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The rapid systemic appearance of CD69 expression suggested that a soluble factor such as IFNα, a known early responder to viral infections [22] and strong trigger of CD69 expression [17], [19], [20], was inducing the response.
Another consideration when examining the systemic appearance of meal-derived glucose is the methodology used to measure this parameter.
17 The triple tracer method was used to measure postprandial suppression of glucose production and postprandial stimulation of glucose disposal as well as the rate of the systemic appearance of the ingested glucose.
However, postprandial hyperglycemia results from the fact that the pharmacodynamics of subcutaneously injected insulin coupled with impaired suppression of postprandial glucagon concentrations cannot keep pace with the rapidity of systemic appearance of meal glucose.
Much of this difference was as a result of an increase in endogenous glucose release because the systemic appearance of ingested glucose was only 7 g greater in the diabetic patients.
This study used a dual-tracer method to test the hypothesis that canagliflozin 300 mg slows the rate of systemic appearance of orally administered glucose (RaO) during a mixed-meal tolerance test (MMTT) compared with placebo.
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During these comparative studies, although the dual-tracer method appeared to underestimate overall systemic glucose appearance (16% lower), profiles for dual- and triple-tracer techniques were very similar (21), and it may be considered that a two-compartmental dual isotope approach is acceptable.
No effect on systemic meal appearance or peripheral glucose disposal was observed.
As emphasized by Pennant et al. (2), in comparison, a dual-tracer approach underestimates systemic glucose appearance by 16%.
Approximately 15% of a glucose load is taken up by skeletal muscle then released as lactate in normal health [ 21] and accounts for approximately 45% of systemic lactate appearance [ 22].
The present findings suggest that regularly skipping breakfast may elicit adaptations to progressively increase systemic glucose appearance and/or impair glucose disposal when the overnight fast remains unbroken until after 1200.
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