine different ponies received four treatments: d-glucose orally, d-glucose iv, oats, and commercial grain mix. Insulin, glucose, and incretin concentrations were measured before and after each treatment. All nine ponies showed similar iv responses, but five were markedly hyperresponsive to oral d-glucose and four were not. Insulin responsiveness to oral d-glucose was strongly associated with blood glucose concentrations and oral glucose bioavailability, presumably driven by glucose absorption/distribution, as there was no difference in glucose clearance rates. Insulin was also positively associated with the active amide of GLP-1 following d-glucose and grain. This study has confirmed a functional enteroinsular axis in ponies that likely contributes to insulin dysregulation that may predispose them to laminitis. Moreover, iv tests for IR are not reliable predictors of the oral response to dietary nonstructural carbohydrate.
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Affiliation(s)
- M A de Laat
- Science and Engineering Faculty, Queensland University of Technology, Brisbane, Queensland, Australia
| | - J M McGree
- Science and Engineering Faculty, Queensland University of Technology, Brisbane, Queensland, Australia
| | - M N Sillence
- Science and Engineering Faculty, Queensland University of Technology, Brisbane, Queensland, Australia
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140
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Affiliation(s)
- Ananda Basu
- Endocrine Research Unit, Division of Endocrinology and Metabolism, Saint Mary's Hospital , Mayo Clinic, Rochester, Minnesota
| | - Rita Basu
- Endocrine Research Unit, Division of Endocrinology and Metabolism, Saint Mary's Hospital , Mayo Clinic, Rochester, Minnesota
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141
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Siebel AL, Heywood SE, Kingwell BA. HDL and glucose metabolism: current evidence and therapeutic potential. Front Pharmacol 2015; 6:258. [PMID: 26582989 PMCID: PMC4628107 DOI: 10.3389/fphar.2015.00258] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2015] [Accepted: 10/19/2015] [Indexed: 12/23/2022] Open
Abstract
High-density lipoprotein (HDL) and its principal apolipoprotein A-I (ApoA-I) have now been convincingly shown to influence glucose metabolism through multiple mechanisms. The key clinically relevant observations are that both acute HDL elevation via short-term reconstituted HDL (rHDL) infusion and chronically raising HDL via a cholesteryl ester transfer protein (CETP) inhibitor reduce blood glucose in individuals with type 2 diabetes mellitus (T2DM). HDL may mediate effects on glucose metabolism through actions in multiple organs (e.g., pancreas, skeletal muscle, heart, adipose, liver, brain) by three distinct mechanisms: (i) Insulin secretion from pancreatic beta cells, (ii) Insulin-independent glucose uptake, (iii) Insulin sensitivity. The molecular mechanisms appear to involve both direct HDL signaling actions as well as effects secondary to lipid removal from cells. The implications of glucoregulatory mechanisms linked to HDL extend from glycemic control to potential anti-ischemic actions via increased tissue glucose uptake and utilization. Such effects not only have implications for the prevention and management of diabetes, but also for ischemic vascular diseases including angina pectoris, intermittent claudication, cerebral ischemia and even some forms of dementia. This review will discuss the growing evidence for a role of HDL in glucose metabolism and outline related potential for HDL therapies.
