Endocrine Abstracts

Objective: Although the importance of islet α-cell dysfunction in the pathogenesis of type 2 diabetes has been reappraised, data on whether increase or decrease of glucagon relative to insulin is related with glucose metabolism parameters or metabolic diseases such as nonalcoholic fatty liver disease(NAFLD) in clinical settings are very limited. Therefore, we investigated the association between glucagon-to-insulin ratio(G/I ratio) and presence of NAFLD and metabolic parameters in T2DM.

Methods: This retrospective, cross-sectional study was performed with data obtained from 230 T2DM patients(mean age, duration of DM, and BMI:56 years, 8 years, and 25 kg/m², respectively). Participants were assessed for serum fasting and postprandial G/I ratio and divided into tertiles. NAFLD was defined as ultrasonographically detected fatty liver. Results: The patients in the lowest tertile of fasting G/I ratio had higher BMI, visceral and subcutaneous fat thickness(VFT, SFT), and HOMA-IR and shorter duration of DM. Fasting and postprandial G/I ratios were negatively correlated with BMI, VFT, SFT, fasting c-peptide, and HOMA-IR. In addition, postprandial G/I ratio was positively correlated with HbA1c levels, FBG, and HDL-C. Subjects with HbA1c>8% showed significantly higher mean G/I ratio than those with HbA1c≤8%. Prevalence of NAFLD was significantly decreased across tertile of fasting and postprandial G/I ratio. Low G/I ratio was significantly associated with presence of NAFLD by both unadjusted analysis and after multivariate adjustment (OR, 95%[CI]:3.24[1.4–7.51], 2.59[1.03–6.55], respectively).

Conclusion: Our results suggest that the high glucagon relative to insulin may contribute to hyperglycemia, whereas low glucagon relative to insulin may contribute to NAFLD in T2DM.