Endocrine Society Annual Meeting

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Presentation transcript:

Endocrine Society Annual Meeting Impaired Glucose Tolerance Is Associated with Impaired Rise in Basal Insulin Secretion during Sustained Hyperglycemia Endocrine Society Annual Meeting Ron T. Varghese, MBBS1, Nana Esi Nkuma Kittah, MB.ChB1, James C. Andrews, MD1, Chiara Dalla Man, PhD2, Robert A Rizza1, Claudio Cobelli, PhD2, Aleksey Matveyenko1 and Adrian Vella, MD1. 1Mayo Clinic, Rochester, MN, USA, 2University of Padova, Padova, Italy

What is prediabetes ? Transitory state to Diabetes 86 million people (1 in 3 adults) in USA Higher risk of developing diabetes Higher risk for developing macrovascular complications Edelstein SL et al. Diabetes 46: 701-710, 1997. Meigs et al. Diabetes Care. 2002;25:1845–1850 Ford et al. J Am Coll Cardiol 55: 1310-1317, 2010. DECODE. Arch Intern Med. 2001;161:397–405

Potential Role of Insulin Pulsatility Partial pancreatectomy (50 %) in dogs caused a approximately 40% decrease in insulin-stimulated glucose disposal Physiological insulin pulses delivered into the portal vein enhance insulin action in dogs. Does insulin pulsatility change in prediabetes? Matveyenko et al. Diabetes. 2006 Aug;55(8):2347-56 Matveyenko et al. Diabetes 2012 Sep; 61(9): 2269-2279

Specific Aim To determine if insulin pulse amplitude and frequency differ in humans with Impaired Glucose Tolerance (IGT) or Normal Glucose Tolerance (NGT).

Hypothesis 1º Hypothesis: Insulin pulse amplitude is decreased in people with IGT compared to those with NGT 2º Hypothesis: Insulin pulse interval is increased in people with IGT compared to those with NGT

Study Design - Recruitment Mayo Clinic Biobank n = ~ 50,000 Genotyping of a random sample at rs7903146 CC TT NGT IGT

Study Design – Hepatic Vein Sampling Glucose Infusion* -120 0 45 75 120 *Glucose infusion (to maintain glucose at ~ 8.3 mmol/l) Placement of hepatic vein catheter Sampling Interval 1 Sampling Interval 2 Indocyanine Green

Demographic Characteristics

Pulse Measurements

Pulse Characteristics

Glucose concentrations Fasting Hyperglycemia

Pulse amplitude

Pulse interval

Pulse mass

Pulsatile secretion

Non – Pulsatile secretion

Total secretion

Response to Hyperglycemia (sym % change)

Summary Insulin pulse amplitude and interval do not differ in IGT and NGT. Insulin pulse mass does not differ between the two groups. IGT is associated with impaired basal insulin secretion in response to hyperglycemia. Net insulin secretion is unchanged because of a compensatory increase in mean pulse mass.

Conclusions Insulin pulse interval or amplitude is not altered by glucose tolerance status in non-diabetic subjects. The net contribution of basal (non-pulsatile) secretion to total insulin secretion in response to hyperglycemia is impaired in these subjects with IGT.

Acknowledgements Research Volunteers CTSA/CRU staff Mayo Clinic Dr. Adrian Vella Dr. Robert Rizza Dr. Michael Jensen Dr. James Andrews Dr. Aleksey Matveyenko Dr. Meera Shah Dr. Anu Sharma Dr. Nana Esi Kittah Paula Giesler Jeanette Laugen Gail DeFoster CTSA/CRU staff University of Padova, Italy Dr. Claudio Cobelli Dr. Chiara Dallaman Marcello Laurenti Funding - NIH Dr. Vella – DK 078646 Training Grant — 2 T32 DK 7352-36