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Affiliation(s)
- Andrew L Siebel
- Metabolic and Vascular Physiology Laboratory, Baker IDI Heart and Diabetes Institute , Melbourne, VIC, Australia
| | - Sarah Elizabeth Heywood
- Metabolic and Vascular Physiology Laboratory, Baker IDI Heart and Diabetes Institute , Melbourne, VIC, Australia
| | - Bronwyn A Kingwell
- Metabolic and Vascular Physiology Laboratory, Baker IDI Heart and Diabetes Institute , Melbourne, VIC, Australia
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142
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Effects of Liraglutide Monotherapy on Beta Cell Function and Pancreatic Enzymes Compared with Metformin in Japanese Overweight/Obese Patients with Type 2 Diabetes Mellitus: A Subpopulation Analysis of the KIND-LM Randomized Trial. Clin Drug Investig 2015; 35:675-84. [DOI: 10.1007/s40261-015-0331-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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143
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Largajolli A, Bertoldo A, Campioni M, Cobelli C. Visual Predictive Check in Models with Time-Varying Input Function. AAPS JOURNAL 2015; 17:1455-63. [PMID: 26265094 DOI: 10.1208/s12248-015-9808-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/12/2015] [Accepted: 07/24/2015] [Indexed: 11/30/2022]
Abstract
The nonlinear mixed effects models are commonly used modeling techniques in the pharmaceutical research as they enable the characterization of the individual profiles together with the population to which the individuals belong. To ensure a correct use of them is fundamental to provide powerful diagnostic tools that are able to evaluate the predictive performance of the models. The visual predictive check (VPC) is a commonly used tool that helps the user to check by visual inspection if the model is able to reproduce the variability and the main trend of the observed data. However, the simulation from the model is not always trivial, for example, when using models with time-varying input function (IF). In this class of models, there is a potential mismatch between each set of simulated parameters and the associated individual IF which can cause an incorrect profile simulation. We introduce a refinement of the VPC by taking in consideration a correlation term (the Mahalanobis or normalized Euclidean distance) that helps the association of the correct IF with the individual set of simulated parameters. We investigate and compare its performance with the standard VPC in models of the glucose and insulin system applied on real and simulated data and in a simulated pharmacokinetic/pharmacodynamic (PK/PD) example. The newly proposed VPC performance appears to be better with respect to the standard VPC especially for the models with big variability in the IF where the probability of simulating incorrect profiles is higher.
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Affiliation(s)
- Anna Largajolli
- Department of Information Engineering, University of Padova, Via G. Gradenigo 6/B, 35131, Padova, Italy
| | - Alessandra Bertoldo
- Department of Information Engineering, University of Padova, Via G. Gradenigo 6/B, 35131, Padova, Italy.
| | | | - Claudio Cobelli
- Department of Information Engineering, University of Padova, Via G. Gradenigo 6/B, 35131, Padova, Italy
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144
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Visentin R, Dalla Man C, Basu R, Basu A, Rizza RA, Cobelli C. Hepatic insulin sensitivity in healthy and prediabetic subjects: from a dual- to a single-tracer oral minimal model. Am J Physiol Endocrinol Metab 2015; 309:E161-7. [PMID: 25991649 PMCID: PMC4504934 DOI: 10.1152/ajpendo.00358.2014] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2014] [Accepted: 05/16/2015] [Indexed: 11/22/2022]
Abstract
Recently, a model was proposed to assess hepatic insulin sensitivity during a meal, i.e., the ability of insulin to suppress glucose production (EGP), SI (P). The model was developed on EGP data obtained from a triple-tracer meal and the tracer-to-tracee clamp technique and validated against the euglycemic hyperinsulinemic clamp. The aim of this study was to assess whether SI (P) can be obtained from plasma concentrations measured after a single-tracer meal by incorporating the above EGP model into the oral glucose minimal model by describing both glucose production and disposal (OMM(PD)). Triple-tracer meal data of two databases (20 healthy and 60 healthy and prediabetic subjects) were used. Virtually model-independent EGP estimates were calculated. OMM(PD) was identified on exogenous and endogenous glucose concentrations, providing indices of SI (P), disposal insulin sensitivity (SI (D)), and EGP. The model fitted the data well, and SI (P) and SI (D) were estimated with precision in both databases (SI (P) = 5.48 ± 0.54 10(-4) dl·kg(-1)·min(-1) per μU/ml and SI (D) = 9.93 ± 2.18 10(-4) dl·kg(-1)·min(-1) per μU/ml in healthy; SI (P) = 5.41 ± 3.55 10(-4) dl·kg(-1)·min(-1) per μU/ml and SI (D) = 5.34 ± 6.17 10(-4) dl·kg(-1)·min(-1) per μU/ml, in healthy and prediabetic subjects). Estimated SI (P) and that derived from the triple-tracer EGP model were very similar on average. Moreover, the time course of EGP normalized to basal EGP (EGPb), and EGP/EGPb agreed with the results obtained using the triple-tracer method. In this study, we have demonstrated that SI (P), SI (D), and EGP/EGPb time course can be estimated reliably from a single-tracer meal protocol in both healthy and prediabetic subjects.
