Beta-cell function in mild type 2 diabetic patients: effects of 6-month glucose lowering with nateglinide.
OBJECTIVE
We studied the effects of the oral insulin secretagogue nateglinide on insulin secretion using a modeling approach to obtain beta-cell function parameters from a meal test and examined the impact of the beta-cell improvement on glucose tolerance.


METHODS
Mild type 2 diabetic men and women (n = 108; fasting glucose 7.0-8.3 mmol/l) on diet treatment alone randomly received 30, 60, or 120 mg nateglinide or placebo for 24 weeks. Beta-cell function parameters were derived by modeling (based on C-peptide deconvolution) from a standardized meal test at baseline and after 24 weeks of treatment.


RESULTS
The baseline demographic and metabolic characteristics of the four groups were similar. Nateglinide treatment resulted in dose-dependent reductions in the mean postprandial glucose response and at the 120-mg dose in fasting glucose. Fasting or total insulin secretion during the meal were not different. In contrast, we found differences in the model parameters. Rate sensitivity (expressing early insulin secretion when glucose is rising) was significantly enhanced at 24 weeks with the lowest nateglinide dose, with no further stimulation at higher doses. Early potentiation (expressing an initial insulin secretion enhancement), glucose sensitivity (the slope of the glucose-insulin secretion relationship), and insulin secretion at a fixed- reference 7-mmol/l glucose concentration all showed a trend toward increasing, with increasing nateglinide dose, and were significantly greater than placebo at the 120-mg dose. In multiple regression analyses, changes in rate sensitivity, glucose sensitivity, and potentiation all contributed to the observed glucose changes.


CONCLUSIONS
The model-derived parameters are sensitive measures of beta-cell function, showing improvements after nateglinide treatment and predicting changes in glucose tolerance.
Mari
Andrea
A
Institute of Biomedical Engineering, National Research Council, Corso Stati Uniti 4, 35127 Padua, Italy. andrea.mari@isib.cnr.it
Gastaldelli
Amalia
A
Foley
James E
JE
Pratley
Richard E
RE
Ferrannini
Ele
E
D000368:Aged; D001786:Blood Glucose / Q000187:drug effects; D003510:Cyclohexanes / Q000008:administration & dosage*; D003924:Diabetes Mellitus, Type 2 / Q000188:drug therapy* / Q000378:metabolism*; D005260:Female; D006801:Humans; D007004:Hypoglycemic Agents / Q000008:administration & dosage*; D007333:Insulin Resistance; D007515:Islets of Langerhans / Q000187:drug effects / Q000502:physiology*; D008297:Male; D008875:Middle Aged; D008954:Models, Biological; D000077715:Nateglinide; D010649:Phenylalanine / Q000008:administration & dosage* / Q000031:analogs & derivatives*; D010919:Placebos; D012720:Severity of Illness Index
D001786:Blood Glucose; D003510:Cyclohexanes; D007004:Hypoglycemic Agents; D010919:Placebos; D000077715:Nateglinide; D010649:Phenylalanine