Dynamic tests in the clinical management of diabetes

Diabetes mellitus affects carbohydrate, lipid and protein metabolism. Although remarkably complex because of the interaction between different metabolisms, diabetes can be investigated with a variety of procedures allowing a precise characterization of the metabolic dysregulation associated with the disease. The diagnostic clue is fasting hyperglycemia (> or = 7 mmol/l). As glucose homeostasis is a dynamic process, in the clinical setting different parameters are usually required to most accurately depict the situation of any individual patient. The most important dynamic tests used are the oral and iv glucose tolerance tests, and the glucagon test which is adopted to evaluate the residual beta-cell function in patients with Type 1 diabetes. For the evaluation of long-term metabolic control in the diabetic patient, glycosylated haemoglobin (HbA1c) and fructosamine are currently adopted in clinical practice. HbA1c < 7% is a target for any type of therapy in diabetic patients. Mathematical modelling and/or computer-assisted analysis of empirical data allow the derivation of dynamic parameters to investigate the functional state of beta-cells with precision and offer information to monitor disease progression in both Type 1 and Type 2 diabetes.