A glimpse of the ‘natural history’ of established Type 2 (non-insulin dependent) diabetes mellitus from the spectrum of metabolic and hormonal responses to a mixed meal at the time of diagnosis

Coates, Philip A.; Ollerton, Richard L.; Luzio, Stephen Denis; Ismail, I.A.; Owens, David R.

doi:10.1016/0168-8227(94)90059-0

Cited by 37 publications

(27 citation statements)

References 28 publications

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“…Coates et al have developed a 500 kcal mixed meal, which provided more physiological and stable stimuli to the pancreatic beta cells producing glycemic excursion [18]. Fat loading tests (20-45 g fat) have also been reported for the evaluation of postprandial hypertriglyceridemia or RLP [19,20].…”

Section: Discussionmentioning

confidence: 99%

Development of Cookie Test for the Simultaneous Determination of Glucose Intolerance, Hyperinsulinemia, Insulin Resistance and Postprandial Dyslipidemia

Harano¹,

Miyawaki

Nabiki

et al. 2006

Endocr J

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Abstract.A new cookie test was developed for the simultaneous evaluation of multiple risk factors such as glucose intolerance, hyperinsulinemia, insulin resistance and postprandial dyslipidemia. The cookie consisting of 75 g carbohydrate and 25 g fat is ingested and the blood samples are obtained at 0, 1 and 2 hours later. When the two carbohydrate sources, liquid glucose and test cookie, were compared as a glucose load within 3 months, the 2 hr plasma glucose levels were not statistically different, proposing the use of the same criteria at 2 hour glucose level for the diagnosis of diabetes and impaired glucose tolerance (IGT) in subjects without exocrine pancreatic dysfunction. In addition, hyperinsulinemia, insulin resistance (AUC insulin, and/or AUC insulin X AUC glucose), and postprandial hyperlipidemia (DTG, Triglyceride; DRLP, remnant like particles) have been simultaneously uncovered. Reactive hypoglycemia with adverse epigastric discomfort was observed in 26.3% of the control subjects with liquid glucose, while it was observed in only 1 case (5.3%) without any symptom with cookie tests. In fact, one reactive hypoglycemia out of 5 with liquid glucose turned out to be IGT with cookie test. In 64 subjects with lifestyle-related diseases, cookie test revealed hyperinsulinemia and insulin resistance in 56% respectively, postprandial hyperlipidemia in 39%, diabetes and IGT in 22-23% of each of the subjects and all showed at least one abnormal value. In contrast, in university students with exercise habit, all showed normal results with cookie test. In addition, improved insulin sensitivity over non-exercise group was obverved. In summary, the cookie test provided more informations compared with OGTT using liquid glucose and with fewer side effects. Simultaneous evaluation of glucose intolerance, hyperinsulinemia, insulin resistance, and postprandial hyperlipidemia was also possible. SIMULTANEOUS determination of glucose intolerance including diabetes mellitus (DM), hyperinsulinemia, insulin resistance and postprandial dyslipidemia is beneficial for the early detection of metabolic factors involved in the lifestyle-related diseases [1]. Oral glucose tolerance test (OGTT) can reveal glucose intolerance, hyperinsulinemia, and apparent insulin resistance [2], but false reactive hypoglycemia has often been observed with adverse epigastric symptoms and does not reflect the daily blood glucose excursion and insulin responses. The cookie was ingested and the blood glucose, insulin and TG or RLP responses were measured in the newly developed cookie test. With the exception of exocrine pancreatic dysfunction, starch and 15% maltose are thought to be well digested and no significant difference has been reported for the postprandial 2 hr blood glucose levels [3]. Thus after ingestion of the cookie, postprandial hyperglycemia using the same criteria as OGTT, as well as postprandial dyslipidemia can be simultaneously evaluated. Measurement of endogenous insulin gives additional information regarding hyperinsulinemia and in...

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Section: Discussionmentioning

confidence: 99%

Development of Cookie Test for the Simultaneous Determination of Glucose Intolerance, Hyperinsulinemia, Insulin Resistance and Postprandial Dyslipidemia

Harano¹,

Miyawaki

Nabiki

et al. 2006

Endocr J

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“…For example, when newly-diagnosed, therapy-naõ Ève patients were strati®ed by fasting glycaemia at time of diagnosis, they were found to have impairments of the prandial insulin response (with corresponding postprandial glucose excursions) that correlated with their fasting blood glucose levels. 12 Measurement of prandial insulin pro®les showed that total insulin release measured over 4 h from commencing a meal was relatively increased in patients with fasting plasma glucose concentrations less than 9 mmolal. However, in patients with higher concentrations of fasting plasma glucose, total insulin release declined progressively to subnormal levels.…”

