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Related Experiment Videos

Differences between the tolbutamide-boosted and the insulin-modified minimal model protocols

M F Saad1, G M Steil, W W Kades

  • 1Department of Medicine, University of Southern California Medical School, Los Angeles 90033, USA. saad@hsc.usc.edu

Diabetes
|July 1, 1997
PubMed
Summary

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The insulin-modified frequently sampled intravenous glucose tolerance test (FSIGTT) using insulin or tolbutamide can estimate insulin sensitivity. However, results differ quantitatively, necessitating consistent protocol use within studies.

Area of Science:

  • Metabolic Research
  • Endocrinology
  • Clinical Physiology

Background:

  • Accurate assessment of insulin sensitivity is crucial for understanding metabolic health and disease.
  • The frequently sampled intravenous glucose tolerance test (FSIGTT) with minimal model analysis (MINMOD) is a common method for quantifying insulin sensitivity.
  • Comparing different FSIGTT protocols is essential for standardizing measurements.

Purpose of the Study:

  • To compare the insulin-modified FSIGTT (FSIGTT-Insulin) with the tolbutamide-modified FSIGTT (FSIGTT-Tolbutamide) and the gold-standard glucose clamp in nondiabetic subjects.
  • To evaluate the correlation and agreement between insulin sensitivity estimates derived from these different methods.

Main Methods:

  • Thirty-five nondiabetic subjects underwent two FSIGTTs (one with insulin, one with tolbutamide) and a euglycemic hyperinsulinemic clamp.

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  • Minimal model analysis (MINMOD) was used to determine insulin sensitivity indexes (S(I)) from both FSIGTT protocols.
  • Insulin sensitivity was also measured using the glucose clamp technique.

    • Main Results:

    • Both FSIGTT protocols showed significant correlations with the glucose clamp for insulin sensitivity (S(I)).
    • However, FSIGTT-Insulin yielded significantly lower insulin sensitivity estimates compared to FSIGTT-Tolbutamide and the clamp.
    • FSIGTT-Tolbutamide underestimated clamp-derived insulin sensitivity by 13%, while FSIGTT-Insulin underestimated it by 44%.

    Conclusions:

    • While both FSIGTT protocols correlate with the clamp, their quantitative estimates of insulin sensitivity are discrepant.
    • Differences may arise from insulin delivery, insulin action saturation, or tolbutamide-induced proinsulin release.
    • Consistent use of a single FSIGTT protocol is recommended for cross-sectional and longitudinal studies to ensure data comparability.