Modeled insulin sensitivity and interstitial insulin action from a pilot study of dynamic insulin sensitivity tests

An accurate test for insulin resistance can delay or prevent the development of Type 2 diabetes and its complications. The current gold standard test, CLAMP, is too labor intensive to be used in general practice. A recently developed dynamic insulin sensitivity test, DIST, uses a glucose-insulin-C-peptide model to calculate model-based insulin sensitivity, S_I. Preliminary results show good correlation to CLAMP. However both CLAMP and DIST ignore saturation in insulin-mediated glucose removal. This study uses the data from 17 patients who underwent multiple DISTs to investigate interstitial insulin action and its influence on modeled insulin sensitivity. The critical parameters influencing interstitial insulin action are saturation in insulin receptor binding, αG, and plasma-interstitial diffusion rate, n_I. Very low values of αG and very low values of n_I produced the most intra-patient variability in S_I. Repeatability in SI is enhanced with modeled insulin receptor saturation. Future parameter study on subjects with varying degree of insulin resistance may provide a better understanding of different contributing factors of insulin resistance.