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Assessment of endogenous insulin secretion in insulin treated diabetes predicts postprandial glucose and treatment response to prandial insulin.

Jones AG, Besser RE, Shields BM, McDonald TJ, Hope SV, Knight BA, Hattersley AT - BMC Endocr Disord (2012)

Bottom Line: We aimed to assess the impact of endogenous insulin secretion on postprandial glucose increase and the effectiveness of prandial exogenous insulin.Similar doses of exogenous prandial insulin lowered glucose increment more when patients had less endogenous insulin; by 6.4(4.2-11.1) verses 1.2(0.03-2.88) mmol/L (p < 0.001) for patients in the lowest verses highest tertiles of endogenous insulin.In insulin treated patients the measurement of endogenous insulin secretion may help predict the degree of postprandial hyperglycaemia and the likely response to prandial insulin.

View Article: PubMed Central - HTML - PubMed

Affiliation: Peninsula NIHR Clinical Research Facility, Peninsula Medical School, University of Exeter, Exeter, UK. angus.jones@pms.ac.uk.

ABSTRACT

Background: In patients with both Type 1 and Type 2 diabetes endogenous insulin secretion falls with time which changes treatment requirements, however direct measurement of endogenous insulin secretion is rarely performed. We aimed to assess the impact of endogenous insulin secretion on postprandial glucose increase and the effectiveness of prandial exogenous insulin.

Methods: We assessed endogenous insulin secretion in 102 participants with insulin treated diabetes (58 Type 1) following a standardised mixed meal without exogenous insulin. We tested the relationship between endogenous insulin secretion and post meal hyperglycaemia. In 80 participants treated with fast acting breakfast insulin we repeated the mixed meal with participants' usual insulin given and assessed the impact of endogenous insulin secretion on response to exogenous prandial insulin.

Results: Post meal glucose increment (90 minute - fasting) was inversely correlated with endogenous insulin secretion (90 minute C-peptide) (Spearman's r = -0.70, p < 0.001). Similar doses of exogenous prandial insulin lowered glucose increment more when patients had less endogenous insulin; by 6.4(4.2-11.1) verses 1.2(0.03-2.88) mmol/L (p < 0.001) for patients in the lowest verses highest tertiles of endogenous insulin.

Conclusions: In insulin treated patients the measurement of endogenous insulin secretion may help predict the degree of postprandial hyperglycaemia and the likely response to prandial insulin.

No MeSH data available.


Related in: MedlinePlus

a: Scatterplot showing the relationship between MMT stimulated C-peptide (nmol/L) and reduction in glucose increment with administration of prandial exogenous insulin.b: Boxplot showing reduction in MMT glucose increment with the addition of prandial exogenous insulin by 90 minute post MMT C-peptide tertile. Horizontal line represents median, box interquartile range, ‘whiskers’ represent spread of remaining values. p for trend <0.001.
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Figure 2: a: Scatterplot showing the relationship between MMT stimulated C-peptide (nmol/L) and reduction in glucose increment with administration of prandial exogenous insulin.b: Boxplot showing reduction in MMT glucose increment with the addition of prandial exogenous insulin by 90 minute post MMT C-peptide tertile. Horizontal line represents median, box interquartile range, ‘whiskers’ represent spread of remaining values. p for trend <0.001.

Mentions: To assess the impact of prandial exogenous insulin we measured the reduction in glucose increment after a mixed meal when prandial exogenous insulin was given (glucose increment in MMT minus glucose increment in MMT + I). The reduction in glucose increment with administration of prandial exogenous insulin was also negatively correlated with SCP (r = −0.61, p < 0.001, n = 80, Figure 2A). Exogenous prandial insulin resulted in a greater reduction in glucose increment in those with lower C-peptide; linear regression B was −2.5 (CI −3.4 to −1.6, p < 0.001) suggesting a fall of 2.5 mmol/L in the reduction in glucose increment with prandial insulin administration for every 1 nmol/L increase in SCP. The relationship persisted after adjusting for age, age of diagnosis, BMI, gender, fasting glucose and HbA1c (p = 0.04). Of these clinical variables in multivariable analysis only SCP and age of diagnosis (p = 0.02) were statistically significant predictors of response to exogenous prandial insulin.


