Modeling glucose and free fatty acid kinetics in glucose and meal tolerance test

Background

Quantitative evaluation of insulin regulation on plasma glucose and free fatty acid (FFA) in response to external glucose challenge is clinically important to assess the development of insulin resistance (World J Diabetes 1:36–47, 2010). Mathematical minimal models (MMs) based on insulin modified frequently-sampled intravenous glucose tolerance tests (IM-FSIGT) are widely applied to ascertain an insulin sensitivity index (IEEE Rev Biomed Eng 2:54–96, 2009). Furthermore, it is important to investigate insulin regulation on glucose and FFA in postprandial state as a normal physiological condition. A simple way to calculate the appearance rate (Ra) of glucose and FFA would be especially helpful to evaluate glucose and FFA kinetics for clinical applications.

Methods

A new MM is developed to simulate the insulin modulation of plasma glucose and FFA, combining IM-FSIGT with a mixed meal tolerance test (MT). A novel simple functional form for the appearance rate (Ra) of glucose or FFA in the MT is developed. Model results are compared with two other models for data obtained from 28 non-diabetic women (13 African American, 15 white).

Results

The new functional form for Ra of glucose is an acceptable empirical approximation to the experimental Ra for a subset of individuals. When both glucose and FFA are included in FSIGT and MT, the new model is preferred using the Bayes Information Criterion (BIC).

Conclusions

Model simulations show that the new MM allows consistent application to both IM-FSIGT and MT data, balancing model complexity and data fitting. While the appearance of glucose in the circulation has an important effect on FFA kinetics in MT, the rate of appearance of FFA can be neglected for the time-period modeled.

     

NEFA minimal model parameters estimated from the oral glucose tolerance test and the meal tolerance test

The kinetics of nonesterified fatty acid (NEFA) metabolism in humans requires quantification to facilitate understanding of diseases like type 1 and 2 diabetes, metabolic syndrome, and obesity, and the mechanisms underpinning various interventions. Oral glucose tolerance tests (OGTT) and glucose meal tolerance tests (MTT) are potentially useful procedures for enabling quantification of NEFA kinetics because they both cause transitory, but substantial, declines and then rebounds in plasma NEFA concentrations in response to physiologically relevant increases in plasma glucose. The Boston MINIMAL model of NEFA kinetics was developed to analyze data from the intravenous glucose tolerance test (IVGTT), but in this work, we present for the first time its application to modeling NEFA data from both OGTT and MTT studies. This model enables estimation of SFFA (micromol.l(-1).min(-1)) (a parameter describing the maximum rate of lipolysis), and KFFA (%/min) (a parameter related to NEFA oxidation rate). The model could well describe the trajectories of NEFA concentrations following an OGTT (R2 in excess of 0.97) but was not as successful with the MTT (R2>0.65). Model parameters derived from analysis of OGTT and MTT data were well identified with coefficients of variation generally less than 15%. Type 2 diabetes, body mass index, and dietary treatment (high-fat vs. high-glycemic-index diets) were all shown to have significant effects on model parameters. Modeling plasma NEFA concentrations over 24 h has helped to identify and quantify the extent that periprandial NEFA peaks and nocturnal elevation in plasma NEFA can be accounted for by our model.     

Effect of repaglinide on endothelial dysfunction during a glucose tolerance test in subjects with impaired glucose tolerance

Background

Secondary treatment of arteriosclerosis may be applicable for the primary prevention of atherosclerosis in diabetic patients. This prospective, 2-year follow-up study was designed to determine the efficacy and safety of antiplatelet therapy in the prevention of atherosclerosis of diabetic subjects.

Methods

Patients with type 2 diabetes and arteriosclerosis obliterans from the Eastern Asian countries were registered online and randomly assigned either to the aspirin group (81–100 mg/day) or the cilostazol group (100–200 mg/day) in this international, 2-year, prospective follow-up interventional study.

Results

The primary study endpoint was changes in right and left maximum intima-media thickness of the common carotid artery. Secondary endpoints include changes in right and left maximum intima-media thickness of the internal carotid artery; semiquantitative evaluation of cerebral infarction by magnetic resonance imaging; cardiovascular events including sudden death, stroke, transient cerebral ischemic attacks, acute myocardial infarction, angina, and progression of arteriosclerosis obliterans; overall death; withdrawal; and change in ankle-brachial pressure index.

Conclusion

This is the first study to use an online system that was developed in Asian countries for pooling data from an international clinical trial. These findings are expected to help in the prevention of diabetic atherosclerosis and subsequent cardiovascular and cerebrovascular disease.     

