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Minimal-Model Estimates of Insulin Sensitivity Are Insensitive to Errors in Glucose Effectiveness¹

Diabetes Research Laboratory (C.M., D.T.F.), School of Kinesiology, Simon Fraser University, Burnaby, British Columbia V5A 1S6, Canada; and Brigham and Women’s Hospital (A.D.), Boston, Massachusetts 02115

Address correspondence and requests for reprints to: Diane T. Finegood, Ph.D., School of Kinesiology, Simon Fraser University, Room K9625, Burnaby, British Columbia V5A 1S6, Canada. E-mail: finegood{at}sfu.ca

The minimal-model method allows for estimation of insulin sensitivity (S_I = P₃/P₂) and glucose effectiveness (S_G = P₁) from the time course of glucose and insulin after a glucose bolus. We previously demonstrated that the minimal-model results in overestimates of S_G in subjects with normal insulin secretory function. To determine whether overestimation of S_G has an impact on estimation of S_I, we examined model estimation of S_I when S_G was constrained to levels below that found by the regular minimal-model fit. Fifty-six glucose tolerance tests from lean and obese women, with and without polycystic ovary syndrome, were used. S_I ranged from 0.2–22.6 x 10^-4 min^-1/(µU/mL), and S_G ranged from 0.8–3.8 x 10^-2 min^-1 for the standard minimal-model fits. Constraining S_G to as low as 40% of the unconstrained value resulted in a 4-fold increase in P₂ and P₃, but only a 3% reduction in S_I. We conclude that estimation of the insulin sensitivity index is independent of errors in minimal-model-derived estimates of glucose effectiveness.

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