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Type 2 diabetes (T2D) has been studied for decades. Many risk factors of T2D have been identified, but few studies were designed to investigate the pharmacokinetics/ pharmacodynamics (PK/PD) risk factors preceding the onset of T2D. Moreover, although the disease progression of T2D has received considerable attention, little is known about the disease development of T2D. It is important to understand the temporal changes of the risk factors of glucose and insulin kinetics during the development of T2D for a better understanding of the etiology of T2D. The objectives of this work are: 1) to develop a population-based glucose-insulin PK/PD model and identify the PK/PD risk factors preceding the onset of T2D, 2) to develop a methodology to evaluate the development of T2D, 3) model the time-course of the disease development based on the disease development variables (DDVs) derived from repeated intravenous glucose tolerance tests (IVGTT) and oral glucose tolerance tests (OGTT). The central hypothesis is that the development of T2D can be described and characterized by the glucose-insulin kinetics by employing a population-PK/PD based disease development analysis.
To summarize, a glucose-insulin kinetic model was developed and presented in Chapter 2. The pharmacokinetics/pharmacodynamics (PK/PD) risk factors preceding the onset of T2D were investigated using a population-based Bayesian nonlinear hierarchical model. In Chapter 3, a methodology describing the disease development of T2D was developed based on four important DDVs of T2D, namely fasting blood glucose (FBG), fasting serum insulin (FSI), homeostatic model assessment of insulin resistance (HOMA-IR) and body mass index (BMI). These DDVs were investigated for their temporal patterns and relationships to the time-course of the development of T2D. The proposed model enables a quantitative, time-based evaluation of the development of T2D in this high risk population. In Chapter 4, the DDVs derived from repeated IVGTTs were evaluated. By applying the mixed effect analysis, important DDVs were identified as potential new biomarkers of T2D. Chapter 5 is an extension of application of the disease development analysis based on the DDVs derived from OGTTs. Chapter 6 is the conclusions and future works of this thesis. The proposed population model of glucose-insulin kinetics has demonstrated that pharmacokinetic differences exists for the high risk population and can be helpful for prediction of T2D. By applying the proposed disease development analysis, the time-dependency and temporal patterns of the DDVs can be identified. An examination of the temporal changes in DDVs for the glucose-insulin system before the diagnosis of the disease provides a quantitative evaluation of the pathophysiological evolution of T2D and is valuable in predicting T2D.