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University of Texas Health Science Center and Texas Diabetes Institute, San Antonio, Texas 78229-3900
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 · min1)
with [3-3H]glucose. SSF, DSF, and VF areas were
quantitated with magnetic resonance imaging at the
L4-5 level. Basal endogenous glucose production (EGP),
hepatic insulin resistance index (basal EGP × 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 cm2) 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.
visceral fat; deep and superficial subcutaneous fat
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