Ndei Beta Cell Slide Kit Can We Assess B Cell Health

Slideshow Transcript

1. Slide 1: Section 3 How Can We Assess -Cell Health and Function? This slide can be downloaded free of charge from www.ndei.org, the website of the National Diabetes Education Initiative
2. Slide 2: -Cell Adaptation and Failure: Opportunities for Prevention and Treatment of Type 2 Diabetes
3. Slide 3: Disclosure This slide kit is intended to provide current  information on issues concerning -cells in patients with type 2 diabetes. Some of the information and agents mentioned may  include discussions of off-label, non–FDA- approved, or investigational uses. Please refer to each manufacturer’s full prescribing information before prescribing any of the agents mentioned in this program. Slides that include discussion of off-label uses are  identified with the symbol . This slide can be downloaded free of charge from www.ndei.org, the website of the National Diabetes Education Initiative
4. Slide 4: Tools to Assess -Cell Health and Function Research Tools  Acute insulin response to glucose (usually IV administration)* – can be used to calculate the Disposition Index  Insulin secretion during hyperglycemia (fixed or increasing)*  Maximum insulin response to arginine during hyperglycemia*  Oscillatory insulin secretion patterns  Glucose-insulin relationships (fasting and during OGTT)  Proinsulin:insulin ratios Clinical Tools  Glucose levels (reflect -cell compensation for insulin resistance) This slide can be downloaded free of charge from www.ndei.org, the website of the *Should be expressed relative to degree of insulin resistance National Diabetes Education Initiative
5. Slide 5: Clinical Assessment of -Cell Function Why not just measure insulin?  Fasting and stimulated insulin levels determined by -cell function and insulin resistance  No practical way to determine -cell compensation for insulin resistance from serum insulin values  Insulin assays are not standardized; cannot establish normal or at-risk values This slide can be downloaded free of charge from www.ndei.org, the website of the National Diabetes Education Initiative
6. Slide 6: Clinical Assessment of -Cell Function: Why Not Just Measure Insulin? Same β-cell function, Same insulin levels, different insulin levels different function Patient #4 Insulin level Insulin level Patient #2 Patient #3 Normal Patient #1 Impaired Normal Insulin sensitivity This slide canInsulin sensitivity be downloaded free of charge from www.ndei.org, the website of the National Diabetes Education Initiative
7. Slide 7: Clinical Assessment of -Cell Function: Why Measure Glucose? Glucose levels are determined by the interaction  between insulin sensitivity (demand) and insulin secretion (supply) Normally, supply changes to meet demand  – if insulin sensitivity falls, insulin secretion rises reciprocally and vice versa Failure to compensate results in elevated glucose levels.  Thus, glucose levels reflect -cell compensation – elevated glucose = inadequate -cell compensation – rising glucose = falling -cell compensation This slide can be downloaded free of charge from www.ndei.org, the website of the National Diabetes Education Initiative
8. Slide 8: Falling -Cell Function and Rising Glucose Levels TRIPOD Study – Incident Diabetes Cases Baseline Posttrial testing IV glucose (U/mL x min) Plasma glucose (mg/dL) 1,000 300 Acute insulin response 800 Baseline 200 600 400 100 Posttrial 200 0 0 0 2 4 6 0 40 80 120 Insulin sensitivity (Si) Minutes This slide can be downloaded free of charge from www.ndei.org, the website TA et al. Diabetes. Buchanan of the Xiang AH et al. J Clin Endocrinol 2002;51:2796-2803. Metab. 2004;89:2846-2851. National Diabetes Education Initiative