The hot but not the cold minimal model allows precise assessment of insulin sensitivity in NIDDM subjects.
The hot but not the cold minimal model allows precise assessment of insulin sensitivity in NIDDM subjects.
复制标题
热而不是冷的最小模型可以精确评估 NIDDM 受试者的胰岛素敏感性。
DOI：
10.1152/ajpendo.1996.270.3.e532
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发表时间：
1996
期刊：
影响因子：
--
通讯作者：
Cobelli,C
中科院分区：
文献类型：
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作者：
Avogaro,A;Vicini,P;Valerio,A;Caumo,A;Cobelli,C
非胰岛素依赖型糖尿病（NIDDM）受试者的胰岛素敏感性评估至关重要，但本质上是困难的。最近已经提出了标准（下文称为冷）最小模型，结合胰岛素修改的方案，但是胰岛素敏感性的估计显示出较差的精确度（Saad等，Diabetes 43：1114-1121，1994）。我们提出示踪剂（以下热）最小模型作为一个高度可靠的方法来估计胰岛素敏感性（SI*）和葡萄糖清除率（SG*），反映葡萄糖处置，在NIDDM受试者。在7名NIDDM受试者中进行了[6，6 - 2 H2]葡萄糖标记的胰岛素修饰的静脉葡萄糖耐量试验。特别是，SI* 为1.07 +/- 0.34 x10（-4）min（-1）. microU-1.ml，平均精密度估计值（平均变异系数为12%，范围为4-22%），而冷最小模型SI为0.96 +/- 0.26 x 10（-4）min-1。microU-1.ml变异系数为105%，范围为3-353%）。热指数相对于冷指数的另一个优点是它们能够仅反映葡萄糖和胰岛素对葡萄糖处置的影响，而不是对肝葡萄糖产生的影响。最后，我们还通过模拟研究了葡萄糖尿损失对冷和热最小模型指数的影响;只有冷葡萄糖有效性（SG）受到显著影响，导致平均约40%的降低。因此，热最小模型似乎比冷模型更可靠，用于评估NIDDM受试者的葡萄糖耐量。特别是它的能力，解剖处理生产过程中，加上非常好的精度估计代谢指标，支持临床使用这种方法在NIDDM受试者。
Assessment of insulin sensitivity in subjects with non-insulin-dependent diabetes mellitus (NIDDM) is of paramount importance but intrinsically difficult. The standard (hereafter cold) minimal model, in conjunction with an insulin-modified protocol, has been recently proposed, but the estimates of insulin sensitivity showed poor precision (Saad et al. Diabetes 43: 1114-1121, 1994). We propose the tracer (hereafter hot) minimal model as a highly reliable method to estimate insulin sensitivity (SI*) and fractional glucose clearance (SG*), reflecting glucose disposal only, in NIDDM subjects. A [6,6- 2H2] glucose-labeled insulin-modified intravenous glucose tolerance test was performed in seven NIDDM subjects. In particular, SI* was 1.07 +/- 0.34 x10(-4)min(-1).microU-1.ml estimated with an average precision (mean coefficient of variation of 12%, range 4-22%), whereas the cold minimal model SI was 0.96 +/- 0.26 x 10(-4) min-1. microU-1.ml (mean coefficient of variation of 105%, range 3-353%). Another advantage of the hot indexes with respect to the cold indexes is their ability to reflect glucose and insulin effect on glucose disposal only, and not also on hepatic glucose production. Finally, we also studied by simulation the effect of glucose urinary loss on cold and hot minimal model indexes; only cold glucose effectiveness (SG) was significantly affected, resulting in a mean approximately 40% lower. The hot minimal model appears therefore more reliable than the cold model for assessing glucose tolerance in NIDDM subjects. In particular its ability to dissect disposal from production processes, coupled with the very good precision of the estimated metabolic indexes, supports the clinical use of this method in NIDDM subjects.