Glucagon Resistance in Individuals With Obesity and Hepatic Steatosis Can Be Measured Using the GLUSENTIC Test and Index
Sasha A. S. Kjeldsen, Michael M. Richter, Nicole Jacqueline Jensen, Malin Nilsson, Niklas Heinz, Janus Damm Nybing, Frederik H. Linden, Erik Høgh‐Schmidt, Mikael Boesen, Thomas Levin Andersen, Helle Hjorth Johannesen, Samuel A.J. Trammell, Trisha J. Grevengoed, Sten Madsbad, Hendrik Vilstrup, Frank Vinholt Schiødt, Andreas Buch Møller, Elias B. Rashu, Kirsten Nørgaard, Signe Schmidt, Lise Lotte Gluud, Steen B. Haugaard, Jens J. Holst, Jørgen Rungby, Nicolai J. Wewer Albrechtsen
Abstract
Increased plasma levels of glucagon (hyperglucagonemia) promote diabetes development but are also observed in patients with metabolic dysfunction-associated steatotic liver disease (MASLD). This may reflect hepatic glucagon resistance toward amino acid catabolism. A clinical test for measuring glucagon resistance has not been validated. We evaluated our glucagon sensitivity (GLUSENTIC) test, which consists of 2 study days: a glucagon injection and measurements of plasma amino acids and an infusion of mixed amino acids and subsequent calculation of the GLUSENTIC index (primary outcome measure) from measurements of glucagon and amino acids. To distinguish glucagon-dependent from insulin-dependent actions on amino acid metabolism, we also studied patients with type 1 diabetes (T1D). The δ-decline in total amino acids was 49% lower in MASLD following exogenous glucagon (P = 0.01), and the calculated GLUSENTIC index was 34% lower in MASLD (P < 0.0001) but not T1D (P > 0.99). In contrast, glucagon-induced glucose increments were similar in control participants and participants with MASLD (P = 0.41). The GLUSENTIC test and index may be used to measure glucagon resistance in individuals with obesity and MASLD.