title: A C-Peptide-Based Model of Pancreatic Insulin Secretion in Extremely Preterm Neonates in Intensive Care.
abstract: BACKGROUND
  Model-based glycemic control relies on sufficiency of underlying models to describe underlying patient physiology. In particular, very preterm infant glucose-insulin metabolism can differ significantly from adults, and is relatively unstudied. In this study, C-peptide concentrations are used to develop insulin-secretion models for the purposes of glycemic control in neonatal intensive care.
  
  
  METHODS
  Plasma C-peptide, insulin, and blood glucose concentrations (BGC) were retrospectively analyzed from a cohort of 41 hyperglycemic very preterm (median age 27.2 [26.2-28.7] weeks) and very low birth-weight infants (median birth weight 839 [735-1000] g). A 2-compartment model of C-peptide kinetics was used to estimate insulin secretion. Insulin secretion was examined with respect to nutritional intake, exogenous and plasma insulin concentration, and BGC.
  
  
  RESULTS
  Insulin secretion was found to be highly variable between patients and over time, and could not be modeled with respect to age, weight, or protein or dextrose intake. In 13 of 54 samples exogenous insulin was being administered, and insulin secretion was lower. However, low data numbers make this result inconclusive. Insulin secretion was found to increase with BG, with a stronger association in female infants than males (R(2) = .51 vs R(2) = .13, and R(2) = .26 for the combined cohort).
  
  
  CONCLUSIONS
  A sex-based insulin secretion model was created and incorporated into a model-based glycemic control framework. Nutritional intake did not predict insulin secretion, indicating that insulin secretion is a complex function of a number of metabolic factors.
authors.affiliation: Department of Mechanical Engineering, University of Canterbury, Christchurch, New Zealand jennifer.dickson@canterbury.ac.nz.
authors.forename: Jennifer L
authors.initials: JL
authors.lastname: Dickson
authors.affiliation: Department of Paediatrics, Child and Youth Health, Auckland, New Zealand Liggins Institute, University of Auckland, Auckland, New Zealand.
authors.forename: Jane
authors.initials: J
authors.lastname: Alsweiler
authors.affiliation: Department of Mechanical Engineering, University of Canterbury, Christchurch, New Zealand.
authors.forename: Cameron A
authors.initials: CA
authors.lastname: Gunn
authors.affiliation: Department of Mechanical Engineering, University of Canterbury, Christchurch, New Zealand.
authors.forename: Christopher G
authors.initials: CG
authors.lastname: Pretty
authors.affiliation: Department of Mechanical Engineering, University of Canterbury, Christchurch, New Zealand.
authors.forename: J Geoffrey
authors.initials: JG
authors.lastname: Chase
mesh_terms: D001786:Blood Glucose; D002096:C-Peptide / Q000097:blood*; D003661:Decision Support Techniques; D005260:Female; D006801:Humans; D062071:Infant, Extremely Premature / Q000378:metabolism*; D007231:Infant, Newborn; D007235:Infant, Premature, Diseases; D007328:Insulin / Q000378:metabolism*; D000078790:Insulin Secretion; D015931:Intensive Care, Neonatal; D008297:Male; D010179:Pancreas / Q000378:metabolism; D012189:Retrospective Studies
chemical_list: D001786:Blood Glucose; D002096:C-Peptide; D007328:Insulin
keywords: glycemic control; insulin secretion; insulin therapy; physiological modeling; very preterm infants