TY - JOUR
T1 - Impaired Diurnal Pattern of Meal Tolerance and Insulin Sensitivity in Type 2 Diabetes
T2 - Implications for Therapy
AU - Yadav, Yogesh
AU - Romeres, Davide
AU - Cobelli, Claudio
AU - Man, Chiara Dalla
AU - Carter, Rickey
AU - Basu, Ananda
AU - Basu, Rita
N1 - Publisher Copyright:
© 2023 by the American Diabetes Association.
PY - 2023/2
Y1 - 2023/2
N2 - To assess the diurnal patterns of postprandial glucose tolerance and insulin sensitivity, 19 subjects with type 2 diabetes (8 women; 60 ± 11 years; BMI 32 ± 5 kg/m2) and 19 anthropometrically matched subjects with no diabetes (ND; 11 women; 53 ± 12 years; BMI 29 ± 5 kg/m2) were studied during breakfast (B), lunch (L), and dinner (D) with identical mixed meals (75 g carbohydrates) on 3 consecutive days in a randomized Latin square design. Three stable isotopes of glucose were ustilized to estimate meal fluxes, and mathematical models were used in estimating indices of insulin action and b-cell function. Postmeal glucose excursions were higher at D versus B and at D versus L in type 2 diabetes (P < 0.05), while in ND they were higher at D versus B (P = 0.025) and at L versus B (P = 0.04). The insulin area under the curve was highest at B compared with L and D in type 2 diabetes, while no differences were observed in ND. Disposition index (DI) was higher at B than at L (P < 0.01) and at D (P < 0.001) in ND subjects, whereas DI was low with unchanging pattern across B-L-D in individuals with type 2 diabetes. Furthermore, between-meal differences in β-cell responsivity to glucose (F) and insulin sensitivity (SI) were concurrent with changes in the DI within groups. Fasting and postmeal glucose, insulin, and C-peptide concentrations, along with estimates of endogenous glucose production (EGP), Rd, SI, F, hepatic extraction of insulin, insulin secretion rate, extracted insulin, and DI, were altered in type 2 diabetes compared with ND (P <0.011 for all). The data show a diurnal pattern of postprandial glucose tolerance in overweight otherwise glucosetolerant ND individuals that differs from overweight individuals with type 2 diabetes.
AB - To assess the diurnal patterns of postprandial glucose tolerance and insulin sensitivity, 19 subjects with type 2 diabetes (8 women; 60 ± 11 years; BMI 32 ± 5 kg/m2) and 19 anthropometrically matched subjects with no diabetes (ND; 11 women; 53 ± 12 years; BMI 29 ± 5 kg/m2) were studied during breakfast (B), lunch (L), and dinner (D) with identical mixed meals (75 g carbohydrates) on 3 consecutive days in a randomized Latin square design. Three stable isotopes of glucose were ustilized to estimate meal fluxes, and mathematical models were used in estimating indices of insulin action and b-cell function. Postmeal glucose excursions were higher at D versus B and at D versus L in type 2 diabetes (P < 0.05), while in ND they were higher at D versus B (P = 0.025) and at L versus B (P = 0.04). The insulin area under the curve was highest at B compared with L and D in type 2 diabetes, while no differences were observed in ND. Disposition index (DI) was higher at B than at L (P < 0.01) and at D (P < 0.001) in ND subjects, whereas DI was low with unchanging pattern across B-L-D in individuals with type 2 diabetes. Furthermore, between-meal differences in β-cell responsivity to glucose (F) and insulin sensitivity (SI) were concurrent with changes in the DI within groups. Fasting and postmeal glucose, insulin, and C-peptide concentrations, along with estimates of endogenous glucose production (EGP), Rd, SI, F, hepatic extraction of insulin, insulin secretion rate, extracted insulin, and DI, were altered in type 2 diabetes compared with ND (P <0.011 for all). The data show a diurnal pattern of postprandial glucose tolerance in overweight otherwise glucosetolerant ND individuals that differs from overweight individuals with type 2 diabetes.
UR - http://www.scopus.com/inward/record.url?scp=85147045614&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85147045614&partnerID=8YFLogxK
U2 - 10.2337/db22-0238
DO - 10.2337/db22-0238
M3 - Article
C2 - 36346619
AN - SCOPUS:85147045614
SN - 0012-1797
VL - 72
SP - 223
EP - 232
JO - Diabetes
JF - Diabetes
IS - 2
ER -