Cutfield W S, Bergman R N, Menon R K, Sperling M A
Department of Pediatrics, University of Cincinnati College of Medicine.
J Clin Endocrinol Metab. 1990 Jun;70(6):1644-50. doi: 10.1210/jcem-70-6-1644.
The modified minimal model (MMM), a recently introduced method that assesses insulin sensitivity (SI) by a computed mathematical analysis of the relation between the change in insulin and glucose clearance after a bolus of iv glucose, followed 20 min later by a bolus of tolbutamide, has been standardized in adults, but this method has not been validated in children. We performed an abbreviated 90-min MMM test in 50 children who were siblings of patients with insulin-dependent diabetes mellitus and 7 healthy adult volunteers and compared the results to the standard 180-min MMM test in 11 of these subjects. The cohort consisted of 29 prepubertal children [16 males and 13 females; 8.7 +/- 2.0 (mean +/- SEM) yr old]; 16 pubertal children defined as less than 17 yr of age and Tanner stage 2-5 (8 males and 8 females; 13.4 +/- 1.8 yr old), and 12 postpubertal subjects (7 males and 5 females; 18.2 +/- 0.9 yr old), with no significant difference in the weight for length index (WLI) among the 3 groups and with sera of all subjects negative for islet cell antibodies and insulin autoantibodies. The test procedure consisted of 3 baseline blood samples over 30 min, followed at zero time by 0.3 g/kg 25% dextrose infused iv over 1 min and an iv injection of tolbutamide (5 mg/kg) 20 min later; sequential blood samples for glucose and insulin measurements were withdrawn from zero time until completion 90 or 180 min later. In the 11 subjects who underwent both the standard and the abbreviated tests, there was no significant difference between the SI estimated by the 2 methods provided that glucose and insulin values were interpolated at 180 min during the computer calculations of the abbreviated test. Using the 90-min abbreviated test, the SI of the pubertal subjects (2.92 +/- 0.45) was markedly less than that of the prepubertal subjects (6.57 +/- 0.45; P = 0.0001). While the postpubertal group value of 4.63 +/- 0.86 was significantly higher than that of the pubertal group (P = 0.0001), the pre- and postpubertal groups remained significantly different (P = 0.0001). The 10 obese subjects with WLI greater than 120% had a lower SI (3.5 +/- 0.53) than the 47 nonobese subjects with WLI less than 120% (SI = 5.48 +/- 0.42; P less than 0.04), and there was a negative correlation between SI and WLI. None of the study subjects experienced symptomatic hypoglycemia during the test.(ABSTRACT TRUNCATED AT 400 WORDS)
改良的最小模型（MMM）是一种最近引入的方法，通过对静脉注射葡萄糖推注后胰岛素变化与葡萄糖清除率之间的关系进行计算数学分析来评估胰岛素敏感性（SI），20分钟后再推注甲苯磺丁脲。该方法已在成人中标准化，但尚未在儿童中得到验证。我们对50名胰岛素依赖型糖尿病患者的兄弟姐妹儿童和7名健康成人志愿者进行了90分钟的简化MMM测试，并将结果与其中11名受试者的标准180分钟MMM测试结果进行了比较。该队列包括29名青春期前儿童[16名男性和13名女性；8.7±2.0（平均±标准误）岁]；16名青春期儿童，定义为年龄小于17岁且 Tanner 分期为2 - 5期（8名男性和8名女性；13.4±1.8岁），以及12名青春期后受试者（7名男性和5名女性；18.2±0.9岁），三组之间的身长体重指数（WLI）无显著差异，且所有受试者的胰岛细胞抗体和胰岛素自身抗体血清学检测均为阴性。测试过程包括在30分钟内采集3份基线血样，然后在0分钟时静脉注射0.3 g/kg 25%葡萄糖，持续1分钟，20分钟后静脉注射甲苯磺丁脲（5 mg/kg）；从0分钟开始直至90或180分钟结束时，依次采集血样用于测量葡萄糖和胰岛素。在接受标准测试和简化测试的11名受试者中，只要在简化测试的计算机计算过程中将葡萄糖和胰岛素值插值到180分钟，两种方法估算的SI之间无显著差异。使用90分钟简化测试，青春期受试者的SI（2.92±0.45）明显低于青春期前受试者（6.57±0.45；P = 0.0001）。虽然青春期后组的值4.63±0.86显著高于青春期组（P = 0.0001），但青春期前组和青春期后组仍有显著差异（P = 0.0001）。10名WLI大于120%的肥胖受试者的SI（3.5±0.53）低于47名WLI小于120%的非肥胖受试者（SI = 5.48±0.42；P＜0.04），且SI与WLI之间存在负相关。在测试过程中，没有研究受试者出现症状性低血糖。（摘要截断于400字）
