Glucose effectiveness: measurement in diabetic and nondiabetic humans

It is well established that under the conditions of daily living, insulin s ecretion and insulin action determine glucose tolerance in nondiabetic huma ns both in the post-absorptive and post-prandial states. However, in recent years, glucose effectiveness (i.e, the ability of glucose per se to stimul ate its own uptake and to suppress its own release) has also been shown to influence glucose tolerance in both diabetic and nondiabetic individuals. I n states of deficient insulin action, eg, in individuals with type 2 diabet es, glucose effectiveness assumes a greater role in determining glucose tol erance both during fasting and post-prandial conditions. A mathematical mod el (Minimal Model) of glucose turn-over has been applied to estimate glucos e effectiveness in both diabetic and nondiabetic individuals. Several inves tigators have demonstrated reduced glucose effectiveness in people with typ e 2 diabetes mellitus. However, measurements of glucose effectiveness by th e traditional single compartment minimal model approach have been fraught w ith errors when compared to model independent estimates, especially in the diabetic population. This has led investigators to modify the parameters of the model with the incorporation of glucose tracers and the use of two-com partment model of glucose kinetics. Although this has made the indices of g lucose effectiveness more robust, proper validation experiments are necessa ry before widespread application of these methods.