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Simple Self-Administered Method for Assessing Insulin Sensitivity in Diabetic Patients

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Abstract

Several methods have been proposed for evaluating a person’s insulin sensitivity from an oral glucose tolerance test (OGTT) and the euglycemic insulin clamp technique. However, none are easy or inexpensive to implement since the plasma insulin concentration, a key variable for assessing the insulin sensitivity index (ISI), is required to be clinically measured at specific times. Therefore, the purpose of this study is to develop a new ISI that can be easily and accurately obtained by patients themselves without costly, time-consuming, and inconvenient testing methods. This study proposes a simple self-administered testing method, simulated on a computerized model of type II diabetic patients, for estimating the ISI. The test involves a 75-g glucose ingestion and two injections of 10 mU/kg insulin. Blood glucose is measured 1 and 2 h later. The test was evaluated by using a previously developed diabetic-patient dynamic model. Fifteen sets of OGTT data from diabetic patients published in the literature were used for the model development. A simulation of the proposed self-administered test indicates that the proposed ISI correlates well with the ISI called M-value obtained from the gold standard but elaborate euglycemic hyperinsulinemic clamp (r = 0.927, p = 0.0045). The proposed ISI is considered to be easy to perform, time-saving, inexpensive, and accurate enough for clinical assessments.

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References

  1. Weir, G., & Bonner-Weir, S. (2004). Five stages of evolving β-cell dysfunction during progression to diabetes. Diabetes, 53, S16–S21.

    Article  Google Scholar 

  2. DeFronzo, R. (1988). The triumvirate: Beta-cell, muscle, liver. A collusion responsible for NIDDM. Diabetes, 37, 667–687.

    Article  Google Scholar 

  3. Reaven, G. M., Lithell, H., & Landsberg, L. (1996). Hypertension and associated metabolic abnormalities—The role of insulin resistance and the sympathoadrenal system. New England Journal of Medicine, 334, 374–381.

    Article  Google Scholar 

  4. Katz, A., Nambi, S., & Mather, K. (2000). Quantitative insulin sensitivity check index: A simple, accurate method for assessing insulin sensitivity in humans. Journal of Clinical Endocrinology and Metabolism, 85, 2402–2410.

    Article  Google Scholar 

  5. Bergman, R. N. (1979). Quantitative estimation of insulin sensitivity. American Physiological Society, 236, E667–E677.

    Google Scholar 

  6. DeFronzo, R. (1979). Glucose clamp technique: A method for quantifying insulin secretion and resistance. American Journal of Physiology—Endocrinology and Metabolism, 237, 214–223.

    Google Scholar 

  7. Steil, G. M., Volund, A., Kahn, S. E., & Bergman, R. N. (1993). Reduced sample number for calculation of insulin sensitivity and glucose effectiveness from the minimal model. Suitability for use in population studies. Diabetes, 42, 250–256.

    Article  Google Scholar 

  8. Yang, Y. J., Youn, J. H., & Bergman, R. N. (1987). Modified protocols improve insulin sensitivity estimation using the minimal model. American Journal of Physiology, 253, E595–E602.

    Google Scholar 

  9. Matthews, D., Hosker, J., Rudenski, A., Naylor, B., Treacher, D., & Turner, R. (1985). Homeostasis model assessment: insulin resistance and beta-cell function from fasting plasma glucose and insulin concentrations in man. Diabetologia, 28, 412–419.

    Article  Google Scholar 

  10. Laakso, M. (1993). How good a marker is insulin level for insulin resistance? American Journal of Epidemiology, 137, 959–965.

    Google Scholar 

  11. Legro, R. S., Finegood, D., & Dunaif, A. (1998). A fasting glucose to insulin ratio is a useful measure of insulin sensitivity in women with polycystic ovary syndrome. Journal of Clinical Endocrinology and Metabolism, 83, 2694–2698.

    Google Scholar 

  12. Davey, R. X. (2002). Birthweight and risk for diabetes. Diabetes Care, 25, 1886–1902.

    Article  Google Scholar 

  13. Cederholm, J., & Wibell, L. (1990). Insulin release and peripheral sensitivity at the oral glucose tolerance test. Diabetes Research and Clinical Practice, 10, 167–175.

    Article  Google Scholar 

  14. Matsuda, M., & DeFronzo, R. (1999). Insulin sensitivity indices obtained from oral glucose tolerance testing comparison with the euglycemic insulin clamp. Diabetes Care, 22, 1462–1470.

    Article  Google Scholar 

  15. Stumvoll, M., Mitrakou, A., Pimenta, W., Jenssen, T., Yki-Järvinen, H., Van Haeften, T., et al. (2000). Use of the oral glucose tolerance test to assess insulin release and insulin sensitivity. Diabetes Care, 23, 295–301.

