Disturbances in dynamics of glucose, insulin and C-peptide in blood after a normalized intake of mixed meal in obesity and type 2 diabetes mellitus

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The aim of the study is to investigate the dynamics of venous blood glucose, insulin, and C-peptide in response to intake a meal normalized to body mass in obese patients without and with type 2 diabetes mellitus. Venous blood samples were taken from 7 healthy subjects, 9 obese patients, and 10 obese patients with type 2 diabetes mellitus (mean period of diagnosed diabetes 7 years) before and 30, 60, 90, 120, and 180 min after a mixed meal (6 kcal/kg of body mass); additionally, 9 patients with obesity and type 2 diabetes mellitus and 3 healthy volunteers completed a hyperinsulinemic euglycemic clamp test. In patient groups the energy content of food did not differ, but was 1.8 times higher than in the control. An increase in glucose level one hour after a meal was maximal in patients with type 2 diabetes, but an increase in insulin and C-peptide — in obese patients, that related to impairment of insulin-dependent glucose uptake by tissues and of the rate of insulin secretion (dysfunction of â-cells) in patients. At the same time, an increase in the total area under the curve “C-peptide–time” shows that the maximum secretory response of â-cells is comparable in obese patients without and with type 2 diabetes mellitus. The absolute blood glucose level 90 minutes after a meal was closely correlated with the M-index — the marker of systemic sensitivity to insulin (rs = –0.82, p = 0.002). Our results characterize the features in the regulation of carbohydrate metabolism after intake a mixed meal, normalized to body mass, in people with the varying severity of metabolic disorders, and open up prospects for a wider application of this test in practice.

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Sobre autores

E. Lednev

Institute of Biomedical Problems of the RAS; National Medical Research Center for Endocrinology

Autor responsável pela correspondência
Email: danil-popov@yandex.ru
Rússia, Moscow; Moscow

A. Gavrilova

National Medical Research Center for Endocrinology

Email: danil-popov@yandex.ru
Rússia, Moscow

T. Vepkhvadze

Institute of Biomedical Problems of the RAS; Moscow State University

Email: danil-popov@yandex.ru
Rússia, Moscow; Moscow

P. Makhnovskii

Institute of Biomedical Problems of the RAS

Email: danil-popov@yandex.ru
Rússia, Moscow

M. Shestakova

National Medical Research Center for Endocrinology

Email: danil-popov@yandex.ru
Rússia, Moscow

D. Popova

Institute of Biomedical Problems of the RAS; Moscow State University

Email: danil-popov@yandex.ru
Rússia, Moscow; Moscow

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2. Fig. 1. Dynamics of glucose, insulin and C-peptide in the blood after ingestion of a mixed meal (6 kcal/kg body weight) in lean volunteers (N), non-obese patients (Ob) and with type 2 diabetes mellitus (Ob + T2D ). The median and interquartile range are presented; ×, ×× and ××× – difference from the initial level at p ≤ 0.05, ≤ 0.01 and ≤ 0.001, respectively.

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3. Fig. 2. Increase in glucose, insulin and C-peptide in the blood after ingestion of a mixed meal (6 kcal/kg body weight) in lean volunteers (H), non-obese patients (Ob) and with type 2 diabetes mellitus (Ob + T2D ). Median, interquartile range, and individual values ​​are presented; * – difference from control, # – difference from Ob; one, two and three characters - p ≤ 0.05, ≤ 0.01 and ≤ 0.001, respectively.

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4. Fig. 3. The relationship between the blood glucose level 90 minutes after eating a mixed meal (6 kcal/kg body weight) and the M-index - a systemic indicator of insulin sensitivity. Gradation of insulin resistance according to the M-index: ≤2 – severe, >2–4 – moderate; >4–6 – mild, >6 – no insulin resistance (vertical dotted line).

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