Katergari S A, Milousis A, Mantatzis M, Gioka T, Tripsianis G, Passadakis P, Prassopoulos P, Papachristou D N
Division of Endocrinology Democritus University of Thrace University Hospital of Alexandroupolis Alexandroupolis, Greece -
Minerva Endocrinol. 2014 Jun;39(2):107-17.
Differences in fat accumulation and distribution might be responsible for the greater insulin resistance (IR) in type 2 diabetes. The study aims at examining the relationship between fat accumulation and distribution, and insulin secretion and action, by multilevel methodological approach.
Thirty-three diabetic men (D), and 28 sex, age and BMI-matched controls (C) were studied for glucose and insulin during OGTT, insulin resistance and sensitivity, employing HOMA and Matsuda index respectively, and, fat accumulation and distribution by anthropometrics, Bioimpendance Analysis (BIA), and multiple slices MRI of abdomen and hip.
D exhibited higher HOMA compared to C (P<0.001), and lower Matsuda index (P=0.062). No differences in fat distribution by anthropometric or MRI measurements were observed; however, fat accumulation by BIA was higher in D (P=0.035). HOMA correlated to basal, AUC, and peak insulin in both groups (all P<0.001); with weight (r=0.415, P=0.031), hip circumference (HC) (r=0.482, P=0.011), %fat (r=0.400, P<0.05) in C; and with weight, BMI, total and %fat, and waist and HC when all subjects were considered as a group. Matsuda inversely correlated with basal, AUC, and peak insulin (all P<0.001), and HC (r=-0.406, P=0.032) in C. HOMA strongest correlated with L3-L4 subcutaneous (r=0.551, P=0.003) in C, and with L3-L4 visceral (r=0.456, P=0.022) in D.
The greater IR in diabetic patients may not be interpreted by differences in fat distribution. IR correlates with different fat compartments in healthy and diabetic subjects of comparable fat distribution, suggesting differences in fat function.
脂肪堆积和分布的差异可能是2型糖尿病中胰岛素抵抗（IR）增强的原因。本研究旨在通过多级方法研究脂肪堆积和分布与胰岛素分泌及作用之间的关系。
对33名糖尿病男性（D组）以及28名性别、年龄和体重指数匹配的对照者（C组）进行口服葡萄糖耐量试验（OGTT）期间的血糖和胰岛素检测，分别采用稳态模型评估法（HOMA）和松田指数评估胰岛素抵抗和敏感性，并通过人体测量学、生物电阻抗分析（BIA）以及腹部和髋部的多层磁共振成像（MRI）评估脂肪堆积和分布情况。
与C组相比，D组的HOMA更高（P<0.001），松田指数更低（P=0.062）。通过人体测量或MRI测量未观察到脂肪分布存在差异；然而，D组通过BIA测得的脂肪堆积更高（P=0.035）。两组中HOMA均与基础胰岛素、曲线下面积（AUC）和胰岛素峰值相关（所有P<0.001）；在C组中与体重（r=0.415，P=0.031）、臀围（HC）（r=0.482，P=0.011）、体脂百分比（r=0.400，P<0.05）相关；当将所有受试者视为一个整体时，与体重、体重指数、总体脂和体脂百分比以及腰围和臀围相关。松田指数与基础胰岛素、AUC和胰岛素峰值呈负相关（所有P<0.001），在C组中与臀围（r=-0.406，P=0.032）呈负相关。在C组中HOMA与L3-L4皮下脂肪相关性最强（r=0.551，P=0.003），在D组中与L3-L4内脏脂肪相关性最强（r=0.456，P=0.022）。
糖尿病患者中较高的IR可能无法用脂肪分布差异来解释。在脂肪分布相当的健康和糖尿病受试者中，IR与不同的脂肪区域相关，提示脂肪功能存在差异。
