Model-Based Assessment of C-Peptide Secretion and Kinetics in Post Gastric Bypass Individuals Experiencing Postprandial Hyperinsulinemic Hypoglycemia.

Schiavon, Michele; Herzig, David; Hepprich, Matthias; Donath, Marc Y; Bally, Lia; Dalla Man, Chiara (2021). Model-Based Assessment of C-Peptide Secretion and Kinetics in Post Gastric Bypass Individuals Experiencing Postprandial Hyperinsulinemic Hypoglycemia. Frontiers in endocrinology, 12, p. 611253. Frontiers Research Foundation 10.3389/fendo.2021.611253

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Assessment of insulin secretion is key to diagnose postprandial hyperinsulinemic hypoglycemia (PHH), an increasingly recognized complication following bariatric surgery. To this end, the Oral C-peptide Minimal Model (OCMM) can be used. This usually requires fixing C-peptide (CP) kinetics to the ones derived from the Van Cauter population model (VCPM), which has never been validated in PHH individuals. The objective of this work was to test the validity of the OCMM coupled with the VCPM in PHH subjects and propose a method to overcome the observed limitations. Two cohorts of adults with PHH after gastric bypass (GB) underwent either a 75 g oral glucose (9F/3M; age=42±9 y; BMI=28.3±6.9 kg/m2) or a 60 g mixed-meal (7F/3M; age = 43 ± 11 y; BMI=27.5±4.2 kg/m2) tolerance test. The OCMM was identified on CP concentration data with CP kinetics fixed to VCPM (VC approach). In both groups, the VC approach underestimated CP-peak and overestimated CP-tail suggesting CP kinetics predicted by VCPM to be inaccurate in this population. Thus, the OCMM was identified using CP kinetics estimated from the data (DB approach) using a Bayesian Maximum a Posteriori estimator. CP data were well predicted in all the subjects using the DB approach, highlighting a significantly faster CP kinetics in patients with PHH compared to the one predicted by VCPM. Finally, a simulation study was used to validate the proposed approach. The present findings question the applicability of the VCPM in patients with PHH after GB and call for CP bolus experiments to develop a reliable CP kinetic model in this population.

Item Type:

Journal Article (Original Article)

Division/Institute:

04 Faculty of Medicine > Department of Gynaecology, Paediatrics and Endocrinology (DFKE) > Clinic of Endocrinology, Diabetology and Clinical Nutrition

UniBE Contributor:

Herzig, David, Bally, Lia Claudia

Subjects:

600 Technology > 610 Medicine & health

ISSN:

1664-2392

Publisher:

Frontiers Research Foundation

Language:

English

Submitter:

Laura Cavalli

Date Deposited:

24 Jan 2022 17:29

Last Modified:

05 Dec 2022 16:03

Publisher DOI:

10.3389/fendo.2021.611253

PubMed ID:

33790855

Uncontrolled Keywords:

OGTT insulin secretion mixed meal model identification obesity oral minimal model parameter estimation

BORIS DOI:

10.48350/164374

URI:

https://boris.unibe.ch/id/eprint/164374

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