title: Raised plasma insulin level and homeostasis model assessment (HOMA) score in cerebral malaria: evidence for insulin resistance and marker of virulence.
abstract: OBJECTIVE
  To study the glycaemic profile of patients with severe malaria (SM).
  
  
  METHODS
  For this purpose, 110 SM patients were recruited. Pre-treatment random blood glucose and plasma insulin were measured in a subset of donors. An ex-vivo experiment was developed for estimation of glucose consumption by parasitized erythrocytes.
  
  
  RESULTS
  Hyperglycaemia was frequent in SM but more commonly associated with cerebral malaria (CM), while hyperinsulinaemia was recognized in severe-malarial-hypotension (median, 25 %-75 %, 188.2, 93.8-336.8 pmol/L). The plasma insulin level was positively correlated with age (CC = 0.457, p < 0.001) and negatively with parasitaemia (CC = -0.368, p = 0.045). Importantly, fatal-CM was associated with hyperglycaemia (12.22, 6.5-14.6 mmol/L), hyperinsulinaemia (141.0, 54.0-186.8 pmol/L) and elevated homeostasis model assessment (HOMA) values. However, there was a trend of higher glucose consumption by parasites in CM compared with that in uncomplicated malaria (UM).
  
  
  CONCLUSIONS
  Hyperglycaemia, hyperinsulinaemia and elevated HOMA are evidence for insulin resistance and possibly pancreatic B-cell dysfunction in fatal-CM.
authors.affiliation: Malaria Research Centre, Department of Biochemistry, University of Khartoum, Sudan.
authors.forename: Elrashid M
authors.initials: EM
authors.lastname: Eltahir
authors.forename: Gehad
authors.initials: G
authors.lastname: El Ghazali
authors.forename: Thoraya M E
authors.initials: TM
authors.lastname: A-Elgadir
authors.forename: Ishraga E
authors.initials: IE
authors.lastname: A-Elbasit
authors.forename: Mustafa I
authors.initials: MI
authors.lastname: Elbashir
authors.forename: Hayder A
authors.initials: HA
authors.lastname: Giha
mesh_terms: D000293:Adolescent; D000328:Adult; D015415:Biomarkers / Q000097:blood*; D002648:Child; D002675:Child, Preschool; D004912:Erythrocytes / Q000469:parasitology; D005947:Glucose / Q000378:metabolism*; D006706:Homeostasis; D006801:Humans; D007223:Infant; D007328:Insulin / Q000097:blood* / Q000378:metabolism; D007333:Insulin Resistance; D016779:Malaria, Cerebral / Q000097:blood* / Q000469:parasitology*; D008875:Middle Aged; D010963:Plasmodium falciparum / Q000378:metabolism / Q000472:pathogenicity*; D015854:Up-Regulation
chemical_list: D015415:Biomarkers; D007328:Insulin; D005947:Glucose