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Affiliation(s)
- Roberto Visentin
- Department of Information Engineering, University of Padua, Padua, Italy; and
| | - Chiara Dalla Man
- Department of Information Engineering, University of Padua, Padua, Italy; and
| | - Rita Basu
- Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Department of Internal Medicine, Mayo Clinic and Foundation, Rochester, Minnesota
| | - Ananda Basu
- Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Department of Internal Medicine, Mayo Clinic and Foundation, Rochester, Minnesota
| | - Robert A Rizza
- Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Department of Internal Medicine, Mayo Clinic and Foundation, Rochester, Minnesota
| | - Claudio Cobelli
- Department of Information Engineering, University of Padua, Padua, Italy; and
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145
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Konopka AR, Asante A, Lanza IR, Robinson MM, Johnson ML, Dalla Man C, Cobelli C, Amols MH, Irving BA, Nair KS. Defects in mitochondrial efficiency and H2O2 emissions in obese women are restored to a lean phenotype with aerobic exercise training. Diabetes 2015; 64:2104-15. [PMID: 25605809 PMCID: PMC4439568 DOI: 10.2337/db14-1701] [Citation(s) in RCA: 83] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2014] [Accepted: 01/13/2015] [Indexed: 01/06/2023]
Abstract
The notion that mitochondria contribute to obesity-induced insulin resistance is highly debated. Therefore, we determined whether obese (BMI 33 kg/m(2)), insulin-resistant women with polycystic ovary syndrome had aberrant skeletal muscle mitochondrial physiology compared with lean, insulin-sensitive women (BMI 23 kg/m(2)). Maximal whole-body and mitochondrial oxygen consumption were not different between obese and lean women. However, obese women exhibited lower mitochondrial coupling and phosphorylation efficiency and elevated mitochondrial H2O2 (mtH2O2) emissions compared with lean women. We further evaluated the impact of 12 weeks of aerobic exercise on obesity-related impairments in insulin sensitivity and mitochondrial energetics in the fasted state and after a high-fat mixed meal. Exercise training reversed obesity-related mitochondrial derangements as evidenced by enhanced mitochondrial bioenergetics efficiency and decreased mtH2O2 production. A concomitant increase in catalase antioxidant activity and decreased DNA oxidative damage indicate improved cellular redox status and a potential mechanism contributing to improved insulin sensitivity. mtH2O2 emissions were refractory to a high-fat meal at baseline, but after exercise, mtH2O2 emissions increased after the meal, which resembles previous findings in lean individuals. We demonstrate that obese women exhibit impaired mitochondrial bioenergetics in the form of decreased efficiency and impaired mtH2O2 emissions, while exercise effectively restores mitochondrial physiology toward that of lean, insulin-sensitive individuals.
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Affiliation(s)
- Adam R Konopka
- Division of Endocrinology, Diabetes, Metabolism, and Nutrition Research, Mayo Clinic College of Medicine, Rochester, MN
| | - Albert Asante
- Division of Endocrinology, Diabetes, Metabolism, and Nutrition Research, Mayo Clinic College of Medicine, Rochester, MN
| | - Ian R Lanza
- Division of Endocrinology, Diabetes, Metabolism, and Nutrition Research, Mayo Clinic College of Medicine, Rochester, MN
| | - Matthew M Robinson
- Division of Endocrinology, Diabetes, Metabolism, and Nutrition Research, Mayo Clinic College of Medicine, Rochester, MN
| | - Matthew L Johnson
- Division of Endocrinology, Diabetes, Metabolism, and Nutrition Research, Mayo Clinic College of Medicine, Rochester, MN
| | - Chiara Dalla Man
- Department of Information Engineering, University of Padova, Padova, Italy
| | - Claudio Cobelli
- Department of Information Engineering, University of Padova, Padova, Italy
| | - Mark H Amols
- Division of Endocrinology, Diabetes, Metabolism, and Nutrition Research, Mayo Clinic College of Medicine, Rochester, MN
| | - Brian A Irving
- Division of Endocrinology, Diabetes, Metabolism, and Nutrition Research, Mayo Clinic College of Medicine, Rochester, MN
| | - K S Nair
- Division of Endocrinology, Diabetes, Metabolism, and Nutrition Research, Mayo Clinic College of Medicine, Rochester, MN
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146
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Dalla Man C, Pillonetto G, Riz M, Cobelli C. An index of parameter reproducibility accounting for estimation uncertainty: theory and case study on β-cell responsivity and insulin sensitivity. Am J Physiol Endocrinol Metab 2015; 308:E971-7. [PMID: 25852005 DOI: 10.1152/ajpendo.00350.2014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2014] [Accepted: 04/01/2015] [Indexed: 11/22/2022]
