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Insulin Sensitivity from Meal Tolerance Tests in Normal Subjects: A Minimal Model Index

San Raffaele Scientific Institute (A.C.), Milan, Italy; University of Southern California (R.N.B.), Los Angeles, California 90033; and Department of Electronics and Informatics, University of Padova (C.C.), I-35131 Padova, Italy

Address all correspondence and requests for reprints to: Prof. Claudio Cobelli, Department of Electronics and Informatics, Via Gradenigo 6/A, University of Padova, I-35131 Padova, Italy. E-mail: cobelli{at}dei.unipd.it

In this report a new approach is introduced that allows estimation of insulin sensitivity (S_I) from orally ingested glucose during an oral glucose tolerance test (OGTT) or a meal glucose tolerance test (MGTT) in normal subjects. The method hinges on the classic minimal model of glucose kinetics that is coupled with an equation describing the rate of appearance of glucose into the circulation after oral glucose ingestion. The model provides an estimate of S_I in a given individual based on simple area under the curve type of calculations. To prove the reliability of the new approach, MGTT studies performed in 10 normal subjects were analyzed and the S_I index from the MGTT was compared with the S_I index obtained in the same subjects from an insulin-modified, frequently sampled iv glucose test (FSIGT). S_I from the MGTT was 13.6 ± 3.9 x 10^-4 dL/kg·min/µU·mL and was strongly correlated to the S_I from the FSIGT (r_s = 0.89; P < 0.01). In conclusion, this study shows that in normal subjects the minimal model can be applied to a MGTT/OGTT to derive an index of insulin sensitivity that is in good agreement with the one estimated from the FSIGT. Due to its simplicity, this method has potential for use in population studies, but further investigation is required to ascertain its applicability to subjects with severe insulin resistance and impaired secretory function.

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