1
|
Nielsen BU, Mathiesen IHM, Krogh-Madsen R, Katzenstein TL, Pressler T, Shaw JAM, Rickels MR, Almdal TP, Faurholt-Jepsen D, Stefanovski D. Insulin sensitivity, disposition index and insulin clearance in cystic fibrosis: a cross-sectional study. Diabetologia 2024:10.1007/s00125-024-06220-6. [PMID: 39093413 DOI: 10.1007/s00125-024-06220-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2024] [Accepted: 05/23/2024] [Indexed: 08/04/2024]
Abstract
AIMS/HYPOTHESIS The aim of this study was to investigate insulin secretion, insulin sensitivity, disposition index and insulin clearance by glucose tolerance status in individuals with cystic fibrosis (CF) and exocrine pancreatic insufficiency. METHODS In a cross-sectional study, we conducted an extended (ten samples) OGTT in individuals with pancreatic-insufficient CF (PI-CF). Participants were divided into normal glucose tolerance (NGT), early glucose intolerance (EGI), impaired glucose tolerance (IGT) and CF-related diabetes (CFRD) groups. We used three different oral minimal models to assess insulin secretion, insulin sensitivity and insulin clearance during the OGTT. We evaluated insulin secretion using total secretion (Φ total), first-phase secretion (Φ dynamic) and second-phase secretion (Φ static) from the model, and we estimated the disposition index by multiplying Φ total and insulin sensitivity. RESULTS Among 61 participants (NGT 21%, EGI 33%, IGT 16%, CFRD 30%), insulin secretion indices (Φ total, dynamic and static) were significantly lower in the CFRD group compared with the other groups. Insulin sensitivity declined with worsening in glucose tolerance (p value for trend <0.001) and the disposition index declined between NGT and EGI and between IGT and CFRD. Those with CFRD had elevated insulin clearance compared with NGT (p=0.019) and low insulin secretion (Φ total) was also associated with high insulin clearance (p<0.001). CONCLUSIONS/INTERPRETATION In individuals with PI-CF, disposition index declined with incremental impairment in glucose tolerance due to a reduction in both insulin secretion and insulin sensitivity. Moreover in CF, reduced insulin secretion was associated with higher insulin clearance.
Collapse
Affiliation(s)
- Bibi U Nielsen
- Cystic Fibrosis Centre Copenhagen, Department of Infectious Diseases, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark.
| | - Inger H M Mathiesen
- Cystic Fibrosis Centre Copenhagen, Department of Infectious Diseases, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | - Rikke Krogh-Madsen
- Centre for Physical Activity Research, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
- Department of Infectious Diseases, Copenhagen University Hospital - Hvidovre, Copenhagen, Denmark
| | - Terese L Katzenstein
- Cystic Fibrosis Centre Copenhagen, Department of Infectious Diseases, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | - Tacjana Pressler
- Cystic Fibrosis Centre Copenhagen, Department of Infectious Diseases, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | - James A M Shaw
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Michael R Rickels
- Division of Endocrinology, Diabetes & Metabolism, Department of Medicine, and Institute for Diabetes, Obesity & Metabolism, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Thomas P Almdal
- Department of Endocrinology, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | - Daniel Faurholt-Jepsen
- Cystic Fibrosis Centre Copenhagen, Department of Infectious Diseases, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | - Darko Stefanovski
- Department of Clinical Studies-New Bolton Center, University of Pennsylvania School of Veterinary Medicine, Kennett Square, PA, USA
| |
Collapse
|
2
|
Mahadevan M, Bose M, Gawron KM, Blumberg R. Metabolic Syndrome and Chronic Disease Risk in South Asian Immigrants: A Review of Prevalence, Factors, and Interventions. Healthcare (Basel) 2023; 11:healthcare11050720. [PMID: 36900725 PMCID: PMC10000781 DOI: 10.3390/healthcare11050720] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Revised: 02/21/2023] [Accepted: 02/26/2023] [Indexed: 03/05/2023] Open
Abstract
South Asians (SAs) are among the fastest-growing ethnic groups in the U.S. Metabolic syndrome (MetS) is a condition that is characterized by multiple health factors that increase the risk for chronic diseases, such as cardiovascular disease (CVD) and diabetes. MetS prevalence among SA immigrants ranges from 27-47% in multiple cross-sectional studies using different diagnostic criteria, which is generally higher compared to other populations in the receiving country. Both genetic and environmental factors are attributed to this increased prevalence. Limited intervention studies have shown effective management of MetS conditions within the SA population. This review reports MetS prevalence in SAs residing in non-native countries, identifies contributing factors, and discusses ways to develop effective community-based strategies for health promotion targeting MetS among SA immigrants. There is a need for more consistently evaluated longitudinal studies to facilitate the development of directed public health policy and education to address chronic diseases in the SA immigrant community.