The impact of insulin administration during the mixed meal tolerance test

Diabet. Med. 29, 1279-1284 (2012) ABSTRACT: Aims The mixed meal tolerance test is the gold standard measure of endogenous insulin secretion. Practical issues limit the routine clinical use of this test, including omitting insulin prior to the ingestion of a high-carbohydrate liquid mixed meal, which can result in marked hyperglycaemia. We aimed to assess whether insulin omission is necessary during the mixed meal tolerance test and whether fasting C-peptide was a practical alternative to the test. Methods Ninety-one adults with insulin-treated diabetes (Type?1 n?=?56, Type?2 n?=?35) underwent two mixed meal tolerance tests; one standard without insulin and one with the patient's usual morning insulin. Results The 90-min serum C-peptide was highly correlated in the standard mixed meal tolerance test and the test with insulin (r?=?0.98, P?相似文献   

Variations in the level of human serum albumin during glucose tolerance test

The serum protein level in patients taking the glucose tolerance test was found to vary. This variation was accounted for by changes in the level of serum albumin which dropped an average of 17% one hour after the administration of glucose. The serum albumin level returned to its normal value when blood glucose and non-esterified fatty acid levels returned to their initial levels. It is suggested that this variation is the result of a shift of albumin between the intravascular and extravascular compartments.     

The relation between free fatty acid levels and tolerance for glucose in a triple glucose tolerance test

The improved glucose tolerance observed in a multiple glucose tolerance test (Staub-Traugott effect) has been observed in dogs with concomitant measurement of immunoreactive insulin (IRI) and plasma free fatty acid (FFA). It was possible to reduce and in one experiment eliminate the improved glucose tolerance observed in the Staub-Traugott procedure. This was done in successive experiments in which the glucose challenge dose was 1 × BW^{0 period; 7} grams: (1) by injecting octanoate (0.1 mmoles/kg each hour) at the same time as the glucose; (2) by supplementing the injections with the infusion of octanoate (0.1 mmoles/kg/15 mins) during the second and third hours; (3) by repeating this last procedure after a seven day fast. Similar experiments were carried out with a larger glucose challenge dose (1 g/kg).Glucose tolerance appeared to depend as strongly on FFA levels as it did on IRI levels, and improvement in glucose tolerance occurred only when there was an associated reduction in FFA for a given glucose challenge. A measure of the Staub-Traugott effect was defined in terms of the different glucose utilizations during a multiple glucose tolerance test. An increase in the mean FFA levels achieved before or during a multiple glucose tolerance test lessened or eliminated the Staub-Traugott effect.     

Positive correlation of galanin with glucose in healthy volunteers during an oral glucose tolerance test.

Galanin has been found in increased amounts in subjects with type 2 diabetes. The purpose of the present study was to determine the levels of galanin in healthy volunteers during an oral glucose tolerance test (OGTT). We enrolled 11 healthy volunteers, 4 males aged 48+/-3.56 years with BMI 27+/-0.5 kg/m (2) and 7 females aged 41.3+/-3.05 years with BMI 27.6+/-0.9 kg/m (2). All were in good health without cardiac, hepatic, renal or other chronic disease. None were taking any medication affecting glucose tolerance (beta-blockers, thiazide diuretics, and corticoids) and none had a first degree relative with type 2 diabetes. Glucose tolerance was determined by using the International Expert Committee criteria. Blood samples were collected at 0, 30, 60, 90, 120 and 180 minutes for the measurement of plasma glucose, insulin, C-peptide and human galanin (hGal). During the OGTT, hGal exhibited a significant increase from time 0 to 90 minutes (p < 0.001) and returned to the basal values at 180 minutes, while a positive correlation of blood glucose with hGal was observed during the time scale of OGTT. A significant increase was detected both in insulin and C-peptide from the early beginning of the test at 30 minutes, which remained steady until 90 minutes, and returned gradually to the basal values at 180 minutes. No relationship was found either between hGal and serum insulin, or between hGal and serum C-peptide among the healthy subjects, during the OGTT.     

Evaluating the glucose tolerance test in mice

The objective of this study was to determine the optimal conditions under which to assess glucose tolerance in chow- and high-fat-fed C57BL/6J mice. Mice were fed either chow or high-fat diet for 8 wk. Variables tested were fasting duration (0-, 3-, 6-, and 24-h and overnight fasting), route of administration (intraperitoneal vs. oral) load of glucose given (2, 1, or 0.5 g/kg and fixed 50-mg dose), and state of consciousness. Basal glucose concentrations were increased in high-fat- compared with chow-fed mice following 6 h of fasting (9.1 +/- 0.3 vs. 7.9 +/- 0.4 mmol/l P = 0.01). Glucose tolerance was most different and therefore significant (P = 0.001) in high-fat-fed mice after 6 h of fasting (1,973 +/- 96 vs. 1,248 +/- 83 mmol.l(-1).120 min(-1)). The difference in glucose tolerance was greater following an OGTT (142%), in contrast to an IPGTT, with a 127% difference between high fat and chow. We also found that administering 2 g/kg of glucose resulted in a greater level of significance (P = 0.0008) in glucose intolerance in high-fat- compared with chow-fed mice. A fixed dose of 50 mg glucose regardless of body weight was enough to show glucose intolerance in high-fat- vs. chow-fed mice. Finally, high-fat-fed mice showed glucose intolerance compared with their chow-fed counterparts whether they were tested under conscious or anesthetized conditions. We conclude that 2 g/kg glucose administered orally following 6 h of fasting is best to assess glucose tolerance in mice under these conditions.     

