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Am J Physiol Endocrinol Metab 277: E481-E488, 1999;
0193-1849/99 $5.00
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Vol. 277, Issue 3, E481-E488, September 1999

EPILOGUE
Minimal model SG overestimation and SI underestimation: improved accuracy by a Bayesian two-compartment model

Claudio Cobelli1, Andrea Caumo2, and Matteo Omenetto1

1 Department of Electronics and Informatics, University of Padova, 35131 Padova; and 2 Scientific Institute San Raffaele, 20132 Milano, Italy

The intravenous glucose tolerance test (IVGTT) single-compartment minimal model (1CMM) method has recently been shown to overestimate glucose effectiveness and underestimate insulin sensitivity. Undermodeling, i.e., use of single- instead of two-compartment description of glucose kinetics, has been advocated to explain these limitations. We describe a new two-compartment minimal model (2CMM) into which we incorporate certain available knowledge on glucose kinetics. 2CMM is numerically identified using a Bayesian approach. Twenty-two standard IVGTT (0.30 g/kg) in normal humans were analyzed. In six subjects, the clamp-based index of insulin sensitivity (ScI) was also measured. 2CMM glucose effectiveness (S2G) and insulin sensitivity (S2I) were, respectively, 60% lower (P < 0.0001) and 35% higher (P < 0.0001) than the corresponding 1CMM S1G and S1I indexes: 2.81 ± 0.29 (SE) vs. S1G = 4.27 ± 0.33 ml · min-1 · kg-1 and S2I = 11.67 ± 1.71 vs. S1I = 8.68 ± 1.62 102 ml · min-1 · kg-1 per µU/ml. S2I was not different from ScI = 12.61 ± 2.13 102 ml · min-1 · kg-1 per µU/ml (nonsignificant), whereas S1I was 60% lower (P < 0.02). In conclusion, a new 2CMM has been presented that improves the accuracy of glucose effectiveness and insulin sensitivity estimates of the classic 1CMM from a standard IVGTT in normal humans.

glucose effectiveness; insulin sensitivity; glucose kinetics; glucose clamp technique


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