Measurement of selective effect of insulin on glucose disposal from labeled glucose oral test minimal model

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Abstract
The oral glucose minimal model (OMM) measures insulin sensitivity (SI) and the glucose rate of appearance (Ra) of ingested glucose in the presence of physiological changes of insulin and glucose concentrations. However, SI of OMM measures the overall effect of insulin on glucose utilization and glucose production. In this study we show that, by adding a tracer to the oral dose, e.g., of a meal, and by using the labeled version of OMM, OMM* to interpret the data, one can measure the selective effect of insulin on glucose disposal, [Formula: see text]. Eighty-eight individuals underwent both a triple-tracer meal with the tracer-to-tracee clamp technique, providing a model-independent reference of the Ra of ingested glucose ([Formula: see text]) and an insulin-modified labeled intravenous glucose tolerance test (IVGTT*). We show that OMM* provides not only a reliable means of tracing the Ra of ingested glucose (Ra meal) but also accurately measures [Formula: see text]. We do so by comparing OMM* Ra meal with the model-independent [Formula: see text] provided by the tracer-to-tracee clamp technique, while OMM* [Formula: see text] is compared with both [Formula: see text], obtained by using as known input [Formula: see text], and with [Formula: see text] measured during IVGTT*.