Collapse
Affiliation(s)
- Meena Mahadevan
- Department of Nutrition and Food Studies, Montclair State University, Montclair, NJ 07043, USA
- Correspondence: ; Tel.: +1-973-655-7574
| | - Mousumi Bose
- Department of Nutrition and Food Studies, Montclair State University, Montclair, NJ 07043, USA
| | | | - Renata Blumberg
- Department of Nutrition and Food Studies, Montclair State University, Montclair, NJ 07043, USA
| |
Collapse
|
3
|
Xia Z, Song L, Fang D, You W, Li F, Zheng D, Li Y, Lin L, Dou J, Su X, Zhai Q, Zuo Y, Zhang Y, Gaisano HY, Jiang J, He Y. Higher systolic blood pressure is specifically associated with better islet beta-cell function in T2DM patients with high glycemic level. Cardiovasc Diabetol 2022; 21:283. [PMID: 36536433 PMCID: PMC9764532 DOI: 10.1186/s12933-022-01723-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Accepted: 12/07/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Patients with type 2 diabetes mellitus (T2DM) usually have higher blood viscosity attributed to high blood glucose that can decrease blood supply to the pancreas. A mild increase in blood pressure (BP) has been reported as a potential compensatory response that can maintain blood perfusion in the islet. However, how BP influences beta-cell function in T2DM subjects remains inconsistent. This study aimed to examine the relationship between BP and beta-cell function in patients with T2DM under different HbA1c levels. METHODS This is a cross-sectional study of 615 T2DM patients, whose clinical data were extracted from hospital medical records. Beta-cell function was assessed by insulin secretion-sensitivity index-2 (ISSI2). Multivariable linear regression analysis and restricted cubic splines (RCS) analysis were performed to identify the association between systolic BP (SBP) and ISSI2. Mediation analysis was performed to determine whether higher SBP could reduce blood glucose by enhancing beta-cell function. RESULTS After adjustment of potential confounders, in participants with HbA1c ≥ 10%, the SBP between 140 to150 mmHg had the highest log ISSI2 (b = 0.227, 95% CI 0.053-0.402), an association specific to participants with < 1 year duration of diabetes. RCS analyses demonstrated an inverted U-shaped association between SBP and ISSI2 with the SBP at 144 mmHg corresponding to the best beta-cell function. This higher SBP was "paradoxically" associated with lower 2 h postprandial blood glucose (PBG) when SBP < 150 mmHg that was almost exclusively mediated by ISSI2 (mediating effect = - 0.043, 95%CI - 0.067 to - 0.018; mediating effect percentage = 94.7%, P < 0.01). SBP was however not associated with improvement in ISSI2 or 2 h PBG in participants with HbA1c < 10%. CONCLUSIONS In early stage of diabetes, a slightly elevated SBP (140-150 mmHg) was transiently associated with better beta-cell function in T2DM patients with HbA1c ≥ 10% but not in those with HbA1c < 10%.
Collapse
Affiliation(s)
- Zhang Xia
- grid.24696.3f0000 0004 0369 153XDepartment of Epidemiology and Health Statistics, School of Public Health, Capital Medical University, No.10 Xitoutiao, You’anmen Wai, Fengtai District, Beijing, 100069 China
| | - Lijuan Song
- Department of Endocrinology, Jining No.1 People’s Hospital, 6 Jiankang Road, Rencheng District, Jining, Shandong 272000 China
| | - Dongdong Fang
- Department of Endocrinology, Jining No.1 People’s Hospital, 6 Jiankang Road, Rencheng District, Jining, Shandong 272000 China
| | - Wenjun You
- Department of Endocrinology, Jining No.1 People’s Hospital, 6 Jiankang Road, Rencheng District, Jining, Shandong 272000 China
| | - Feng Li
- Department of Endocrinology, Jining No.1 People’s Hospital, 6 Jiankang Road, Rencheng District, Jining, Shandong 272000 China ,Institute for Chronic Disease Management, Jining No.1 People’s Hospital, Jining, Shandong China
| | - Deqiang Zheng
- grid.24696.3f0000 0004 0369 153XDepartment of Epidemiology and Health Statistics, School of Public Health, Capital Medical University, No.10 Xitoutiao, You’anmen Wai, Fengtai District, Beijing, 100069 China ,grid.24696.3f0000 0004 0369 153XBeijing Municipal Key Laboratory of Clinical Epidemiology, Beijing, China
| | - Yuhao Li
- grid.24696.3f0000 0004 0369 153XDepartment of Epidemiology and Health Statistics, School of Public Health, Capital Medical University, No.10 Xitoutiao, You’anmen Wai, Fengtai District, Beijing, 100069 China
| | - Lu Lin
- grid.414252.40000 0004 1761 8894Department of Endocrinology, The First Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Jingtao Dou
- grid.414252.40000 0004 1761 8894Department of Endocrinology, The First Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Xin Su
- grid.24696.3f0000 0004 0369 153XDepartment of Epidemiology and Health Statistics, School of Public Health, Capital Medical University, No.10 Xitoutiao, You’anmen Wai, Fengtai District, Beijing, 100069 China
