title: Application of the integrated glucose-insulin model for cross-study characterization of T2DM patients on metformin background treatment.
abstract: The integrated glucose-insulin (IGI) model is a semi-mechanistic physiological model which can describe the glucose-insulin homeostasis system following various glucose challenge settings. The aim of the present work was to apply the model to a large and diverse population of metformin-only-treated type 2 diabetes mellitus (T2DM) patients and identify patient-specific covariates.
  
  
  
  Data from four clinical studies were pooled, including glucose and insulin concentration-time profiles from T2DM patients on stable treatment with metformin alone following mixed-meal tolerance tests. The data were collected from a wide range of patients with respect to the duration of diabetes and level of glycaemic control.
  
  
  
  The IGI model was expanded by four patient-specific covariates. The level of glycaemic control, represented by baseline glycosylated haemoglobin was identified as a significant covariate for steady-state glucose, insulin-dependent glucose clearance and the magnitude of the incretin effect, while baseline body mass index was a significant covariate for steady-state insulin levels. In addition, glucose dose was found to have an impact on glucose absorption rate. The developed model was used to simulate glucose and insulin profiles in different groups of T2DM patients, across a range of glycaemic control, and it was found accurately to characterize their response to the standard oral glucose challenge.
  
  
  
  The IGI model was successfully applied to characterize differences between T2DM patients across a wide range of glycaemic control. The addition of patient-specific covariates in the IGI model might be valuable for the future development of antidiabetic treatment and for the design and simulation of clinical studies.
authors.affiliation: Cardiovascular & Metabolic Disease, Innovative Medicines and Early Development Biotech Unit, AstraZeneca, Mölndal, 431 83, Sweden.
authors.forename: Joanna
authors.initials: J
authors.lastname: Parkinson
authors.affiliation: Cardiovascular & Metabolic Disease, Innovative Medicines and Early Development Biotech Unit, AstraZeneca, Mölndal, 431 83, Sweden.
authors.forename: Bengt
authors.initials: B
authors.lastname: Hamrén
authors.affiliation: Pharmacometrics Research Group, Department of Pharmaceutical Biosciences, Uppsala University, Sweden.
authors.forename: Maria C
authors.initials: MC
authors.lastname: Kjellsson
authors.affiliation: Cardiovascular & Metabolic Disease, Innovative Medicines and Early Development Biotech Unit, AstraZeneca, Mölndal, 431 83, Sweden.|Department of Endocrinology, Sahlgrenska University Hospital and Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
authors.forename: Stanko
authors.initials: S
authors.lastname: Skrtic
mesh_terms: D001786:Blood Glucose / Q000378:metabolism*; D003924:Diabetes Mellitus, Type 2 / Q000097:blood* / Q000188:drug therapy; D005260:Female; D006442:Glycated Hemoglobin / Q000032:analysis; D006801:Humans; D007004:Hypoglycemic Agents / Q000627:therapeutic use*; D007328:Insulin / Q000097:blood*; D008297:Male; D008687:Metformin / Q000627:therapeutic use*; D008954:Models, Biological; D016032:Randomized Controlled Trials as Topic
chemical_list: D001786:Blood Glucose; D006442:Glycated Hemoglobin; D007004:Hypoglycemic Agents; D007328:Insulin; D008687:Metformin
keywords: NONMEM; glucose; glycaemic control; insulin; integrated glucose-insulin model; type 2 diabetes mellitus