Choosing an optimal input for an intravenous glucose tolerance test to aid parameter identification

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Abstract

Objective The minimal model is used to estimate insulin sensitivity in patientswith diabetes, following an intravenous glucose tolerance test (IVGTT). Issueshave been reported regarding parameter estimation, including correlationbetween insulin sensitivity and action parameters. The objective was to reducethese issues, by modifying the input of glucose in the test.Methods Data were available for 24 volunteers following an IVGTT and glucoseclamp test. Correlation between parameters was explored using likelihood heat-maps. An integrated glucose –insulin model was used to simulate glucose andinsulin concentrations following new glucose inputs. The improved input for thetest was selected by finding the minimum inverse of the determinant of the Fisherinformation matrix.Key findings When the minimal model was fitted to the IVGTT data, there wasclear correlation between the insulin parameters. With the glucose clamp, allparameters were correlated and badly estimated. The modified input, a bolusdose followed by constant infusion, resulted in improvement in parameter esti-mation and reduction in parameter correlation.Conclusions It is possible to reduce the issues with parameter estimation in theminimal model by modifying the glucose input, leading to a simplified test deignand a reduction in the total amount of glucose infused.

Bibliographical metadata

Original languageEnglish
Pages (from-to)1-9
JournalJournal of Pharmacy and Pharmacology
Early online date27 Jun 2017
DOIs
StatePublished - 5 Sep 2017