A Study of Correlation of Glucagon-Insulin Ratio with Hba1c in Diabetic Patients in a Tertiary Care Hospital.

Apart from defects in insulin secretion and insulin resistance, hyperglucagonemia is a major factor affecting diabetes development and progression. Diabetic patients show relatively higher fasting and postprandial glucagon levels due to alpha cell resistance or dysfunction. As glucagon secretion is highly affected by insulin, it is better to consider glucagon relative to insulin as a glucagon insulin ratio instead of assessing each absolute value seperately. Data on increase in glucagon relative to insulin and their association with clinical parameters are scarce. In this study, we evaluated whether increase in glucagon relative to insulin correlates with HbA1c in diabetic patients. This will help to develop newer therapies aimed at suppressing glucagon levels for achieving glycemic control in diabetic patients. MATERIAL: A prospective type of observational study was conducted in outdoor and indoor patients of a tertiary care hospital. Patients of either sex, with type 2 DM, who were naive to insulin therapy were participating in the study. Patients with type 1 DM, gestational diabetes and patients on long term insulin therapy were excluded from the study.The sample size was 80. Fasting and post prandial quantitative glucagon estimation was done by Sandwich ELISA kit method. OBSERVATION: We observed that mean fasting and postprandial glucagon/ insulin ratio were 104.85 +/- 59.1 and 101.63 +/- 88.0 respectively. Mean Hba1c value was 9.9 +/- 2.41%, mean duration of diabetes was 6.6 +/- 2.5 years and mean age of subjects was 54.4 +/- 9.9 years. Linear regression analysis was conducted, in which both fasting and post prandial glucagon to insulin ratio showed statistically significant correlation with HbA1c (p values 0.018 and 0.029 respectively). CONCLUSION: In this study, we found that patients with a higher glucagon to insulin ratio in both fasting and postprandial state exhibit worse blood glucose levels i.e, higher HbA1c levels. Thus, instead of concentrating on improvement in insulin resistance, a strategy to suppress glucagon together with increasing insulin secretion maybe another key therapeutic option for achieving glycemic control in type 2 diabetic patients in future.

To study the correlation of serum S-100 protein level with the severity of stroke and its prognostic implication.

OBJECTIVE: This study investigated correlation between mortality, stroke subtype and stroke severity with serum S-100 protein level prior to the treatment of the patients admitted to the emergency department and diagnosed with a stroke. METHODS: Pretreatment sample were collected from the patients (n = 142) to determine S-100 protein level, age and sex-matched healthy individuals (n = 40) served as control. All patients had cranial computerized tomography scan/magnetic resonance imaging in the first 24 h. The neurological evaluation was made with the National Institute of Health Stroke Scale (NIHSS) in the acute stage. RESULTS: Compared with controls, S-100 protein level were significantly higher in the stroke groups. In stroke groups, S-100 protein level was more significantly higher in the ischemic group than hemorrhage and transient ischemic attack group and highest in expired patients. CONCLUSION: Serum S-100 protein measurement can be used as an early marker of brain damage. There is a role of S-100 protein as a co-predictor of outcome in patients with acute stroke.