Abstract
Parameter reproducibility is necessary to perform longitudinal studies where parameters are assessed to monitor disease progression or effect of therapy but are also useful in powering the study, i.e., to define how many subjects should be studied to observe a given effect. The assessment of parameter reproducibility is usually accomplished by methods that do not take into account the fact that these parameters are estimated with uncertainty. This is particularly relevant in physiological and clinical studies where usually reproducibility cannot be assessed by multiple testing and is usually assessed from a single replication of the test. Working in a suitable stochastic framework, here we propose a new index (S) to measure reproducibility that takes into account parameter uncertainty and is particularly suited to handle the normal testing conditions of physiological and clinical investigations. Simulation results prove that S, by properly taking into account parameter uncertainty, is more accurate and robust than the methods available in the literature. The new metric is applied to assess reproducibility of insulin sensitivity and β-cell responsivity of a mixed-meal tolerance test from data obtained in the same subjects retested 1 wk apart. Results show that the indices of insulin sensitivity and β-cell responsivity to glucose are well reproducible. We conclude that the oral minimal models provide useful indices that can be used safely in prospective studies or to assess the efficacy of a given therapy.
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Affiliation(s)
- Chiara Dalla Man
- Department of Information Engineering, University of Padua, Padua, Italy
| | | | - Michela Riz
- Department of Information Engineering, University of Padua, Padua, Italy
| | - Claudio Cobelli
- Department of Information Engineering, University of Padua, Padua, Italy
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147
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Javed A, Balagopal PB, Vella A, Fischer PR, Piccinini F, Dalla Man C, Cobelli C, Giesler PD, Laugen JM, Kumar S. Association between thyrotropin levels and insulin sensitivity in euthyroid obese adolescents. Thyroid 2015; 25:478-84. [PMID: 25777801 PMCID: PMC4426325 DOI: 10.1089/thy.2015.0005] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND Thyrotropin (TSH) levels display a positive association with body mass index (BMI), and the prevalence of isolated hyperthyrotropinemia is higher in obese adolescents compared to their normal weight controls. However, the metabolic significance of the higher TSH in obese adolescents is less clear. The objective of this study was to determine the relationship between TSH concentrations and insulin sensitivity, lipids, and adipokines in euthyroid, non-diabetic, obese adolescents. METHODS Thirty-six euthyroid, non-diabetic, obese adolescents between the ages of 12 and 18 years underwent a 75 g oral glucose tolerance test. Insulin sensitivity (Si) and pancreatic β-cell function as assessed by disposition index (DI) were measured using the oral glucose minimal model approach. Cholesterol (total, low-density lipoprotein [LDL-C], and high-density lipoprotein [HDL-C]), triglycerides (TG), interleukin-6 (IL-6), total and high molecular weight (HMW) adiponectin, and retinol binding protein-4 (RBP4) were also determined. Associations between measures of thyroid function and Si, DI, lipids, and adipokines were computed using Pearson's correlation coefficient and multiple regression analysis. RESULTS The mean age of the subjects was 14.3±1.88 years, and the mean BMI was 32.5±4.65 kg/m2; 97% were non-Hispanic white and 47% were male. The mean TSH was 2.7±1.2 mIU/L. Increasing serum TSH was correlated with decreasing Si (log Si) in the entire cohort (p=0.03), but this relationship persisted only in males (p=0.02). The correlation between TSH and Si in males remained significant after adjusting for BMI (p=0.02). There was no correlation between TSH and pancreatic β-cell function as assessed by DI (p=0.48). TSH correlated positively with LDL-C (p=0.04) and IL-6 (p=0.03), but these associations vanished or weakened after adjusting for BMI (LDL-C p-value=0.44; IL-6 p-value=0.07). CONCLUSIONS This study suggests a sex-specific association between TSH and insulin sensitivity in euthyroid, non-diabetic, obese adolescent males. Prospective studies are warranted to explore further this sexual dimorphism in the relationship between thyroid function and insulin sensitivity and to determine if obese adolescents with insulin resistance receiving thyroid supplements for hypothyroidism would benefit from targeting TSH levels in the lower half of normal range.