    Article  Google Scholar 

  16. Gutt, M., Davis, C. L., Spitzer, S. B., Llabre, M. M., Kumar, M., Czarnecki, E. M., et al. (2000). Validation of the insulin sensitivity index (ISI(0,120)): Comparison with other measures. Diabetes Research and Clinical Practice, 47, 177–184.

    Article  Google Scholar 

  17. Vahidi, O. (2013). Dynamic modeling of glucose metabolism for the assessment of type II diabetes mellitus. Ph.D. Thesis, The University of British Columbia, 2013.

  18. Vahidi, O., Kwok, K. E., Gopaluni, R. B., & Sun, L. (2011). Developing a physiological model for type II diabetes mellitus. Biochemical Engineering Journal, 55, 7–16.

    Article  Google Scholar 

  19. Guyton, J. R., Foster, R. O., Soeldner, J. S., Tan, M. H., Kahn, C. B., Koncz, L., & Gleason, R. E. (1978). A model of glucose-insulin homeostasis in man that incorporates the heterogeneous fast pool theory of pancreatic insulin release. Diabetes, 27, 1027–1042.

    Article  Google Scholar 

  20. Sorensen, J. T. (1985). A physiological model of glucose metabolism in man and its use to design and assess improved insulin therapies for diabetes. Ph.D. Thesis, Massachusetts Institute of Technology, 1985.

  21. Vahidi, O., Gopaluni, R., & Kwok, E. (2011). Detection of organ dysfunction in type II diabetic patients. In American Control Conference, vol 3, pp. 4769–4774

  22. Vahidi, O., Kwok, E., Gopaluni, R. B. & Sun, L. (2010). Development of a physiological model for patients with type 2 diabetes mellitus. In American Control Conference, pp. 2027–2032

  23. Barazandegan, M., Ekram, F., Kwok, E., Gopaluni, B., & Tulsyan, A. (2015). Assessment of type II diabetes mellitus using irregularly sampled measurements with missing data. Bioprocess and Biosystems Engineering, 38, 615–629.

    Article  Google Scholar 

  24. Ekoé, J.-M., Punthakee, Z., Ransom, T., Prebtani, A. P. H., & Goldenberg, R. (2013). Screening for type 1 and type 2 Diabetes. Canadian Journal of Diabetes, 37, S12–S15.

    Article  Google Scholar 

  25. Hayashi, T., Boyko, E. J., Sato, K. K., McNeely, M. J., Leonetti, D. L., Kahn, S. E., & Fujimoto, W. Y. (2013). Patterns of insulin concentration during the OGTT predict the risk of type 2 diabetes in Japanese Americans. Diabetes Care, 36, 1229–1235.

    Article  Google Scholar 

  26. Bakari, A., & Onyemelukwe, G. (2004). Plasma insulin response to oral glucose tolerance test in type-2 Nigerian diabetics. East African Medical Journal, 81, 463–467.

    Article  Google Scholar 

  27. Jarrett, R., Baker, I., Keen, H., & Oakley, N. (1972). Diurnal variation in oral glucose tolerance: Blood sugar and plasma insulin levels morning, afternoon, and evening. British Medical Journal, 1, 199–201.

    Article  Google Scholar 

  28. Knop, F. K., Vilsbøll, T., Madsbad, S., Holst, J. J., & Krarup, T. (2007). Inappropriate suppression of glucagon during OGTT but not during isoglycaemic i.v. glucose infusion contributes to the reduced incretin effect in type 2 diabetes mellitus. Diabetologia, 50, 797–805.

    Article  Google Scholar 

  29. Knop, F. K., Vilsbøll, T., Højberg, P. V., Larsen, S., Madsbad, S., Vølund, A., et al. (2007). Reduced incretin effect in type 2 diabetes: Cause or consequence of the diabetic state? Diabetes, 56, 1951–1959.

    Article  Google Scholar 

  30. Chisholm, D., Young, J., & Lazarus, L. (1969). The gastrointestinal stimulus to insulin release: I. Secretin. Journal of Clinical Investigation, 48, 1453–1460.

    Article  Google Scholar 

  31. Ekram, F., Barazandegan, M., Kwok, E. & Gopaluni, B. (2015). Evaluation of treatment regimens for blood glucose regulation in type II diabetes using pharmacokinetic-pharmacodynamic modeling. In Proceedings of 34th Chinese control conference (pp. 8519–8524).

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Acknowledgments

We would like to thank Dr. Omid Vahidi for his suggestions and support.

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Correspondence to Ezra Kwok.

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Barazandegan, M., Ekram, F., Kwok, E. et al. Simple Self-Administered Method for Assessing Insulin Sensitivity in Diabetic Patients. J. Med. Biol. Eng. 36, 197–205 (2016). https://doi.org/10.1007/s40846-016-0122-3

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  • DOI: https://doi.org/10.1007/s40846-016-0122-3

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