Glucose effectiveness: measurement in diabetic and nondiabetic humans

It is well established that under the conditions of daily living, insulin secretion and insulin action determine glucose tolerance in nondiabetic humans both in the post-absorptive and post-prandial states. However, in recent years, glucose effectiveness (i.e., the ability of glucose per se to stimulate its own uptake and to suppress its own release) has also been shown to influence glucose tolerance in both diabetic and nondiabetic individuals. In states of deficient insulin action, e.g., in individuals with type 2 diabetes, glucose effectiveness assumes a greater role in determining glucose tolerance both during fasting and post-prandial conditions. A mathematical model (Minimal Model) of glucose turnover has been applied to estimate glucose effectiveness in both diabetic and nondiabetic individuals. Several investigators have demonstrated reduced glucose effectiveness in people with type 2 diabetes mellitus. However, measurements of glucose effectiveness by the traditional single compartment minimal model approach have been fraught with errors when compared to model independent estimates, especially in the diabetic population. This has led investigators to modify the parameters of the model with the incorporation of glucose tracers and the use of two-compartment model of glucose kinetics. Although this has made the indices of glucose effectiveness more robust, proper validation experiments are necessary before widespread application of these methods.