Exercise effect on insulin-dependent and insulin-independent glucose utilization in healthy individuals and individuals with type 1 diabetes: a modeling study.
Exercise effect on insulin-dependent and insulin-independent glucose utilization in healthy individuals and individuals with type 1 diabetes: a modeling study.
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运动对健康个体和 1 型糖尿病个体的胰岛素依赖性和胰岛素非依赖性葡萄糖利用的影响：一项模型研究。
DOI：
10.1152/ajpendo.00084.2021
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发表时间：
2021
期刊：
影响因子：
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通讯作者：
DallaMan,Chiara
中科院分区：
文献类型：
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作者：
Romeres,Davide;Schiavon,Michele;Basu,Ananda;Cobelli,Claudio;Basu,Rita;DallaMan,Chiara
运动对全身葡萄糖消失率（Rd）的影响（EE）通过胰岛素非依赖性（IIRd）和胰岛素依赖性（IDRd）机制发生。量化这些过程在体内将允许更好地了解葡萄糖调节的生理学。这对1型糖尿病（T1 D）患者尤其重要，因为这样的知识可能有助于改善血糖管理。然而，这样的模式仍然缺乏。在这里，我们分析了6名T1 D和6名非糖尿病（ND）受试者在65%V ~ o2 maxon下进行60分钟运动期间、之前和之后的标记葡萄糖钳夹研究的数据，三次随机访视：正常血糖-低胰岛素、正常血糖-高胰岛素和高血糖-低胰岛素。我们测试了一组模型，所有共享的葡萄糖动力学的单室描述，但不同的运动是如何假设调节葡萄糖处置。模型选择基于简约标准。最好的模型假设运动引起的即时影响IIRd和IDRd的延迟效应。与休息时相比，运动可使T1 D和ND患者的IIRd分别增加66%-82%和67%-97%，但两组之间无显著差异。相反，运动对IDRd的影响在T1 D中介于81%和155%之间，并且显著高于ND，ND介于10%和40%之间。在IDRd中观察到的夸大效应可以解释与T1 D个体相关的较高低血糖风险。这种新的运动模型可以帮助T1D.NEW和NOTEWORTHY个体在运动期间和运动后提供安全有效的血糖管理。在这里，我们提出了一个新的数学模型，描述了适度的体力活动对胰岛素介导的和非胰岛素介导的葡萄糖处置的影响，在有和没有糖尿病的受试者。我们相信，这代表了1型糖尿病病理生理学知识的一个进步，也是设计安全有效的胰岛素治疗的有用工具。
Exercise effects (EE) on whole body glucose rate of disappearance (Rd) occur through insulin-independent (IIRd) and insulin-dependent (IDRd) mechanisms. Quantifying these processes in vivo would allow a better understanding of the physiology of glucose regulation. This is of particular importance in individuals with type 1 diabetes (T1D) since such a knowledge may help to improve glucose management. However, such a model is still lacking. Here, we analyzed data from six T1D and six nondiabetic (ND) subjects undergoing a labeled glucose clamp study during, before, and after a 60-min exercise session at 65% V̇o2maxon three randomized visits: euglycemia-low insulin, euglycemia-high insulin, and hyperglycemia-low insulin. We tested a set of models, all sharing a single-compartment description of glucose kinetics, but differing in how exercise is assumed to modulate glucose disposal. Model selection was based on parsimony criteria. The best model assumed an exercise-induced immediate effect on IIRd and a delayed effect on IDRd. It predicted that exercise increases IIRd, compared with rest, by 66%–82% and 67%–97% in T1D and ND, respectively, not significantly different between the two groups. Conversely, the exercise effect on IDRd ranged between 81% and 155% in T1D and it was significantly higher than ND, which ranged between 10% and 40%. The exaggerated effect observed in IDRd can explain the higher hypoglycemia risk related to individuals with T1D. This novel exercise model could help in informing safe and effective glucose management during and after exercise in individuals with T1D.NEW & NOTEWORTHYHere, we present a new mathematical model describing the effect of moderate physical activity on insulin-mediated and noninsulin-mediated glucose disposal in subjects with and without diabetes. We believe that this represents a step-forward in the knowledge of type 1 diabetes pathophysiology, and an useful tool to design safe and effective insulin-therapies.