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The Impact of Exogenous Insulin Input on Calculating Hepatic Clearance Parameters.

  • McHugh, Alexander D1
  • Chase, J Geoffrey1
  • Knopp, Jennifer L1
  • Ormsbee, Jennifer J1
  • Kulawiec, Diana G2
  • Merry, Troy L3, 4
  • Murphy, Rinki3
  • Shepherd, Peter R3
  • Burden, Hannah J3
  • Docherty, Paul D1, 5
  • 1 Centre for Bioengineering, Department of Mechanical Engineering, University of Canterbury, Christchurch, New Zealand. , (New Zealand)
  • 2 Department of Biomedical Engineering, Rochester Institute of Technology, Rochester, NY, USA.
  • 3 Discipline of Nutrition, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand. , (New Zealand)
  • 4 Maurice Wilkins Centre for Molecular Biodiscovery, University of Auckland, Auckland, New Zealand. , (New Zealand)
  • 5 Institute for Technical Medicine, Furtwangen University, Villingen-Schwenningen, Germany. , (Germany)
Published Article
Journal of Diabetes Science and Technology
SAGE Publications
Publication Date
Jul 01, 2022
DOI: 10.1177/1932296820986878
PMID: 33478257


Model-based metabolic tests require accurate identification of subject-specific parameters from measured assays. Insulin assays are used to identify insulin kinetics parameters, such as general and first-pass hepatic clearances. This study assesses the impact of intravenous insulin boluses on parameter identification precision. Insulin and C-peptide data from two intravenous glucose tolerance test (IVGTT) trials of healthy adults (N = 10 × 2; denoted A and B), with (A) and without (B) insulin modification, were used to identify insulin kinetics parameters using a grid search. Monte Carlo analysis (N = 1000) quantifies variation in simulation error for insulin assay errors of 5%. A region of parameter values around the optimum was identified whose errors are within variation due to assay error. A smaller optimal region indicates more precise practical identifiability. Trial results were compared to assess identifiability and precision. Trial B, without insulin modification, has optimal parameter regions 4.7 times larger on average than Trial A, with 1-U insulin bolus modification. Ranges of optimal parameter values between trials A and B increase from 0.04 to 0.12 min-1 for hepatic clearance and from 0.07 to 0.14 for first-pass clearance on average. Trial B's optimal values frequently lie outside physiological ranges, further indicating lack of distinct identifiability. A small 1-U insulin bolus improves identification of hepatic clearance parameters by providing a smaller region of optimal parameter values. Adding an insulin bolus in metabolic tests can significantly improve identifiability and outcome test precision. Assay errors necessitate insulin modification in clinical tests to ensure identifiability and precision.

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