A mathematical model of the euglycemic hyperinsulinemic clamp
U. Picchini, A. De Gaetano, S. Panunzi, S. Ditlevsen and G. Mingrone
Published as
Theoretical
Biology and Medical Modelling (2005) 3;2(1):44.
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article (322 Kb, pdf)
Background: The Euglycemic Hyperinsulinemic Clamp (EHC) is the most widely used
experimental procedure for the determination of insulin sensitivity, and in its usual form the patient
is followed under insulinization for two hours. In the present study, sixteen subjects with BMI
between 18.5 and 63.6 kg/m^2 were studied by long-duration (five hours) EHC.
Results: From the results of this series and from similar reports in the literature it is clear that, in
obese subjects, glucose uptake rates continue to increase if the clamp procedure is prolonged
beyond the customary 2 hours. A mathematical model of the EHC, incorporating delays, was fitted
to the recorded data, and the insulin resistance behaviour of obese subjects was assessed
analytically. Obese subjects had significantly less effective suppression of hepatic glucose output and
higher pancreatic insulin secretion than lean subjects. Tissue insulin resistance appeared to be
higher in the obese group, but this difference did not reach statistical significance.
Conclusion: The use of a mathematical model allows a greater amount of information to be
recovered from clamp data, making it easier to understand the components of insulin resistance in
obese vs. normal subjects.
Keywords: delay differential equations, dynamical models, parameter estimation, glucose, insulin, insulin sensitivity.
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