J Endocrinol Metab
Journal of Endocrinology and Metabolism, ISSN 1923-2861 print, 1923-287X online, Open Access
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Editorial

Volume 8, Number 1, February 2018, pages 1-1


Impaired Crosstalk Between Insulin and Glucagon Secretion in Patients With Type 2 Diabetes

Hidekatsu Yanai

Department of Internal Medicine, National Center for Global Health and Medicine Kohnodai Hospital, 1-7-1 Kohnodai, Ichikawa, Chiba 272-8516, Japan

Manuscript submitted January 30, 2018, accepted February 14, 2018
Short title: Editorial
doi: https://doi.org/10.14740/jem489w

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In this issue (P6), Morimitsu and Hamasaki report that once-weekly glucagon-like peptide-1 (GLP-1) receptor agonist, dulaglutide ameliorated glycemic control by suppressing fasting and postprandial glucagon secretion in a patient with type 2 diabetes [1]. Their report reminded me a significance of impaired crosstalk between insulin and glucagon secretion in patients with type 2 diabetes.

In normal individuals, serum glucagon falls after carbohydrate ingestion. In diabetic patients, serum glucagon is not suppressed by carbohydrate ingestion despite hyperglycemia [2]. An inverse relationship between insulin and glucagon secretion observed in normal individuals has been lost in patients with type 2 diabetes [3]. Such an impaired crosstalk between insulin and glucagon secretion was also observed in pre-diabetic individuals [4]. Postprandial hyperglucagonemia in type 2 diabetes is likely due to loss of intra-islet postprandial suppression of glucagon secretion by insulin [5]. Therefore, altered insulin-to-glucagon ratio which was used in the report by Morimitsu and Hamasaki should play an important role in the pathophysiology of type 2 diabetes [6].

GLP-1 receptor agonist improved glycemic control by amelioration of insulin-to-glucagon ratio. Effects of other anti-diabetic drugs on insulin-to-glucagon ratio should be studied in the future.

Conflict of Interest

The author declares that he has no conflict of interest concerning this article.


References▴Top 
  1. Morimitsu S, Hamasaki H. Improved glycemic control due to reduction in glucagon levels by the administration of once-weekly dulaglutide in a non-obese patient with type 2 diabetes. J Endocrinol Metab;2018;8(1):6-9.
  2. Muller WA, Faloona GR, Aguilar-Parada E, Unger RH. Abnormal alpha-cell function in diabetes. Response to carbohydrate and protein ingestion. N Engl J Med. 1970;283(3):109-115.
    doi pubmed
  3. Menge BA, Gruber L, Jorgensen SM, Deacon CF, Schmidt WE, Veldhuis JD, Holst JJ, et al. Loss of inverse relationship between pulsatile insulin and glucagon secretion in patients with type 2 diabetes. Diabetes. 2011;60(8):2160-2168.
    doi pubmed
  4. Rohrer S, Menge BA, Gruber L, Deacon CF, Schmidt WE, Veldhuis JD, Holst JJ, et al. Impaired crosstalk between pulsatile insulin and glucagon secretion in prediabetic individuals. J Clin Endocrinol Metab. 2012;97(5):E791-795.
    doi pubmed
  5. Meier JJ, Kjems LL, Veldhuis JD, Lefebvre P, Butler PC. Postprandial suppression of glucagon secretion depends on intact pulsatile insulin secretion: further evidence for the intraislet insulin hypothesis. Diabetes. 2006;55(4):1051-1056.
    doi pubmed
  6. Jiang G, Zhang BB. Glucagon and regulation of glucose metabolism. Am J Physiol Endocrinol Metab. 2003;284(4):E671-678.
    doi pubmed


This article is distributed under the terms of the Creative Commons Attribution Non-Commercial 4.0 International License, which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.


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Journal of Endocrinology and Metabolism, bimonthly, ISSN 1923-2861 (print), 1923-287X (online), published by Elmer Press Inc.     
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