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- Mingrone, G., et al.
(författare)
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Insulin sensitivity depends on the route of glucose administration
- 2020
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Ingår i: Diabetologia. - : Springer Science and Business Media LLC. - 0012-186X .- 1432-0428. ; 63, s. 1382-1395
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Tidskriftsartikel (refereegranskat)abstract
- Aims/hypothesis The small intestine plays an important role in hepatic and whole-body insulin sensitivity, as shown by bariatric surgery. Our goal was to study whether routes and dose of glucose administration have an acute impact on insulin sensitivity. The primary endpoint of this proof-of-concept study was the difference in insulin-mediated metabolic clearance rate (MCR/I) of glucose between the oral and intravenous routes of glucose administration. Secondary endpoints were differences in insulin effect on proteolysis, ketogenesis, lipolysis and glucagon levels. Methods In this parallel cohort study, we administered multiple oral glucose loads to 23 participants (aged between 18 and 65 years) with morbid obesity and with normal or impaired glucose tolerance or type 2 diabetes. In a different session, we administered isoglycaemic intravenous glucose infusions (IGIVI) to match the plasma glucose levels observed during the oral challenges. Glucose rate of appearance (R-a) and disappearance (R-d) and endogenous glucose production (EGP) were calculated by infusing [6,6-H-2(2)]glucose with or without oral [U-C-13(6)]glucose. Plasma small polar metabolites were measured by gas chromatography and time-of-flight mass spectrometry. Lipids were measured by ultra-HPLC and quadrupole mass spectrometry. Glucagon-like peptide-1, insulin, C-peptide and glucagon were also measured. Participants, caregivers, people doing measurements or examinations, and people assessing the outcomes were unblinded to group assignment. Results Glucose MCR/I was significantly higher during IGIVI than during oral glucose administration, independently of glycaemic status (12 +/- 6 for IGIVI vs 7.4 +/- 3 ml min(-1) kg(-1) per nmol/l for oral, p< 0.001 from paired t test). Insulin secretion was higher during oral administration than during IGIVI (p< 0.001). The disposition index was significantly lower during the oral procedure: 4260 +/- 1820 vs 5000 +/- 2360 (ml min(-1) kg(-1) (nmol/l)(-1) pmol/min; p = 0.005). Insulin clearance was significantly higher when glucose was infused rather than ingested (2.53 +/- 0.82 vs 2.16 +/- 0.49 l/min in intravenous and oral procedure, respectively, p = 0.006). The efficacy of insulin in inhibiting lipolysis and proteolysis was decreased after oral glucose loads. A heat map diagram showed a different pattern for the metabolites between the two routes of glucose administration. Conclusions/interpretation Our study shows that insulin sensitivity depends on the route of glucose administration, the oral route leading to increased insulin secretion and compensatory insulin resistance compared with the intravenous route. The efficacy of insulin in blocking lipolysis and protein breakdown is lower after oral glucose loads vs the intravenous route. Our findings suggest that, while the glucose-mediated incretin release is followed by an increase in insulin release, the effect of the released insulin is limited by an increase in insulin resistance.
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| 2. |
- Ahlin, Karin, 1963-
(författare)
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Benefits of Digital Technical Information
- 2020
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- In our daily work life, we use a wealth of information, including a category of information produced as a part of products and their life-cycle phases, named digital technical information (DTI). Manufacturing organizations focus more often on the product than on DTI, because DTI’s impact seems almost invisible, despite its crucial role to the product and its life-cycle phases, development, production, maintenance, and destruction. Hence, the aim of this thesis is to describe DTI’s benefits and the research questions: “What are the benefits of the DTI?” and “What are the perceptions of how to measure benefits of DTI?” The thesis contains five studies related to identifying and measuring DTI’s benefits. The empirical material is based on semi-structured interviews and group interviews within five organizations and a survey among manufacturing organizations in Sweden.I used three characteristics of the DTI and two pairs of previously known benefit categories to analyse the benefits. The analysis shows that the benefits are recognized in the particular product’s life cycle phase where the DTI is published. However, the DTI continues to offer benefits in the product’s other life cycle phases. In relationship to the product, the benefits evolve from supporting an individual product to supporting more general product lines or all products and a more complex product is said to increase DTI’s benefits. DTI’s structure adds benefits as synthesized or aggregated DTI, where the DTI is synthesized or aggregated automatically or manually. The categorization predetermined benefits related to the change are less numerous than the emerging benefits. The predetermined benefits are strategic by nature, and the emerging ones are mainly used to achieve operational goals. Measuring DTI’s benefits is of importance for a formal comparison of its development and is of special interest for managers. Perceptions from the initial stages on how to measure show that to establish common interpretations among the stakeholders of the measurement process is of importance, especially when it comes to what is viewed as a benefit. The benefits are viewed as intangible by the respondents, which creates difficulties when one is evaluating, using conventional measurement methods. The only perceived way to measure is when DTI reduces co-worker’s workload and efficiency is achieved. The thesis’s contribution to academia consists of the analysis of DTI’s benefits, showing details of the relationships between the DTI and its benefits. For practice, the contributions focus on the systematic evaluation process, which can be used for further development of the DTI and comparison of the evolvement of the DTI itself and relating to other resources. One proposal for future research is to use the analysed benefits and compare various approaches to digitizing DTI, e.g. Industry 4.0. Another proposal is to list, in detail, various ways on how to measure DTI’s benefits and their usefulness. The latter can positively impact on any intangible benefits due to the general approach we have established of how to measure those benefits.
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