Prolonged fasting significantly changes nutrient oxidation and glucose tolerance after a normal mixed meal

The aim of this study wasto establish the experimental paradigm of fasting, followed byrefeeding, to investigate individual differences in nutrientpartitioning. Eight nonobese men were fed a normal meal (25% ofdaily energy requirements) on two occasions, after an overnight (13-h)fast and after a prolonged (72-h) fast. During the entire fastingperiod, subjects were resident in a whole room indirect calorimeter,and blood samples were drawn periodically. Because no other food wasconsumed over the 12 h after either meal, negative energy balancewas observed after the overnight and prolonged fast. Postprandialcarbohydrate oxidation was significantly reduced after the 72- vs. 13-hfast (P < 0.0001), whereas fat oxidation wassignificantly increased (P < 0.0001). Interestingly,carbohydrate balance was positive after the prolonged fast but negativeafter the overnight fast (24 ± 17 vs. 57 ± 16 g/12 h,respectively; P < 0.001), whereas fat balance wasnegative under both conditions (78 ± 7 vs. 47 ± 8 g/12h, respectively; P < 0.002). With 72 h offasting, the glucose and insulin excursions in response to the mixedmeal were significantly greater compared with the 13-h fast(P < 0.001). In conclusion, prolonged fasting resulted in a significant decrease in carbohydrate oxidation and anincrease in fat oxidation, after a normal mixed meal, in healthy men.This was associated with a significant decrease in glucose tolerance.Because circulating free fatty acids were greatly elevated at all timesafter the prolonged fast, these may be mediating some of the changes inpostprandial metabolism.

     

Scaling, growth and cyclicity in biology: a new computational approach

Background

The Phenomenological Universalities approach has been developed by P.P. Delsanto and collaborators during the past 2–3 years. It represents a new tool for the analysis of experimental datasets and cross-fertilization among different fields, from physics/engineering to medicine and social sciences. In fact, it allows similarities to be detected among datasets in totally different fields and acts upon them as a magnifying glass, enabling all the available information to be extracted in a simple way. In nonlinear problems it allows the nonscaling invariance to be retrieved by means of suitable redefined fractal-dimensioned variables.

Results

The main goal of the present contribution is to extend the applicability of the new approach to the study of problems of growth with cyclicity, which are of particular relevance in the fields of biology and medicine.

Conclusion

As an example of its implementation, the method is applied to the analysis of human growth curves. The excellent quality of the results (R ² = 0.988) demonstrates the usefulness and reliability of the approach.     

Mathematical modelling of the intravenous glucose tolerance test

 Several attempts at building a satisfactory model of the glucose-insulin system are recorded in the literature. The minimal model, which is the model currently mostly used in physiological research on the metabolism of glucose, was proposed in the early eighties for the interpretation of the glucose and insulin plasma concentrations following the intravenous glucose tolerance test. It is composed of two parts: the first consists of two differential equations and describes the glucose plasma concentration time-course treating insulin plasma concentration as a known forcing function; the second consists of a single equation and describes the time course of plasma insulin concentration treating glucose plasma concentration as a known forcing function. The two parts are to be separately estimated on the available data. In order to study glucose-insulin homeostasis as a single dynamical system, a unified model would be desirable. To this end, the simple coupling of the original two parts of the minimal model is not appropriate, since it can be shown that, for commonly observed combinations of parameter values, the coupled model would not admit an equilibrium and the concentration of active insulin in the “distant” compartment would be predicted to increase without bounds. For comparison, a simple delay-differential model is introduced, is demonstrated to be globally asymptotically stable around a unique equilibrium point corresponding to the pre-bolus conditions, and is shown to have positive and bounded solutions for all times. The results of fitting the delay-differential model to experimental data from ten healthy volunteers are also shown. It is concluded that a global unified model is both theoretically desirable and practically usable, and that any such model ought to undergo formal analysis to establish its appropriateness and to exclude conflicts with accepted physiological notions. Received: 22 June 1998 / Revised version: 24 February 1999