Adapting Protocols or Models for Use in Insulin-Requiring Diabetes and Islet Transplant Recipients.

Glenn M Ward,Raymond C Boston,Judith L Gooley,Jacqueline M Walters

doi:10.3389/fendo.2021.611512

Abstract

The authors’ perspective is described regarding modifications made in their clinic to glucose challenge protocols and mathematical models in order to estimate insulin secretion, insulin sensitivity and glucose effectiveness in patients living with Insulin-Requiring Diabetes and patients who received Pancreatic Islet Transplants to treat Type I diabetes (T1D) with Impaired Awareness of Hypoglycemia. The evolutions are described of protocols and models for use in T1D, and Insulin-Requiring Type 2 Diabetes (T2D) that were the basis for studies in the Islet Recipients. In each group, the need for modifications, and how the protocols and models were adapted is discussed. How the ongoing application of the adaptations is clarifying the Islet pathophysiology in the Islet Transplant Recipients is outlined.

Highlights

In this article we describe the evolution of the modifications we made in our clinic to glucose challenge protocols or mathematical models of insulin secretion, insulin sensitivity and glucose effectiveness, in order to study these parameters in patients with Insulin-Requiring Type2 Diabetes (T2D) and Type 1 diabetes (T1D), including T1D patients who have received Islet Transplants to treat their severe recurrent hypoglycemia and impaired awareness of hypoglycemia
We revisit the adaptations that were made for use in T1D, and Insulin-Requiring Type 2 Diabetes (T2D) as it helps to build a cohesive account of the work in our clinic aimed at studying the pathophysiology of insulin secretion and insulin action in the Islet Transplant Recipients
We addressed the frequent presence in T1D of insulin antibodies which interfere with the insulin radioimmunoassay, by measuring plasma free-insulin after precipitation of bound insulin according to the method of Nakagawa et al [8] using polyethylene glycol precipitation before freezing in order to avoid disturbing the equilibrium between free and antibodybound insulin [9]

Summary

Introduction

The evolutions are described of protocols and models for use in T1D, and Insulin-Requiring Type 2 Diabetes (T2D) that were the basis for studies in the Islet Recipients. In this article we describe the evolution of the modifications we made in our clinic to glucose challenge protocols or mathematical models of insulin secretion, insulin sensitivity and glucose effectiveness, in order to study these parameters in patients with Insulin-Requiring Type2 Diabetes (T2D) and Type 1 diabetes (T1D), including T1D patients who have received Islet Transplants to treat their severe recurrent hypoglycemia and impaired awareness of hypoglycemia.

Objectives

Results

Conclusion