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Articles in PresS, published online ahead of print August 13, 2002
Am J Physiol Endocrinol Metab, 10.1152/ajpendo.0327.2001
Submitted on July 19, 2001
Accepted on August 1, 2002
1 Diabetes Division, University of Texas Health Science Center, San Antonio, TX, USA
* To whom correspondence should be addressed. E-mail: albarado{at}uthscsa.edu.
A recent study has suggested that deep subcutaneous fat tissue is a strong predictor of insulin resistance in non-diabetic individuals. In the present study we have examined the relationship between peripheral (muscle)/hepatic sensitivity to insulin and deep subcutaneous fat, superficial subcutaneous fat, and intraabdominal visceral fat in male and female patients with type 2 diabetes mellitus. Sixty-two type 2 diabetic patients (M/F=36/26, age=55±3 y, BMI=30±1 kg/m2) underwent a 2-step euglycemic insulin clamp (insulin infusion rates: 40 and 160 mU/m2.min) with 3-3H-glucose. Total subcutaneous, superficial subcutaneous, deep subcutaneous, and intraabdominal visceral fat areas were quantitated with magnetic resonance imaging at the level of L4-5. Basal endogenous glucose production (EGP), the product of basal EGP and fasting plasma insulin concentration (an index of hepatic insulin resistance), and total body glucose disposal (TGD) during the 1st and 2nd insulin clamp steps were similar in male and female subjects. Intraabdominal visceral fat area (VF: 159±9 vs 143±9 cm2) and deep subcutaneous fat area (DSF: 199±14 vs 200±15 cm2) were not significantly different in male and female subjects. However, superficial subcutaneous fat area (SSF: 104±8 vs 223±15 cm2) was significantly greater (p<0.0001) in female compared to male subjects despite a similar body mass index (31±1 vs 30±1 kg/m2) and similar total body fat mass (31±2 vs 33±2 kg; measured by 3H2O). In male type 2 diabetic subjects, TGD during the 1st 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 female type 2 diabetic subjects, 1st TGD (r=-0.45, p<0.05) and the hepatic insulin resistance index (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 the type 2 diabetic patients. In male, but not in female, type 2 diabetic subjects deep subcutaneous adipose tissue also is associated with peripheral and hepatic insulin resistance.
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