Assessment of endogenous insulin secretion in insulin treated diabetes predicts postprandial glucose and treatment response to prandial insulin.

Jones AG, Besser RE, Shields BM, McDonald TJ, Hope SV, Knight BA, Hattersley AT - BMC Endocr Disord (2012)

a: Scatterplot showing the relationship between MMT stimulated C-peptide (nmol/L) and reduction in glucose increment with administration of prandial exogenous insulin.b: Boxplot showing reduction in MMT glucose increment with the addition of prandial exogenous insulin by 90 minute post MMT C-peptide tertile. Horizontal line represents median, box interquartile range, ‘whiskers’ represent spread of remaining values. p for trend <0.001.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3405447&req=5

Figure 2: a: Scatterplot showing the relationship between MMT stimulated C-peptide (nmol/L) and reduction in glucose increment with administration of prandial exogenous insulin.b: Boxplot showing reduction in MMT glucose increment with the addition of prandial exogenous insulin by 90 minute post MMT C-peptide tertile. Horizontal line represents median, box interquartile range, ‘whiskers’ represent spread of remaining values. p for trend <0.001.
Mentions: To assess the impact of prandial exogenous insulin we measured the reduction in glucose increment after a mixed meal when prandial exogenous insulin was given (glucose increment in MMT minus glucose increment in MMT + I). The reduction in glucose increment with administration of prandial exogenous insulin was also negatively correlated with SCP (r = −0.61, p < 0.001, n = 80, Figure 2A). Exogenous prandial insulin resulted in a greater reduction in glucose increment in those with lower C-peptide; linear regression B was −2.5 (CI −3.4 to −1.6, p < 0.001) suggesting a fall of 2.5 mmol/L in the reduction in glucose increment with prandial insulin administration for every 1 nmol/L increase in SCP. The relationship persisted after adjusting for age, age of diagnosis, BMI, gender, fasting glucose and HbA1c (p = 0.04). Of these clinical variables in multivariable analysis only SCP and age of diagnosis (p = 0.02) were statistically significant predictors of response to exogenous prandial insulin.

Bottom Line: We aimed to assess the impact of endogenous insulin secretion on postprandial glucose increase and the effectiveness of prandial exogenous insulin.Similar doses of exogenous prandial insulin lowered glucose increment more when patients had less endogenous insulin; by 6.4(4.2-11.1) verses 1.2(0.03-2.88) mmol/L (p < 0.001) for patients in the lowest verses highest tertiles of endogenous insulin.In insulin treated patients the measurement of endogenous insulin secretion may help predict the degree of postprandial hyperglycaemia and the likely response to prandial insulin.

View Article: PubMed Central - HTML - PubMed

Affiliation: Peninsula NIHR Clinical Research Facility, Peninsula Medical School, University of Exeter, Exeter, UK. angus.jones@pms.ac.uk.

ABSTRACT

Background: In patients with both Type 1 and Type 2 diabetes endogenous insulin secretion falls with time which changes treatment requirements, however direct measurement of endogenous insulin secretion is rarely performed. We aimed to assess the impact of endogenous insulin secretion on postprandial glucose increase and the effectiveness of prandial exogenous insulin.

Methods: We assessed endogenous insulin secretion in 102 participants with insulin treated diabetes (58 Type 1) following a standardised mixed meal without exogenous insulin. We tested the relationship between endogenous insulin secretion and post meal hyperglycaemia. In 80 participants treated with fast acting breakfast insulin we repeated the mixed meal with participants' usual insulin given and assessed the impact of endogenous insulin secretion on response to exogenous prandial insulin.

Results: Post meal glucose increment (90 minute - fasting) was inversely correlated with endogenous insulin secretion (90 minute C-peptide) (Spearman's r = -0.70, p < 0.001). Similar doses of exogenous prandial insulin lowered glucose increment more when patients had less endogenous insulin; by 6.4(4.2-11.1) verses 1.2(0.03-2.88) mmol/L (p < 0.001) for patients in the lowest verses highest tertiles of endogenous insulin.

Conclusions: In insulin treated patients the measurement of endogenous insulin secretion may help predict the degree of postprandial hyperglycaemia and the likely response to prandial insulin.

No MeSH data available.


Related in: MedlinePlus