The Oral Minimal Model Method

• Published in: Diabetes (New York, N.Y.) Vol. 63; no. 4; pp. 1203 - 1213
• Main Authors: Cobelli, Claudio, Dalla Man, Chiara, Toffolo, Gianna, Basu, Rita, Vella, Adrian, Rizza, Robert
• Format: Journal Article
• Language: English
• Published: Alexandria, VA American Diabetes Association 01.04.2014
• Subjects: Adolescent; Biological and medical sciences; Blood Glucose - metabolism; C-Peptide - metabolism; Child; Diabetes; Diabetes. Impaired glucose tolerance; Endocrine pancreas. Apud cells (diseases); Endocrinopathies; Etiopathogenesis. Screening. Investigations. Target tissue resistance; Food; Glucose; Glucose - metabolism; Glucose Clamp Technique; Glucose Tolerance Test; Human subjects; Humans; Insulin; Insulin - metabolism; Insulin - physiology; Insulin Resistance - physiology; Insulin-Secreting Cells - drug effects; Insulin-Secreting Cells - physiology; Liver - metabolism; Mathematical models; Medical sciences; Metabolism; Methodology Review; Models, Biological; Pancreatic beta cells; Physiology; Postprandial Period - physiology; Testing; Endocrinopathy; Diabetes mellitus; Models
• DOI: 10.2337/db13-1198
• ISSN: 0012-1797; 1939-327X

The simultaneous assessment of insulin action, secretion, and hepatic extraction is key to understanding postprandial glucose metabolism in nondiabetic and diabetic humans. We review the oral minimal method (i.e., models that allow the estimation of insulin sensitivity, β-cell responsivity, and hepatic insulin extraction from a mixed-meal or an oral glucose tolerance test). Both of these oral tests are more physiologic and simpler to administer than those based on an intravenous test (e.g., a glucose clamp or an intravenous glucose tolerance test). The focus of this review is on indices provided by physiological-based models and their validation against the glucose clamp technique. We discuss first the oral minimal model method rationale, data, and protocols. Then we present the three minimal models and the indices they provide. The disposition index paradigm, a widely used β-cell function metric, is revisited in the context of individual versus population modeling. Adding a glucose tracer to the oral dose significantly enhances the assessment of insulin action by segregating insulin sensitivity into its glucose disposal and hepatic components. The oral minimal model method, by quantitatively portraying the complex relationships between the major players of glucose metabolism, is able to provide novel insights regarding the regulation of postprandial metabolism.