Miyazaki Yoshinori, Glass Leonard, Triplitt Curtis, Wajcberg Estela, Mandarino Lawrence J, DeFronzo Ralph A
University of Texas Health Science Center and Texas Diabetes Institute, San Antonio, Texas 78229-3900, USA.
Am J Physiol Endocrinol Metab. 2002 Dec;283(6):E1135-43. doi: 10.1152/ajpendo.0327.2001.
We examined the relationship between peripheral/hepatic insulin sensitivity and abdominal superficial/deep subcutaneous fat (SSF/DSF) and intra-abdominal visceral fat (VF) in patients with type 2 diabetes mellitus (T2DM). Sixty-two T2DM patients (36 males and 26 females, age = 55 +/- 3 yr, body mass index = 30 +/- 1 kg/m2) underwent a two-step euglycemic insulin clamp (40 and 160 mU. m(-2). min(-1)) with [3-3H]glucose. SSF, DSF, and VF areas were quantitated with magnetic resonance imaging at the L(4-5) level. Basal endogenous glucose production (EGP), hepatic insulin resistance index (basal EGP x FPI), and total glucose disposal (TGD) during the first and second insulin clamp steps were similar in male and female subjects. VF (159 +/- 9 vs. 143 +/- 9 cm2) and DSF (199 +/- 14 vs. 200 +/- 15 cm(2)) were not different in male and female subjects. SSF (104 +/- 8 vs. 223 +/- 15 cm2) was greater (P < 0.0001) in female vs. male subjects despite similar body mass index (31 +/- 1 vs. 30 +/- 1 kg/m2) and total body fat mass (31 +/- 2 vs. 33 +/- 2 kg). In male T2DM, TGD during the first insulin clamp step (1st TGD) correlated inversely with VF (r = -0.45, P < 0.01), DSF (r = -0.46, P < 0.01), and SSF (r = -0.39, P < 0.05). In males, VF (r = 0.37, P < 0.05), DSF (r = 0.49, P < 0.01), and SSF (r = 0.33, P < 0.05) were correlated positively with hepatic insulin resistance. In females, the first TGD (r = -0.45, P < 0.05) and hepatic insulin resistance (r = 0.49, P < 0.05) correlated with VF but not with DSF, SSF, or total subcutaneous fat area. We conclude that visceral adiposity is associated with both peripheral and hepatic insulin resistance, independent of gender, in T2DM. In male but not female T2DM, deep subcutaneous adipose tissue also is associated with peripheral and hepatic insulin resistance.
我们研究了2型糖尿病（T2DM）患者外周/肝脏胰岛素敏感性与腹部浅表/深部皮下脂肪（SSF/DSF）及腹内内脏脂肪（VF）之间的关系。62例T2DM患者（36例男性和26例女性，年龄 = 55±3岁，体重指数 = 30±1kg/m²）接受了两步正常血糖胰岛素钳夹试验（40和160mU·m⁻²·min⁻¹），同时输注[3-³H]葡萄糖。在L(4 - 5)水平通过磁共振成像对SSF、DSF和VF面积进行定量分析。男性和女性受试者在首次和第二次胰岛素钳夹步骤期间的基础内源性葡萄糖生成（EGP）、肝脏胰岛素抵抗指数（基础EGP×空腹血糖胰岛素比）和总葡萄糖处置（TGD）相似。男性和女性受试者的VF（159±9 vs. 143±9cm²）和DSF（199±14 vs. 200±15cm²）无差异。尽管体重指数（31±1 vs. 30±1kg/m²）和总体脂肪量（31±2 vs. 33±2kg）相似，但女性受试者的SSF（104±8 vs. 223±15cm²）大于男性（P < 0.0001）。在男性T2DM患者中，首次胰岛素钳夹步骤期间的TGD（1st TGD）与VF（r = -0.45，P < 0.01）、DSF（r = -0.46，P < 0.01）和SSF（r = -0.39，P < 0.05）呈负相关。在男性中，VF（r = 0.37，P < 0.05）、DSF（r = 0.49，P < 0.01）和SSF（r = 0.33，P < 0.05）与肝脏胰岛素抵抗呈正相关。在女性中，首次TGD（r = -0.45，P < 0.05）和肝脏胰岛素抵抗（r = 0.49，P < 0.05）与VF相关，但与DSF、SSF或总皮下脂肪面积无关。我们得出结论，在T2DM中，内脏肥胖与外周和肝脏胰岛素抵抗相关，且与性别无关。在男性而非女性T2DM患者中，深部皮下脂肪组织也与外周和肝脏胰岛素抵抗相关。