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Affiliation(s)
- Asma Javed
- Division of Pediatric Endocrinology, Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, Minnesota
| | | | - Adrian Vella
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota
| | - Philip R. Fischer
- Division of General Pediatric and Adolescent Medicine, Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, Minnesota
| | | | - Chiara Dalla Man
- Department of Information Engineering, University of Padua, Padua, Italy
| | - Claudio Cobelli
- Department of Information Engineering, University of Padua, Padua, Italy
| | - Paula D. Giesler
- Endocrine Research Unit, Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota
| | - Jeanette M. Laugen
- Endocrine Research Unit, Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota
| | - Seema Kumar
- Division of Pediatric Endocrinology, Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, Minnesota
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148
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Abstract
Diabetes is a common multisystem disease that results in hyperglycemia due to a relative or absolute insulin deficiency. Improved glycemic control decreases the risk of development and progression of microvascular and, to a lesser extent, macrovascular complications and prevents symptomatic hyperglycemia. However, complex treatment regimens aimed at improving glycemic control are associated with an increased incidence of hypoglycemia. On paper at least, cellular therapies arising from reprogramed stem cells or other somatic cell types would provide ideal therapy for diabetes and the prevention of its complications. This hypothesis has led to intensive efforts to grow β cells from various sources. In this review, we provide an overview of β-cell development as well as the efforts reported to date in terms of cellular therapy for diabetes. Engineering β-cell replacement therapy requires an understanding of how β cells respond to other metabolites such as amino acids, free fatty acids, and ketones. Indeed, efforts thus far have been characterized by an inability of cellular replacement products to adequately respond to metabolites that normally couple the metabolic state to β-cell function and insulin secretion. Efforts to date intended to capitalize on current knowledge of islet cell development and stimulus-secretion coupling of the β cell are encouraging but as yet of little clinical relevance.
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Affiliation(s)
- Aleksey Matveyenko
- Department of Physiology and Biomedical Engineering, Mayo Clinic, Rochester, MN
| | - Adrian Vella
- Division of Endocrinology, Diabetes, Metabolism and Nutrition, Mayo Clinic, Rochester, MN.
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149
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Javed A, Vella A, Balagopal PB, Fischer PR, Weaver AL, Piccinini F, Dalla Man C, Cobelli C, Giesler PD, Laugen JM, Kumar S. Cholecalciferol supplementation does not influence β-cell function and insulin action in obese adolescents: a prospective double-blind randomized trial. J Nutr 2015; 145:284-90. [PMID: 25644349 PMCID: PMC6619681 DOI: 10.3945/jn.114.202010] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND There is increasing interest in the extraskeletal effects of vitamin D, particularly in the obese state with regard to the development of insulin resistance and diabetes. OBJECTIVE The objective of the study was to determine the effect of 2 doses of cholecalciferol (vitamin D3) supplementation on insulin action (Si) and pancreatic β-cell function in obese adolescents. METHODS We performed a 12-wk double-blind, randomized comparison of the effect of vitamin D3 supplementation on Si and β-cell function in obese Caucasian adolescents (body mass index > 95(th) percentile). The subjects were randomly assigned to receive either 400 IU/d (n = 25) or 2000 IU/d (n = 26) of vitamin D3. Each subject underwent a 7-sample 75 g oral glucose tolerance test, with glucose, insulin, and C-peptide measurements, to calculate Si and β-cell function as assessed by the disposition index (DI), with use of the oral minimal model before and after supplementation. A total of 51 subjects aged 15.0 ± 1.9 y were enrolled. Included for analysis at follow-up were a total of 46 subjects (20 male and 26 female adolescents), 23 in each group. RESULTS Initial serum 25-hydroxyvitamin D [25(OH)D] was 24.0 ± 8.1 μg/L. There was no correlation between 25(OH)D concentrations and Si or DI. There was a modest but significant increase in 25(OH)D concentration in the 2000 IU/d group (3.1 ± 6.5 μg/L, P = 0.04) but not in the 400 IU/d group (P = 0.39). There was no change in Si or DI following vitamin D3 supplementation in either of the treatment groups (all P > 0.10). CONCLUSIONS The current study shows no effect from vitamin D3 supplementation, irrespective of its dose, on β-cell function or insulin action in obese nondiabetic adolescents with relatively good vitamin D status. Whether obese adolescents with vitamin D deficiency and impaired glucose metabolism would respond differently to vitamin D3 supplementation remains unclear and warrants further studies. This trial was registered at clinicaltrials.gov as NCT00858247.
