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Cited by 297Diabetes Management and ResearchPancreatic function and diabetesDiabetes, Cardiovascular Risks, and Lipoproteins

Diurnal pattern to insulin secretion and insulin action in healthy individuals

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Saad, Ahmed, Dalla Man, Chiara, Nandy, Debashis K., Levine, James A., Bharucha, Adil E., Rizza, Robert A., Basu, Rita, Carter, Rickey E. +3 more·2012·Diabetes
DOI 10.2337/db11-1478PMC PMC3478548
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Abstract

Evaluation of the existence of a diurnal pattern of glucose tolerance after mixed meals is important to inform a closed-loop system of treatment for insulin requiring diabetes. We studied 20 healthy volunteers with normal fasting glucose (4.8 ± 0.1 mmol/L) and HbA1c (5.2 ± 0.0%) to determine such a pattern in nondiabetic individuals. Identical mixed meals were ingested during breakfast, lunch, or dinner at 0700, 1300, and 1900 h in randomized Latin square order on 3 consecutive days. Physical activity was the same on all days. Postprandial glucose turnover was measured using the triple tracer technique. Postprandial glucose excursion was significantly lower (P < 0.01) at breakfast than lunch and dinner. β-Cell responsivity to glucose and disposition index was higher (P < 0.01) at breakfast than lunch and dinner. Hepatic insulin extraction was lower (P < 0.01) at breakfast than dinner. Although meal glucose appearance did not differ between meals, suppression of endogenous glucose production tended to be lower (P < 0.01) and insulin sensitivity tended to be higher (P < 0.01) at breakfast than at lunch or dinner. Our results suggest a diurnal pattern to glucose tolerance in healthy humans, and if present in type 1 diabetes, it will need to be incorporated into artificial pancreas systems.

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  • In healthy individuals, there is a diurnal pattern to postprandial insulin action and secretion, with both parameters highest at breakfast than later in the day under controlled experimental conditions.

    “We recently showed the presence of a diurnal pattern to postprandial insulin action and secretion in healthy individuals with both of these parameters to be highest at breakfast than later in the day under controlled experimental conditions (1).”

    From Diurnal Pattern of Insulin Action in Type 1 Diabetes (2013) · cites this paper as [1]

  • In the present study, the authors carefully accounted for confounding factors by controlling for size, calorie content, and composition of all meals as well as for physical activity levels by applying an identical study design as that reported recently.

    “In an effort to determine the existence of a diurnal pattern to postprandial glucose tolerance in type 1 diabetic subjects with subcutaneous open loop insulin delivery, we carefully accounted for confounding factors by controlling for size, calorie content, and composition of all meals as well as for physical activity levels by applying an identical study design as that reported recently (1).”

    From Diurnal Pattern of Insulin Action in Type 1 Diabetes (2013) · cites this paper as [1]

  • Estimated mean response profiles gave the impression that SI trended to rise from breakfast through dinner in type 1 diabetic subjects, whereas the opposite was noted in healthy subjects, with SI falling from breakfast to dinner.

    “Thus, the estimated mean response profiles (11.2–7.9–8.1 vs. 5.1–7.6–7.2 × 10−4 dL/kg/min per μU/mL for breakfast, lunch, and dinner, respectively) gave the impression that SI trended to rise from breakfast through dinner in type 1 diabetic subjects, whereas the opposite was noted in the healthy subjects, with SI falling from breakfast to dinner (1).”

    From Diurnal Pattern of Insulin Action in Type 1 Diabetes (2013) · cites this paper as [1]

  • The residual variance for healthy subjects was 11.5 × 10−4 dL/kg/min per μU/mL, and in type 1 diabetic subjects, this variation was nearly three times larger (30.1 × 10−4 dL/kg/min per μU/mL).

    “Specifically, the residual variance for healthy subjects (1) was 11.5 × 10−4 dL/kg/min per μU/mL, and in the type 1 diabetic subjects, this variation was nearly three times larger (30.1 × 10−4 dL/kg/min per μU/mL).”

    From Diurnal Pattern of Insulin Action in Type 1 Diabetes (2013) · cites this paper as [1]

  • The finding that type 1 diabetic individuals do not demonstrate a uniform diurnal pattern of postprandial SI is contrary to the authors' recent report in a similar cohort of healthy individuals.

    “This finding is contrary to our recent report in a similar cohort of healthy individuals (1)”

    From Diurnal Pattern of Insulin Action in Type 1 Diabetes (2013) · cites this paper as [1]

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Authors
Saad, A., Dalla Man, C., Nandy, D. K., Levine, J. A., Bharucha, A. E., Rizza, R. A., Basu, R., Carter, R. E., Cobelli, C., Kudva, Y. C., & Basu, A.
Affiliations
  • Mayo Clinic (US)
  • Department of Information Engineering, University of Padova, Via Gradenigo 6B, Padova, Italy
  • University of Padua (IT)
Corresponding author
Basu, Ananda
ORCID
Venue
Diabetes
Publisher
American Diabetes Association
Published
2012-10-16
Volume
61
Issue
11
Pages
2691-2700
ISSN
  • 0012-1797 (ISSN-L)
  • 1939-327X
DOI
10.2337/db11-1478
PMC
PMC3478548
OpenAlex
W2157457288
Cited by
297
References
27
Citations by year
2026: 28 · 2025: 22 · 2024: 26 · 2023: 22 · 2022: 27 · 2021: 21 · 2020: 45 · 2019: 19 · 2018: 19 · 2017: 14 · 2016: 14 · 2015: 16 · 2014: 12 · 2013: 9 · 2012: 2
FWCI
10.01
Type
journal article
Language
en
Open access
Licence
Locations
  • Diabetes (publishedVersion, cc-by-nc-nd)
  • Europe PMC (PubMed Central) (publishedVersion, cc-by-nc-nd)
  • PubMed Central (publishedVersion, cc-by-nc-nd)
  • PubMed (publishedVersion)
  • Padua Research Archive (University of Padova) (submittedVersion)
Funders
  • National Institutes of Health
  • National Institute of Diabetes and Digestive and Kidney Diseases (P30DK050456, R01DK085516, DK-R01-085561)
  • National Center for Research Resources (UL1RR024150)
Topics
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Research
  • Health Sciences › Medicine › Surgery › Pancreatic function and diabetes
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes, Cardiovascular Risks, and Lipoproteins
Keywords
diurnal variation, insulin secretion, insulin sensitivity, glucose tolerance, mixed meal, postprandial glucose excursions, disposition index, hepatic insulin extraction, endogenous glucose production, artificial pancreas, type 1 diabetes
MeSH terms
Insulin Secretion, Adolescent, Adult, Blood Glucose, Carbon Isotopes, Circadian Rhythm, Deuterium, Female, Gluconeogenesis, Glucose, Humans, Insulin, Insulin Resistance, Male, Middle Aged, Cohort Studies, Glucose Intolerance, Cross-Over Studies, Postprandial Period, Insulin-Secreting Cells, Young Adult

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