• Swaminathan Selvanayagam Apollo Speciality Hospitals
  • Gandhi M
  • Arivazhagan R
  • Sangeetha R


Objectives: To evaluate new diabetic control monitoring parameters insulin, ghrelin, body mass index, waist-to-hip ratio, homeostasis model assessment-insulin resistance (HOMA-IR), and HOMA-β for Type 2 diabetes mellitus (T2DM) with obesity and to compare them with the existing diabetic control markers plasma glucose and glycosylated hemoglobin (HbA1c) and to recommended these additional tests to assess complications associated with kidney, liver, cardiac, and pancreas.

Methods: A total of 100 T2DM patients with obesity who attended the sugar clinic attached to Apollo Speciality Hospitals, Vanagaram and who were on standard treatment and 50 age and sex matched controls attending the routine master health check in the same hospital were enrolled for the study. Fully automated analyzers and reagents and controls were used for all assays to ensure validity of the results obtained. For insulin and ghrelin assays, established commercial kits were used and all other parameters were calculated using formulae established previously. Graphpad online calculator was used to calculate t and p values.

esults: The results obtained for both controls and patients for the set of additional parameters were compared with fasting plasma glucose (FPG), post prandial plasma glucose (PPPG), and HbA1c between controls, patients and controls with patients by calculating r and p values. Highly significant correlations were obtained in all comparisons.

Conclusions: Very good associations (p<0.0001) were found between FPG, PPPG, and HbA1c to each of the new parameters for controls, patients and between controls and patients. These additional parameters may be done at fixed intervals of time to evaluate kidney, liver, cardiac and pancreatic complications/dysfunction in T2DM patients with obesity.

Keywords: Diabetes mellitus, Glycosylated hemoglobin, Plasma glucose, Waist-to-hip ratio, Body mass index, Homeostasis model assessment-insulin resistance, Homeostasis model assessment-β.

Author Biography

Swaminathan Selvanayagam, Apollo Speciality Hospitals
Sr Consultant and Head


1. International Diabetes Federation. Diabetes Atlas. 6th ed. Brussels, Belgium: International Diabetes Federation; 2013.
2. Marjaani A. Alteration of waist circumference, body mass index, hip circumference and waist-to-hip ratio in Type 2 diabetes patients. J Clin Diagn Res 2011;5(2):201-5.
3. Ibrahim R. Diabetes mellitus Type II review of oral treatment options. Int J Pharm Pharm Sci 2010;2 Suppl 1:21-30.
4. Horvath TL, Castañeda T, Tang-Christensen M, Pagotto U, Tschöp MH. Ghrelin as a potential anti-obesity target. Curr Pharm Des 2003;9(17):1383-95.
5. Seyoum B, Fite A, Abou-Samra A. Sitagliptin suppresses active ghrelin in patients with diabetes. J Diabetes Metab 2011;2:9.
6. AlHakeim H, Ali MM. Low ghrelin level is associated with poor control and bad prognosis parameters in obese diabetic patients. J Diabetol 2012;1:5.
7. Goldstein DE, Little RR. More than you ever wanted to know (but need to know) about glycohemoglobin testing. Diabetes Care 1994;17(8):938-9.
8. Gerich JE, Schneider V, Dippe SE, Langlois M, Noacco C, Karam JH, et al. Characterization of the glucagon response to hypoglycemia in man. J Clin Endocrinol Metab 1974;38(1):77-82.
9. Cryer PE. Glucose homeostasis and hypoglycaemia. In: Wilson JD, Foster DW, editors. William’s Textbook of Endocrinology. Philadelphia, PA: W. B. Saunders Company; 1992. p. 1223-53.
10. Haghighaptpnah M, Thunga G, Khare S, Mallayasamy S. Correlation of glycosylated haemoglobin levels with fasting and post prandial glucose in south Indian Type 2 diabetic patients. Int J Pharm Pharm Sci 2016;8(8):285-8.
11. Heppner KM, Tong J. Mechanisms in endocrinology: Regulation of glucose metabolism by the ghrelin system: Multiple players and multiple actions. Eur J Endocrinol 2014;171(1):R21-32.
12. Sharifi F, Yamini M, Esmaeilzadeh A, Mousavinasab N, Shajari Z. Acylated ghrelin and leptin concentrations in patients with Type 2 diabetes mellitus, people with prediabetes and first degree relatives of patients with diabetes, a comparative study. J Diabetes Metab Disord 2013;12(1):51.
13. Mohd-Radzman NH, Ismail WI, Adam Z, Jaapar SS, Adam A. Potential roles of Stevia rebaudiana Bertoni in abrogating insulin resistance and diabetes: A review. Evid Based Complement Alternat Med 2013;2013:718049.
14. Bahrmann A, Abel A, Zeyfang A, Petrak F, Kubiak T, Hummel J, et al. Psychological insulin resistance in geriatric patients with diabetes mellitus. Patient Educ Couns 2014;94(3):417-22.
15. Wallace TM, Levy JC, Matthews DR. Use and abuse of HOMA modeling. Diabetes Care 2004;27(6):1487-95.
16. Arafat M, Salam A, Arafat O. The association of Type 2 diabetes with obesity and other factors in multinational community. Int J Pharm Pharm Sci 2014:6(9):257-60.
17. Lotfi MH, Saadati1 H, Afzali M. Association between anthropometric parameters (WC, BMI, WHR) and Type 2 diabetes in the adult Yazd population, Iran. J Diabetes Metab 2014;5:10.
18. Schmidt MI, Duncan BB, Canani LH, Karohl C, Chambless L. Association of waist-hip ratio with diabetes mellitus. Strength and possible modifiers. Diabetes Care 1992;15(7):912-4.
19. Hu FB, Manson JE, Stampfer MJ, Colditz G, Liu S, Solomon CG, et al. Diet, lifestyle, and the risk of Type 2 diabetes mellitus in women. N Engl J Med 2001;345(11):790-7.
20. World Health Organization. 2006 Obesity: Preventing and Managing the Global Epidemic, Report of WHO Consultation on Obesity. 3-5 June, 1997. Geneva: WHO; 1998.
21. Clinical guidelines on the identification, evaluation, and treatment of overweight and obesity in adults – The evidence report. National Institutes of Health. Obes Res 1998;6 Suppl 2:51S-209.
22. Song Y, Manson JE, Tinker L, Howard BV, Kuller LH, Nathan L, et al. Insulin sensitivity and insulin secretion determined by homeostasis model assessment and risk of diabetes in a multiethnic cohort of women: The Women’s Health Initiative Observational Study. Diabetes Care 2007;30(7):1747-52.
307 Views | 216 Downloads
How to Cite
Selvanayagam, S., G. M, A. R, and S. R. “ASSOCIATION BETWEEN INSULIN,GHRELIN, HOMA-IR, HOMA-β, WHR AND BMI TO PLASMA GLUCOSE AND HbA1C AND ITS CLINICAL USEFULNESS IN T2DM PATIENTS WITH OBESITY”. Asian Journal of Pharmaceutical and Clinical Research, Vol. 10, no. 4, Apr. 2017, pp. 287-91, doi:10.22159/ajpcr.2017.v10i4.16727.
Original Article(s)