Ndei Beta Cell Slide Kit Can We Assess B Cell Health


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  • How Can We Assess  -Cell Health and Function? Deterioration of the health of  -cells leads to impaired glucose tolerance and type 2 diabetes. This section introduces the methods used to assess  -cell health.
  • Ndei Beta Cell Slide Kit Can We Assess B Cell Health

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