Hyperglucagonemia Does Not Explain the β-Cell Hyperresponsiveness and Insulin Resistance in Dysglycemic Youth Compared With Adults: Lessons From the RISE Study
Steven E Kahn, Kieren J Mather, Silva A Arslanian, Elena Barengolts, Thomas A Buchanan, Sonia Caprio, David A Ehrmann, Tamara S Hannon, Santica Marcovina, Kristen J Nadeau, Kristina M Utzschneider, Anny H Xiang, Sharon L Edelstein, RISE Consortium, Rise Consortium Investigators:, David A Ehrmann, Karla A Temple, Abby Rue, Elena Barengolts, Babak Mokhlesi, Eve Van Cauter, Susan Sam, M Annette Miller, Steven E Kahn, Karen M Atkinson, Jerry P Palmer, Kristina M Utzschneider, Tsige Gebremedhin, Abigail Kernan-Schloss, Alexandra Kozedub, Brenda K Montgomery, Emily J Morse, Kieren J Mather, Tammy Garrett, Tamara S Hannon, Amale Lteif, Aniket Patel, Robin Chisholm, Karen Moore, Vivian Pirics, Linda Pratt, Kristen J Nadeau, Susan Gross, Philip S Zeitler, Jayne Williams, Melanie Cree Green, Yesenia Garcia Reyes, Krista Vissat, Silva A Arslanian, Kathleen Brown, Nancy Guerra, Kristin Porter, Sonia Caprio, Mary Savoye, Bridget Pierpont, Thomas A Buchanan, Anny H Xiang, Enrique Trigo, Elizabeth Beale, Fadi N Hendee, Namir Katkhouda, Krishan Nayak, Mayra Martinez, Cortney Montgomery, Xinhui Wang, Sharon L Edelstein, John M Lachin, Ashley N Hogan, Santica Marcovina, Jessica Harting, John Albers, Dave Hill, Peter J Savage, Ellen W Leschek, Steven E Kahn, Kieren J Mather, Silva A Arslanian, Elena Barengolts, Thomas A Buchanan, Sonia Caprio, David A Ehrmann, Tamara S Hannon, Santica Marcovina, Kristen J Nadeau, Kristina M Utzschneider, Anny H Xiang, Sharon L Edelstein, RISE Consortium, Rise Consortium Investigators:, David A Ehrmann, Karla A Temple, Abby Rue, Elena Barengolts, Babak Mokhlesi, Eve Van Cauter, Susan Sam, M Annette Miller, Steven E Kahn, Karen M Atkinson, Jerry P Palmer, Kristina M Utzschneider, Tsige Gebremedhin, Abigail Kernan-Schloss, Alexandra Kozedub, Brenda K Montgomery, Emily J Morse, Kieren J Mather, Tammy Garrett, Tamara S Hannon, Amale Lteif, Aniket Patel, Robin Chisholm, Karen Moore, Vivian Pirics, Linda Pratt, Kristen J Nadeau, Susan Gross, Philip S Zeitler, Jayne Williams, Melanie Cree Green, Yesenia Garcia Reyes, Krista Vissat, Silva A Arslanian, Kathleen Brown, Nancy Guerra, Kristin Porter, Sonia Caprio, Mary Savoye, Bridget Pierpont, Thomas A Buchanan, Anny H Xiang, Enrique Trigo, Elizabeth Beale, Fadi N Hendee, Namir Katkhouda, Krishan Nayak, Mayra Martinez, Cortney Montgomery, Xinhui Wang, Sharon L Edelstein, John M Lachin, Ashley N Hogan, Santica Marcovina, Jessica Harting, John Albers, Dave Hill, Peter J Savage, Ellen W Leschek
Abstract
Objective: To determine whether β-cell hyperresponsiveness and insulin resistance in youth versus adults in the Restoring Insulin Secretion (RISE) Study are related to increased glucagon release.
Research design and methods: In 66 youth and 350 adults with impaired glucose tolerance (IGT) or recently diagnosed type 2 diabetes (drug naive), we performed hyperglycemic clamps and oral glucose tolerance tests (OGTTs). From clamps we quantified insulin sensitivity (M/I), plasma fasting glucagon and C-peptide, steady-state glucagon and C-peptide at glucose of 11.1 mmol/L, and arginine-stimulated glucagon (acute glucagon response [AGR]) and C-peptide (ACPRmax) responses at glucose >25 mmol/L.
Results: Mean ± SD fasting glucagon (7.63 ± 3.47 vs. 8.55 ± 4.47 pmol/L; P = 0.063) and steady-state glucagon (2.24 ± 1.46 vs. 2.49 ± 1.96 pmol/L, P = 0.234) were not different in youth and adults, respectively, while AGR was lower in youth (14.1 ± 5.2 vs. 16.8 ± 8.8 pmol/L, P = 0.001). Significant age-group differences in insulin sensitivity, fasting C-peptide, steady-state C-peptide, and ACPRmax were not related to glucagon. Fasting glucose and glucagon were positively correlated in adults (r = 0.133, P = 0.012) and negatively correlated in youth (r = -0.143, P = 0.251). In both age-groups, higher fasting glucagon was associated with higher fasting C-peptide (youth r = 0.209, P = 0.091; adults r = 0.335, P < 0.001) and lower insulin sensitivity (youth r = -0.228, P = 0.066; adults r = -0.324, P < 0.001). With comparable fasting glucagon, youth had greater C-peptide and lower insulin sensitivity. OGTT suppression of glucagon was greater in youth.
Conclusions: Youth with IGT or recently diagnosed type 2 diabetes (drug naive) have hyperresponsive β-cells and lower insulin sensitivity, but their glucagon concentrations are not increased compared with those in adults. Thus, α-cell dysfunction does not appear to explain the difference in β-cell function and insulin sensitivity in youth versus adults.
Trial registration: ClinicalTrials.gov NCT01779362 NCT01779375 NCT01763346.
© 2021 by the American Diabetes Association.
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Source: PubMed