| | - Qi Zhai
- grid.24696.3f0000 0004 0369 153XDepartment of Epidemiology and Health Statistics, School of Public Health, Capital Medical University, No.10 Xitoutiao, You’anmen Wai, Fengtai District, Beijing, 100069 China
| | - Yingting Zuo
- grid.24696.3f0000 0004 0369 153XDepartment of Epidemiology and Health Statistics, School of Public Health, Capital Medical University, No.10 Xitoutiao, You’anmen Wai, Fengtai District, Beijing, 100069 China
| | - Yibo Zhang
- grid.24696.3f0000 0004 0369 153XDepartment of Epidemiology and Health Statistics, School of Public Health, Capital Medical University, No.10 Xitoutiao, You’anmen Wai, Fengtai District, Beijing, 100069 China
| | - Herbert Y. Gaisano
- grid.17063.330000 0001 2157 2938Departments of Medication and Physiology, University of Toronto, Toronto, ON Canada
| | - Jiajia Jiang
- Department of Endocrinology, Jining No.1 People’s Hospital, 6 Jiankang Road, Rencheng District, Jining, Shandong 272000 China ,Institute for Chronic Disease Management, Jining No.1 People’s Hospital, Jining, Shandong China
| | - Yan He
- grid.24696.3f0000 0004 0369 153XDepartment of Epidemiology and Health Statistics, School of Public Health, Capital Medical University, No.10 Xitoutiao, You’anmen Wai, Fengtai District, Beijing, 100069 China ,grid.24696.3f0000 0004 0369 153XBeijing Municipal Key Laboratory of Clinical Epidemiology, Beijing, China
| |
Collapse
|
4
|
Eichenlaub MM, Hattersley JG, Gannon MC, Nuttall FQ, Khovanova NA. Bayesian parameter estimation in the oral minimal model of glucose dynamics from non-fasting conditions using a new function of glucose appearance. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2021; 200:105911. [PMID: 33485076 DOI: 10.1016/j.cmpb.2020.105911] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Accepted: 12/10/2020] [Indexed: 06/12/2023]
Abstract
BACKGROUND AND OBJECTIVE The oral minimal model (OMM) of glucose dynamics is a prominent method for assessing postprandial glucose metabolism. The model yields estimates of insulin sensitivity and the meal-related appearance of glucose from insulin and glucose data after an oral glucose challenge. Despite its success, the OMM approach has several weaknesses that this paper addresses. METHODS A novel procedure introducing three methodological adaptations to the OMM approach is proposed. These are: (1) the use of a fully Bayesian and efficient method for parameter estimation, (2) the model identification from non-fasting conditions using a generalised model formulation and (3) the introduction of a novel function to represent the meal-related glucose appearance based on two superimposed components utilising a modified structure of the log-normal distribution. The proposed modelling procedure is applied to glucose and insulin data from subjects with normal glucose tolerance consuming three consecutive meals in intervals of four hours. RESULTS It is shown that the glucose effectiveness parameter of the OMM is, contrary to previous results, structurally globally identifiable. In comparison to results from existing studies that use the conventional identification procedure, the proposed approach yields an equivalent level of model fit and a similar precision of insulin sensitivity estimates. Furthermore, the new procedure shows no deterioration of model fit when data from non-fasting conditions are used. In comparison to the conventional, piecewise linear function of glucose appearance, the novel log-normally based function provides an improved model fit in the first 30 min of the response and thus a more realistic estimation of glucose appearance during this period. The identification procedure is implemented in freely accesible MATLAB and Python software packages. CONCLUSIONS We propose an improved and freely available method for the identification of the OMM which could become the future standardard for the oral minimal modelling method of glucose dynamics.
Collapse
Affiliation(s)
- Manuel M Eichenlaub
- School of Engineering, University of Warwick, Coventry CV4 7AL, UK; Coventry NIHR CRF Human Metabolic Research Unit, University Hospitals Coventry and Warwickshire NHS Trust, Coventry CV2 2DX, UK
| | - John G Hattersley
- School of Engineering, University of Warwick, Coventry CV4 7AL, UK; Coventry NIHR CRF Human Metabolic Research Unit, University Hospitals Coventry and Warwickshire NHS Trust, Coventry CV2 2DX, UK
| | - Mary C Gannon
- Veterans Affairs Medical Center/University of Minnesota Medical School, Minneapolis, MN, USA
| | - Frank Q Nuttall
- Veterans Affairs Medical Center/University of Minnesota Medical School, Minneapolis, MN, USA
| | - Natasha A Khovanova
- School of Engineering, University of Warwick, Coventry CV4 7AL, UK; University Hospitals Coventry and Warwickshire NHS Trust, Coventry CV2 2DX, UK.
| |
Collapse
|