Section: Introductioǹmentioning

confidence: 99%

The importance of early insulin secretion and its impact on glycaemic regulation

Garber

2000

Int J Obes

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Type 2 diabetes is characterised by a progressive deterioration of the prandial insulin response, in a situation of continuing insulin resistance. Early phase insulin release is attenuated and delayed and there is a consequent failure to suppress glucagon secretion and curtail hepatic glucose production and gluconeogenesis. Postprandial plasma glucose concentration rises to pathological levels and fails to return to normal before the patient consumes their next meal, creating a problem of continuous daytime hyperglycaemia. Although late insulin secretion is preserved it does not rectify the hyperglycaemia. The pathology of excessive prandial glucose excursions and continual daytime hyperglycaemia can be normalised, at least in part, if early-phase insulin availability is restored through pharmacologic intervention. Initially, the feasibility of this approach was demonstrated experimentally with the use of carefully controlled insulin infusions or insulin analogue injections. More recently, the availability of the rapid or early augmentor of insulin secretion Ð repaglinide Ð provides a means for restoring prandial glucose regulation with oral therapy. Placebo-controlled and oral hypoglycaemic agent (OHA) comparative studies of repaglinide have established its antidiabetic ef®cacy and¯exible mealtimeadosing studies have con®rmed the importance of the prandial approach to treatment. Prandial glucose regulation with repaglinide has also been demonstrated to provide synergies when used as combination therapy with insulin sensitising agents. As a strategy, prandial glucose regulation has a number of theoretical advantages over the use of ®xed doses of conventional insulin secretagogues, and these have been borne out in clinical trials. As well as offering a more¯exible approach to treatment, prandial repaglinide is associated with a reduced risk of severe hypoglycaemia.

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“…Importantly, a consistent finding in individuals with Type 2 diabetes is that the first-phase prandial insulin response is lost (Figure 1), and that postprandial blood glucose levels become greatly elevated (13,(15)(16)(17)(18). Attempts at restoring the first-phase insulin response (with exogenous insulin given intravenously over 30 minutes from commencing a meal) have significantly attenuated abnormalities in the prandial and postprandial glycaemic and endocrine responses of such patients (15).…”

Section: The Prandial Glucose Response In Type 2 Diabetesmentioning

confidence: 83%

“…In the individual with Type 2 diabetes, blood glucose control is progressively compromised. Although fasting blood glucose levels are elevated, it is at mealtimes that the greatest imbalances between insulin supply and metabolic demands are detected (16)(17)(18). At these times, blood glucose peaks may be elevated by as much as 2.5-3-fold compared with healthy controls (16).…”

Section: The Prandial Glucose Response In Type 2 Diabetesmentioning

confidence: 99%

[No Title Available]

Frandsen

Tambascia

1999

Arq Bras Endocrinol Metab

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This article reviews the clinical evidence and pharmacological rationale for repaglinide, a prandial glucose regulator. Repaglinide has a rapid onset and short duration of action -a pharmacokinetic profile that allows administration in a flexible schedule at mealtimes to limit the postprandial blood glucose excursions typical of type 2 diabetes mellitus. Placebocontrolled and comparative studies of repaglinide have demonstrated that prandial repaglinide also achieves overall glycaemic control, indicated by essential blood glucose parameters such as fasting blood glucose and hemoglobin A1c (HbA1c) levels. Regulation of postprandial glucose is of clinical importance, as this is an important independent risk factor for diabetic complications. Glycaemic control has been further improved in patients with drug-resistant type 2 diabetes when repaglinide is incorporated into combination therapy regimens with insulin-sensitizing agents such as metformin or troglitazone. There are also data to suggest that a mealtime regimen of repaglinide can reduce the likelihood of hypoglycemia compared with traditional sulphonylurea-based regimens. This benefit may be particularly marked when the patient is free to adopt a varying meal pattern. While sulphonylureas can effectively improve overall glycaemic control, their prolonged action may result in inappropriate stimulation of beta-cells during periods of relatively low blood glucose, thereby incurring the risk of hypoglycemia. Although this risk can be reduced if meals are consumed at regular intervals, such an approach places restrictions on the patient's routine and freedom to implement lifestyle measures such as caloric restriction. Repaglinide is metabolized in the liver to inactive metabolites and excreted in bile, a potential advantage for patients with renal dysfunction. In conclusion, compelling reasons for considering a prandial approach to glycaemic management include risk reductions for diabetic complications and hypoglycemia, and greater flexibility for the patient. Available data concerning repaglinide suggest that many theoretical benefits of the prandial approach to glucose regulation may be achievable in clinical practice. RESUMOEste artigo revisa as evidências clínicas e farmacológicas para o uso da repaglinida, um regulador da glicose prandial. Repaglinida tem um iní-cio rápido de ação e curta duração -um perfil farmacocinético que permite sua administração em esquemas flexíveis no horário das alimentações limitando as flutuações pós-prandiais da glicemia, típicas do diabetes mellitus do tipo 2 (DM2). Estudos comparativos com repaglinida controlados por placebo demonstram que seu uso também controla os níveis médios da glicemia, conforme indicado por parâmetros essenciais de glicemia, como a glicemia de jejum e os níveis de hemoglobina A1c (HbA1c). O controle da glicemia pós-prandial é de grande importância clínica, uma vez que ela é um importante fator de risco

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A glimpse of the ‘natural history’ of established Type 2 (non-insulin dependent) diabetes mellitus from the spectrum of metabolic and hormonal responses to a mixed meal at the time of diagnosis

Cited by 37 publications

References 28 publications

Development of Cookie Test for the Simultaneous Determination of Glucose Intolerance, Hyperinsulinemia, Insulin Resistance and Postprandial Dyslipidemia

Development of Cookie Test for the Simultaneous Determination of Glucose Intolerance, Hyperinsulinemia, Insulin Resistance and Postprandial Dyslipidemia

The importance of early insulin secretion and its impact on glycaemic regulation

[No Title Available]

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