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Affiliation(s)
- Asma Javed
- Division of Pediatric Endocrinology, Department of Pediatric and Adolescent
Medicine, Mayo Clinic, Rochester, MN
| | - Adrian Vella
- Division of Endocrinology and Metabolism, Mayo Clinic, Rochester, MN
| | | | - Philip R Fischer
- Division of General Pediatric and Adolescent Medicine, Department of
Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, MN
| | - Amy L Weaver
- Division of Biomedical Statistics and Informatics, Department of Health
Sciences Research, Mayo Clinic, Rochester, MN
| | | | - Chiara Dalla Man
- Department of Electronics and Informatics, University of Padua, Padua,
Italy
| | - Claudio Cobelli
- Department of Electronics and Informatics, University of Padua, Padua,
Italy
| | - Paula D Giesler
- Endocrine Research Unit, Division of Endocrinology, Diabetes, Metabolism,
and Nutrition, Department of Internal Medicine, Mayo Clinic, Rochester, MN
| | - Jeanette M Laugen
- Endocrine Research Unit, Division of Endocrinology, Diabetes, Metabolism,
and Nutrition, Department of Internal Medicine, Mayo Clinic, Rochester, MN
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150
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Overexpression of sphingosine kinase 1 in liver reduces triglyceride content in mice fed a low but not high-fat diet. Biochim Biophys Acta Mol Cell Biol Lipids 2014; 1851:210-9. [PMID: 25490466 DOI: 10.1016/j.bbalip.2014.12.002] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2014] [Revised: 11/11/2014] [Accepted: 12/01/2014] [Indexed: 11/23/2022]
Abstract
Hepatic insulin resistance is a major risk factor for the development of type 2 diabetes and is associated with the accumulation of lipids, including diacylglycerol (DAG), triacylglycerols (TAG) and ceramide. There is evidence that enzymes involved in ceramide or sphingolipid metabolism may have a role in regulating concentrations of glycerolipids such as DAG and TAG. Here we have investigated the role of sphingosine kinase (SphK) in regulating hepatic lipid levels. We show that mice on a high-fat high-sucrose diet (HFHS) displayed glucose intolerance, elevated liver TAG and DAG, and a reduction in total hepatic SphK activity. Reduced SphK activity correlated with downregulation of SphK1, but not SphK2 expression, and was not associated with altered ceramide levels. The role of SphK1 was further investigated by overexpressing this isoform in the liver of mice in vivo. On a low-fat diet (LFD) mice overexpressing liver SphK1, displayed reduced hepatic TAG synthesis and total TAG levels, but with no change to DAG or ceramide. These mice also exhibited no change in gluconeogenesis, glycogenolysis or glucose tolerance. Similarly, overexpression of SphK1 had no effect on the pattern of endogenous glucose production determined during a glucose tolerance test. Under HFHS conditions, normalization of liver SphK activity to levels observed in LFD controls did not alter hepatic TAG concentrations. Furthermore, DAG, ceramide and glucose tolerance were also unaffected. In conclusion, our data suggest that SphK1 plays an important role in regulating TAG metabolism under LFD conditions.
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