Visceral Fat Volume is a Better Predictor of Insulin Resistance than Abdominal Wall Fat Index in Patients with Prediabetes and Type 2 Diabetes Mellitus.

UNLABELLED

Diabetes mellitus is a global pandemic. India, China and USA will be the countries with major diabetic population in the year 2040. Age of onset is a decade earlier in India compared to other European countries. Relative increase in visceral fat vs. subcutaneous fat in Asians and Asian Indians may explain the greater prevalence of metabolic syndrome in those population than in African American men, in whom Subcutaneous fat predominates. It is possible that visceral fat is a marker for excess postprandial free fatty acids in obesity, which is an early major contributor to the development of insulin resistance. Present study attempts to compare and co-relate the association of visceral fat and abdominal wall fat index to Insulin resistance in patients suffering from T2DM and prediabetes. Material and Objectives: To study the relationship between insulin resistance (HOMA-IR) and abdominal wall fat index (AFI) in Prediabetes and type II Diabetes Mellitus patients. To compare the visceral fat volume (VFV) with abdominal wall fat index in relation to insulin resistance in same subset of patients.

METHOD

Cross sectional, observational study in 75 subjects (25 T2DM, 25 Prediabetes, 25 Controls). Detailed history including physical examination was performed. Patients were subjected to these investigations; FBS, HbA1C, S. Fasting Insulin levels, Lipid Profile, USG Abdomen to assess Visceral Fat Volume and Abdominal Wall Fat Index. Data were collected and analysed.

OBSERVATION

Mean age of T2DM & prediabetes subjects was a decade higher than controls (T2DM 53 ±11.62 years, Prediabetes 55.76±11.97 years, Controls 45.72±10.42 years). Mean Systolic BP in T2DM subjects was 138.56±14.69, subjects with Prediabetes were 139.2±19.63 which is higher (p 0.02) compared to Controls(128±8.26). Average fasting serum insulin levels (mu/ml) of three groups; for T2DM: 25.41±13.7, for Prediabetes: 8.76 ±2.55, Controls: 6.07±2.55. The highest levels were in patients with T2DM, when compared to Prediabetes and controls. There was significant difference in the value of HOMA-IR, AFI, and the parameters of VFV (length between interior of abdominal muscle and splenic vein, length between interior of abdominal muscle and posterior wall of Aorta, Fat thickness of posterior renal wall) p<0.05. A significant correlation between HOMA-IR levels and VFV was found with a p value of <0.05.

CONCLUSION

VFV acted as an independent marker in predicting Insulin resistance in subjects with prediabetes and T2DM. Fasting Insulin levels were highest in T2DM group amongst all three groups reflecting inadequate response of the body to appropriate levels of Insulin.