Glucose allostasis
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Glucose allostasis. / Stumvoll, Michael; Tataranni, P Antonio; Stefan, Norbert; Vozarova, Barbora; Bogardus, Clifton; de Courten, Barbora.
In: Diabetes, Vol. 52, No. 4, 01.04.2003, p. 903-9.Research output: Contribution to journal › Journal article › Research › peer-review
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TY - JOUR
T1 - Glucose allostasis
AU - Stumvoll, Michael
AU - Tataranni, P Antonio
AU - Stefan, Norbert
AU - Vozarova, Barbora
AU - Bogardus, Clifton
AU - de Courten, Barbora
PY - 2003/4/1
Y1 - 2003/4/1
N2 - In many organisms, normoglycemia is achieved by a tight coupling of nutrient-stimulated insulin secretion in the pancreatic beta-cell (acute insulin response [AIR]) and the metabolic action of insulin to stimulate glucose disposal (insulin action [M]). It is widely accepted that in healthy individuals with normal glucose tolerance, normoglycemia can always be maintained by compensatorily increasing AIR in response to decreasing M (and vice versa). This has been mathematically described by the hyperbolic relationship between AIR and M and referred to as glucose homeostasis, with glucose concentration assumed to remain constant along the hyperbola. Conceivably, glucose is one of the signals stimulating AIR in response to decreasing M. Hypothetically, as with any normally functioning feed-forward system, AIR should not fully compensate for worsening M, since this would remove the stimulus for the compensation. We provide evidence from cross-sectional, longitudinal, and prospective data from Pima Indians (n = 413) and Caucasians (n = 60) that fasting and postprandial glucose concentrations increase with decreasing M despite normal compensation of AIR. For this physiologic adaptation to chronic stress (insulin resistance), we propose to use the term "glucose allostasis." Allostasis (stability through change) ensures the continued homeostatic response (stability through staying the same) to acute stress at some cumulative costs to the system. With increasing severity and over time, the allostatic load (increase in glycemia) may have pathological consequences, such as the development of type 2 diabetes.
AB - In many organisms, normoglycemia is achieved by a tight coupling of nutrient-stimulated insulin secretion in the pancreatic beta-cell (acute insulin response [AIR]) and the metabolic action of insulin to stimulate glucose disposal (insulin action [M]). It is widely accepted that in healthy individuals with normal glucose tolerance, normoglycemia can always be maintained by compensatorily increasing AIR in response to decreasing M (and vice versa). This has been mathematically described by the hyperbolic relationship between AIR and M and referred to as glucose homeostasis, with glucose concentration assumed to remain constant along the hyperbola. Conceivably, glucose is one of the signals stimulating AIR in response to decreasing M. Hypothetically, as with any normally functioning feed-forward system, AIR should not fully compensate for worsening M, since this would remove the stimulus for the compensation. We provide evidence from cross-sectional, longitudinal, and prospective data from Pima Indians (n = 413) and Caucasians (n = 60) that fasting and postprandial glucose concentrations increase with decreasing M despite normal compensation of AIR. For this physiologic adaptation to chronic stress (insulin resistance), we propose to use the term "glucose allostasis." Allostasis (stability through change) ensures the continued homeostatic response (stability through staying the same) to acute stress at some cumulative costs to the system. With increasing severity and over time, the allostatic load (increase in glycemia) may have pathological consequences, such as the development of type 2 diabetes.
KW - Adolescent
KW - Adult
KW - Blood Glucose
KW - Cross-Sectional Studies
KW - Diabetes Mellitus, Type 2
KW - Fasting
KW - Female
KW - Glucose Clamp Technique
KW - Glucose Tolerance Test
KW - Homeostasis
KW - Humans
KW - Indians, North American
KW - Insulin
KW - Insulin Resistance
KW - Islets of Langerhans
KW - Longitudinal Studies
KW - Male
KW - Prospective Studies
KW - Risk Factors
M3 - Journal article
C2 - 12663459
VL - 52
SP - 903
EP - 909
JO - Diabetes
JF - Diabetes
SN - 0012-1797
IS - 4
ER -
ID: 33926676