PC-based differential model fitting as a support for clinical research

PROBABILISTIC DETERMINATION OF STABILITY FOR A DELAY-DIFFERENTIAL MODEL OF THE GLUCOSE-INSULIN DYNAMICAL SYSTEM

Some of the questions involved in the formulation of a new model for a physiological phenomenon, when the model represents a dynamical system, concern its qualitative behavior. The determination of the stability of a particular dynamical system is usually made analytically, from a linearization of the system around an equilibrium point. This analytic proof may often be complicated or impossible, leading to the imposition of conditions on the relative magnitude of the model structural parameters or to other partial results. We discuss a general technique whereby a probabilistic judgement is made on the stability of a dynamical system, and we apply it to the study of a particular delay differential system modelling the relationship between insulin secretion and glucose uptake. This technique is applicable in case experimental material is available: a stability criterion is obtained via the usual linearization around an equilibrium point and its distribution is approximated from the estimated dispersion of the model parameters. The probability that the stability criterion is such as to make the model stable can then be computed directly. While the conclusion is probabilistic in nature, it is generally applicable to a vast class of models.

Carnitine increases glucose disposal in humans

OBJECTIVE

The goal of this work is to assess the effect of L-carnitine on glucose disposal, particularly on insulin sensitivity, in healthy volunteers.

METHODS

Fourteen healthy human volunteers were subjected to the intravenous glucose tolerance test (analyzed by means of the minimal model technique), together with indirect calorimetry and measurement of serum free fatty acids, after a bolus of glucose plus carnitine (C) or a bolus of glucose plus saline (P).

RESULTS

The minimal model demonstrated a significant increase in glucose disposal from plasma with carnitine: Glucose effectiveness passed from 2.7%/min to 3.8%/min. No significant changes were observed in the Insulin Sensitivity Index or in Insulin/C-Peptide secretion. Calorimetry showed a significant increase in respiratory quotient, resulting from a significant increase in carbohydrate oxidation rate during carnitine administration by an average of 0.0176+/-0.0118 g/min (p=0.015). Energy expenditure was not modified by treatment. A smaller decrease in plasma fatty acid concentrations was noted with carnitine plus glucose than after glucose alone.

CONCLUSIONS

From these data it appears that carnitine stimulates glucose disposal and oxidation in the healthy volunteer. Therefore, carnitine might be useful as an adjunct in the therapy of diabetes mellitus.