Dalla Man Chiara, Toffolo Gianna, Basu Rita, Rizza Robert A, Cobelli Claudio
Department of Information Engineering, University of Padova, Italy.
Conf Proc IEEE Eng Med Biol Soc. 2006;2006:5647-50. doi: 10.1109/IEMBS.2006.260809.
The efficiency of glucose and insulin control on glucose production (EGP) plays an important role in glucose homeostasis and its derangement in diabetes. Therefore the ability to accurately quantify indices of the individual role of glucose (GE(L)) and insulin (S(I)(L)) in the suppression of EGP would allow to improve the understanding of liver metabolism. Measuring these indices by minimal modelling of tracer labelled and unlabelled glucose data is often unreliable, possibly due to an inadequate description of EGP included in the minimal model (EGP(MM)). Moreover a validation of EGP(MM) on EGP data has never been done. Here EGP(MM) and alternative EGP descriptions were tested on recent model-independent EGP data of 20 subjects obtained with a triple-tracer meal protocol. Model performances were compared in terms of data fit and physiological plausibility. EGP(MM) was not able to describe EGP data, while one of the new model showed a good fit and provided accurate and precise estimates of hepatic sensitivity indices: GE(L) = 0.013 +/- 0.001 dl/kg/min; S(I)(L) =5.71 +/- 0.48 10(-4) dl/kg/min per microU/ml (36% and 41%, respectively, of total sensitivity indices GE(TOT) and S(I)(TOT)). This novel approach will allow to enhance our understanding of the role of the liver in pathophysiological states.
葡萄糖和胰岛素对葡萄糖生成（EGP）的控制效率在葡萄糖稳态及其在糖尿病中的紊乱中起着重要作用。因此，准确量化葡萄糖（GE(L)）和胰岛素（S(I)(L)）在抑制EGP中的个体作用指标的能力，将有助于增进对肝脏代谢的理解。通过对示踪剂标记和未标记葡萄糖数据进行最小模型化来测量这些指标往往不可靠，这可能是由于最小模型（EGP(MM)）中对EGP的描述不充分所致。此外，从未对EGP(MM)在EGP数据上进行过验证。在此，我们使用三重示踪剂餐协议，在20名受试者的最新独立于模型的EGP数据上测试了EGP(MM)和其他EGP描述。从数据拟合和生理合理性方面比较了模型性能。EGP(MM)无法描述EGP数据，而新模型之一显示出良好的拟合，并提供了肝脏敏感性指标的准确和精确估计：GE(L)=0.013±0.001 dl/kg/min；S(I)(L)=5.71±0.48×10⁻⁴ dl/kg/min per microU/ml（分别占总敏感性指标GE(TOT)和S(I)(TOT)的36%和41%）。这种新方法将有助于增强我们对肝脏在病理生理状态中作用的理解。
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