That's fascinating! Insulin sensitivity is an incredibly complex mechanism, and is always in flux. Hyperinsulemic clamps are one way to measure the boundaries of insulin sensitivity, but doesn't really help you understand the day to day individual dynamics very well. Like I said, drugs are _not_ our area of expertise, so I can't comment much more than that.

State of the art treatment these days (at least in artificial pancreas land, where I spend all of my time) is more focused on sensitivity-agnostic treatment; figuring out the insulin sensitivity dynamically rather than trying to control the sensitivity itself (it's much more multifaceted than a few hormones, we're talking hundreds of possible ways it can change).

Also, and I'm sure the authors would acknowledge this, n=32 is enough to demonstrate a possible effect, but not nearly enough to show this effect in the population at large. You usually need n~5000 or more for such effects to be shown generally, though the actual number depends a lot on the drug and what you're trying to treat.

We're conducting our first human study at a world renowned US diabetes center soon, I'll see what our PI thinks of this work. Thanks for sharing.