Coates P A, Luzio S D, Brunel P, Owens D R
Diabetes Research Unit, University of Wales College of Medicine, Cardiff, U.K.
Diabetes. 1995 Jun;44(6):631-5. doi: 10.2337/diab.44.6.631.
Minimal model (MINMOD) analysis of the frequently sampled intravenous glucose tolerance test (FSIVGTT) is dependent on an adequate insulin response to the glucose load. As this is characteristically deficient in subjects with non-insulin-dependent diabetes mellitus (NIDDM), the technique has been modified by the use of an intravenous bolus of insulin. Previous validation of this modification in humans has relied on agreement between insulin sensitivity indexes (SI) estimated from tolbutamide- and insulin-modified tests and not on direct comparison with estimates derived from the isoglycemic glucose clamp. We have compared estimates of insulin sensitivity derived from minimal modeling of a 4-h insulin-modified FSIVGTT and the glucose clamp in subjects with NIDDM. Twelve subjects underwent an insulin-modified FSIVGTT and an isoglycemic hyperinsulinemic clamp in random order 2-4 weeks apart. Fasting plasma glucose (8.4 vs. 9.0 mmol/l) and immunoreactive insulin (IRI) concentrations (104.5 vs. 101.5 pmol/l) were not different between the 2 study days. SI(clamp) was derived from the steady-state glucose infusion rate during the 3rd h of the clamp, corrected for the ambient insulin and glucose concentrations. SI(ivgtt) was derived using MINMOD. SI(ivgtt) was 1.06 +/- 0.18 min-1.mU-1.ml x 10(4), and mean SI(clamp) was 4.97 +/- 0.69 l.min-1/pmol.l-1 x 10(4) (mean +/- SE). SI(ivgtt) was positively correlated with SI(clamp) (r = 0.73, P = 0.004) and negatively correlated with body mass index (r = -0.7, P = 0.005) and fasting IRI(ivgtt) (r = -0.64, P = 0.008). In summary, MINMOD analysis of the insulin-modified FSIVGTT provides a valid measure of insulin sensitivity in subjects with NIDDM.
对频繁采样的静脉葡萄糖耐量试验（FSIVGTT）进行最小模型（MINMOD）分析依赖于对葡萄糖负荷有足够的胰岛素反应。由于非胰岛素依赖型糖尿病（NIDDM）患者的这一反应通常不足，因此通过静脉注射胰岛素推注对该技术进行了改进。此前对人类这种改进方法的验证依赖于从甲苯磺丁脲和胰岛素改良试验估计的胰岛素敏感性指数（SI）之间的一致性，而不是与等血糖葡萄糖钳夹法得出的估计值进行直接比较。我们比较了NIDDM患者4小时胰岛素改良FSIVGTT最小模型得出的胰岛素敏感性估计值与葡萄糖钳夹法得出的估计值。12名受试者在相隔2至4周的时间里随机顺序接受了胰岛素改良FSIVGTT和等血糖高胰岛素钳夹试验。在两个研究日之间，空腹血糖（8.4对9.0 mmol/l）和免疫反应性胰岛素（IRI）浓度（104.5对101.5 pmol/l）没有差异。SI（钳夹法）来自钳夹试验第3小时的稳态葡萄糖输注速率，并根据环境胰岛素和葡萄糖浓度进行校正。SI（静脉葡萄糖耐量试验法）使用MINMOD得出。SI（静脉葡萄糖耐量试验法）为1.06±0.18 min-1.mU-1.ml×10(4)，平均SI（钳夹法）为4.97±0.69 l.min-1/pmol.l-1×10(4)（平均值±标准误）。SI（静脉葡萄糖耐量试验法）与SI（钳夹法）呈正相关（r = 0.73，P = 0.004），与体重指数呈负相关（r = -0.7，P = 0.005），与空腹IRI（静脉葡萄糖耐量试验法）呈负相关（r = -0.64，P = 0.008）。总之，对胰岛素改良FSIVGTT进行MINMOD分析可有效测量NIDDM患者的胰岛素敏感性。
