Impaired glucose-induced glucagon suppression after partial pancreatectomy
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Impaired glucose-induced glucagon suppression after partial pancreatectomy. / Schrader, Henning; Menge, Bjoern A; Breuer, Thomas G K; Ritter, Peter R; Uhl, Waldemar; Schmidt, Wolfgang E; Holst, Jens J; Meier, Juris J.
In: Journal of Clinical Endocrinology and Metabolism, Vol. 94, No. 8, 2009, p. 2857-63.Research output: Contribution to journal › Journal article › Research › peer-review
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TY - JOUR
T1 - Impaired glucose-induced glucagon suppression after partial pancreatectomy
AU - Schrader, Henning
AU - Menge, Bjoern A
AU - Breuer, Thomas G K
AU - Ritter, Peter R
AU - Uhl, Waldemar
AU - Schmidt, Wolfgang E
AU - Holst, Jens J
AU - Meier, Juris J
N1 - Keywords: Adult; Aged; Blood Glucose; C-Peptide; Female; Glucagon; Glucagon-Secreting Cells; Glucose; Humans; Insulin; Insulin-Secreting Cells; Male; Middle Aged; Pancreatectomy
PY - 2009
Y1 - 2009
N2 - INTRODUCTION: The glucose-induced decline in glucagon levels is often lost in patients with type 2 diabetes. It is unclear whether this is due to an independent defect in alpha-cell function or secondary to the impairment in insulin secretion. We examined whether a partial pancreatectomy in humans would also impair postchallenge glucagon concentrations and, if so, whether this could be attributed to the reduction in insulin levels. PATIENTS AND METHODS: Thirty-six patients with pancreatic tumours or chronic pancreatitis were studied before and after approximately 50% pancreatectomy with a 240-min oral glucose challenge, and the plasma concentrations of glucose, insulin, C-peptide, and glucagon were determined. RESULTS: Fasting and postchallenge insulin and C-peptide levels were significantly lower after partial pancreatectomy (P < 0.0001). Likewise, fasting glucagon concentrations tended to be lower after the intervention (P = 0.11). Oral glucose ingestion elicited a decline in glucagon concentrations before surgery (P < 0.0001), but this was lost after partial pancreatectomy (P < 0.01 vs. preoperative values). The loss of glucose-induced glucagon suppression was found after both pancreatic head (P < 0.001) and tail (P < 0.05) resection. The glucose-induced changes in glucagon levels were closely correlated to the respective increments in insulin and C-peptide concentrations (P < 0.01). CONCLUSIONS: The glucose-induced suppression in glucagon levels is lost after a 50% partial pancreatectomy in humans. This suggests that impaired alpha-cell function in patients with type 2 diabetes may also be secondary to reduced beta-cell mass. Alterations in glucagon regulation should be considered as a potential side effect of partial pancreatectomies.
AB - INTRODUCTION: The glucose-induced decline in glucagon levels is often lost in patients with type 2 diabetes. It is unclear whether this is due to an independent defect in alpha-cell function or secondary to the impairment in insulin secretion. We examined whether a partial pancreatectomy in humans would also impair postchallenge glucagon concentrations and, if so, whether this could be attributed to the reduction in insulin levels. PATIENTS AND METHODS: Thirty-six patients with pancreatic tumours or chronic pancreatitis were studied before and after approximately 50% pancreatectomy with a 240-min oral glucose challenge, and the plasma concentrations of glucose, insulin, C-peptide, and glucagon were determined. RESULTS: Fasting and postchallenge insulin and C-peptide levels were significantly lower after partial pancreatectomy (P < 0.0001). Likewise, fasting glucagon concentrations tended to be lower after the intervention (P = 0.11). Oral glucose ingestion elicited a decline in glucagon concentrations before surgery (P < 0.0001), but this was lost after partial pancreatectomy (P < 0.01 vs. preoperative values). The loss of glucose-induced glucagon suppression was found after both pancreatic head (P < 0.001) and tail (P < 0.05) resection. The glucose-induced changes in glucagon levels were closely correlated to the respective increments in insulin and C-peptide concentrations (P < 0.01). CONCLUSIONS: The glucose-induced suppression in glucagon levels is lost after a 50% partial pancreatectomy in humans. This suggests that impaired alpha-cell function in patients with type 2 diabetes may also be secondary to reduced beta-cell mass. Alterations in glucagon regulation should be considered as a potential side effect of partial pancreatectomies.
U2 - 10.1210/jc.2009-0826
DO - 10.1210/jc.2009-0826
M3 - Journal article
C2 - 19491219
VL - 94
SP - 2857
EP - 2863
JO - Journal of Clinical Endocrinology and Metabolism
JF - Journal of Clinical Endocrinology and Metabolism
SN - 0021-972X
IS - 8
ER -
ID: 18700661