The Oral Minimal Model Method
The Oral Minimal Model Method
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DOI：
10.2337/db13-1198
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发表时间：
2014-04-01
期刊：
影响因子：
7.7
通讯作者：
Rizza, Robert
中科院分区：
文献类型：
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作者：
Cobelli, Claudio;Dalla Man, Chiara;Rizza, Robert
同时评估胰岛素的作用、分泌和肝提取是了解非糖尿病和糖尿病患者餐后葡萄糖代谢的关键。我们回顾了口服最小方法（即允许估计胰岛素敏感性、β细胞反应性以及从混合餐或口服葡萄糖耐量测试中提取的肝胰岛素的模型）。与基于静脉内测试（例如葡萄糖钳或静脉内葡萄糖耐量测试）的测试相比，这两种口服测试更符合生理学且更易于实施。本次综述的重点是基于生理的模型提供的指数及其针对葡萄糖钳技术的验证。我们首先讨论口头最小模型方法的基本原理、数据和协议。然后我们介绍三个最小模型及其提供的索引。处置指数范式是一种广泛使用的 β 细胞功能指标，在个体与群体建模的背景下被重新审视。在口服剂量中添加葡萄糖示踪剂可将胰岛素敏感性分为其葡萄糖处理和肝脏成分，从而显着增强对胰岛素作用的评估。口服最小模型方法通过定量描述葡萄糖代谢主要参与者之间的复杂关系，能够提供有关餐后代谢调节的新见解。
The simultaneous assessment of insulin action, secretion, and hepatic extraction is key to understanding postprandial glucose metabolism in nondiabetic and diabetic humans. We review the oral minimal method (i.e., models that allow the estimation of insulin sensitivity, beta-cell responsivity, and hepatic insulin extraction from a mixed-meal or an oral glucose tolerance test). Both of these oral tests are more physiologic and simpler to administer than those based on an intravenous test (e.g., a glucose clamp or an intravenous glucose tolerance test). The focus of this review is on indices provided by physiological-based models and their validation against the glucose clamp technique. We discuss first the oral minimal model method rationale, data, and protocols. Then we present the three minimal models and the indices they provide. The disposition index paradigm, a widely used beta-cell function metric, is revisited in the context of individual versus population modeling. Adding a glucose tracer to the oral dose significantly enhances the assessment of insulin action by segregating insulin sensitivity into its glucose disposal and hepatic components. The oral minimal model method, by quantitatively portraying the complex relationships between the major players of glucose metabolism, is able to provide novel insights regarding the regulation of postprandial metabolism.