The Korean journal of internal medicine

The Korean Association of Internal Medicine (대한내과학회)
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Higher glucagon-to-insulin ratio is associated with elevated glycated hemoglobin levels in type 2 diabetes patients

  • Lee, Minyoung (Department of Internal Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine) ;
  • Kim, Minkyung (Department of Internal Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine) ;
  • Park, Jong Suk (Department of Internal Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine) ;
  • Lee, Sangbae (Department of Internal Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine) ;
  • You, Jihong (Department of Internal Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine) ;
  • Ahn, Chul Woo (Department of Internal Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine) ;
  • Kim, Kyung Rae (Department of Internal Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine) ;
  • Kang, Shinae (Department of Internal Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine)
  • Received : 2016.07.23
  • Accepted : 2017.06.26
  • Published : 2019.09.01
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Abstract

Background/Aims: The importance of α-cell dysfunction in the pathogenesis of type 2 diabetes has re-emerged recently. However, data on whether relative glucagon excess is present in clinical settings are scarce. We aimed to investigate associations between glucagon-to-insulin ratio and various metabolic parameters. Methods: A total of 451 patients with type 2 diabetes naïve to insulin treatment were recruited. Using glucagon-to-insulin ratio, we divided subjects into quartiles according to both fasting and postprandial glucagon-to-insulin ratios. Results: The mean age of the subjects was 58 years, with a mean body mass index of 25 kg/m2. The patients in the highest quartile of glucagon-to-insulin ratio had higher glycated hemoglobin (HbA1c) levels. HbA1c levels were positively correlated with both fasting and postprandial glucagon-to-insulin ratios. Subjects in the highest quartile of postprandial glucagon-to-insulin ratio were more likely to exhibit uncontrolled hyperglycemia, even after adjusting for confounding factors (odds ratio, 2.730; 95% confidence interval, 1.236 to 6.028; p for trend < 0.01). Conclusions: Hyperglucagonemia relative to insulin could contribute to uncontrolled hyperglycemia in type 2 diabetes patients.

Keywords

Acknowledgement

This research was supported by a grant from the Korea Health Technology R&D Project through the Korea Health Industry Development Institute (KHIDI), funded by the Ministry of Health and Welfare, Republic of Korea (grant number: HI14C0336). The authors are grateful to Dr. Lee and Ms. Hong (the Biostatistics Collaboration Units of Yonsei University College of Medicine) for their advice on the statistical analyses.

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