Glucagon/insulin ratio in preoperative screening before pancreatic surgery: correlation with hemoglobin A1C in subjects with and without pancreatic cancer

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• 作者：Sang-Man Jin (1)
  Seong Ho Choi (2)
  Dong-Wook Choi (2)
  Jin Seok Heo (2)
  Sunghwan Suh (1)
  Ji Cheol Bae (1)
  Jae Hyeon Kim (1)
  Myung-Shik Lee (1)
  Kwang-Won Kim (1)
  Moon-Kyu Lee (1)
  
• 关键词：Glucagon ; Diabetes mellitus ; Hemoglobin A1C ; Pancreatic cancer
• 刊名：Endocrine
• 出版年：2014
• 出版时间：November 2014
• 年：2014
• 卷：47
• 期：2
• 页码：493-499
• 全文大小：552 KB
• 参考文献：1. R.A. Jamison, R. Stark, J. Dong, S. Yonemitsu, D. Zhang, G.I. Shulman, R.G. Kibbey, Hyperglucagonemia precedes a decline in insulin secretion and causes hyperglycemia in chronically glucose-infused rats. Am. J. Physiol. Endocrinol. Metab. 301(6), E1174–E1183 (2011). doi:10.1152/ajpendo.00175.2011 CrossRef
  2. A. Mitrakou, D. Kelley, M. Mokan, T. Veneman, T. Pangburn, J. Reilly, J. Gerich, Role of reduced suppression of glucose production and diminished early insulin release in impaired glucose tolerance. N. Engl. J. Med. 326(1), 22-9 (1992). doi:10.1056/NEJM199201023260104 CrossRef
  3. K.H. Yoon, S.H. Ko, J.H. Cho, J.M. Lee, Y.B. Ahn, K.H. Song, S.J. Yoo, M.I. Kang, B.Y. Cha, K.W. Lee, H.Y. Son, S.K. Kang, H.S. Kim, I.K. Lee, S. Bonner-Weir, Selective beta-cell loss and alpha-cell expansion in patients with type 2 diabetes mellitus in Korea. J. Clin. Endocrinol. metab. 88(5), 2300-308 (2003) CrossRef
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  7. H.S. Seltzer, E.W. Allen, A.L. Herron Jr, M.T. Brennan, Insulin secretion in response to glycemic stimulus: relation of delayed initial release to carbohydrate intolerance in mild diabetes mellitus. J. Clin. Investig. 46(3), 323-35 (1967). doi:10.1172/JCI105534 CrossRef
  8. A. Katz, S.S. Nambi, K. Mather, A.D. Baron, D.A. Follmann, G. Sullivan, M.J. Quon, Quantitative insulin sensitivity check index: a simple, accurate method for assessing insulin sensitivity in humans. J. Clin. Endocrinol. Metab. 85(7), 2402-410 (2000) CrossRef
  9. D.R. Matthews, J.P. Hosker, A.S. Rudenski, B.A. Naylor, D.F. Treacher, R.C. Turner, Homeostasis model assessment: insulin resistance and beta-cell function from fasting plasma glucose and insulin concentrations in man. Diabetologia 28(7), 412-19 (1985) CrossRef
  10. K.M. Utzschneider, R.L. Prigeon, M.V. Faulenbach, J. Tong, D.B. Carr, E.J. Boyko, D.L. Leonetti, M.J. McNeely, W.Y. Fujimoto, S.E. Kahn, Oral disposition index predicts the development of future diabetes above and beyond fasting and 2-h glucose levels. Diabetes Care 32(2), 335-41 (2008). doi:10.2337/dc08-1478 CrossRef
  
• 作者单位：Sang-Man Jin (1)
  Seong Ho Choi (2)
  Dong-Wook Choi (2)
  Jin Seok Heo (2)
  Sunghwan Suh (1)
  Ji Cheol Bae (1)
  Jae Hyeon Kim (1)
  Myung-Shik Lee (1)
  Kwang-Won Kim (1)
  Moon-Kyu Lee (1)
  
  1. Division of Endocrinology and Metabolism, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 50 Ilwon-Dong, Gangnam-Gu, Seoul, 135-710, Republic of Korea
  2. Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, 50 Ilwon-Dong, Gangnam-Gu, Seoul, 135-710, Republic of Korea
  
• ISSN：1559-0100

文摘

Role of impaired suppression of glucagon secretion in the pathogenesis of pancreatic cancer-associated diabetes has been suggested. We examined the correlation between glucagon/insulin ratio (G/I) after glucose challenge and hemoglobin A1C (A1C) in subjects with and without pancreatic cancer. Data were gathered from a preoperative screening 75-g oral glucose tolerance test in patients who would eventually undergo pancreatic resection. A multiple linear regression analysis was conducted using the following covariates: age, body mass index, hemoglobin, glucose and insulin levels at the corresponding time points, indices of insulin resistance, duration of diabetes, insulinogenic index, and use of glucose-lowering drugs. In subject group with pancreatic cancer (n?=?45), but not in subject group without pancreatic cancer (n?=?101), participants with A1C ?.5?% had significantly higher glucagon levels, lower insulin levels, and higher G/I ratios after the glucose challenge than those of the subjects with A1C p?=?0.004) and less insulin resistance (p?=?0.008). In conclusion, post-challenge G/I ratio independently correlated with A1C in patients with pancreatic cancer. Although significant, the degree of correlation was weakened in the subjects without pancreatic cancer because some had lower insulin secretory reserve compensated by less insulin resistance, resulting in inappropriately elevated G/I ratios relative to A1C.