Associations Between Adipose Tissue Distribution And Glycemic Control And Vascular Complications In Type 2 Diabetic Patients

Aim: Previous research has revealed the important role of abdominal adipose tissue in affecting lipid,glucose metabolism,onset of type 2 diabetes(T2DM)and cardiovascular diseases(CVD).However,it remains unclear whether it plays a role in the progression of type 2 diabetes and its complications.Therefore,this study aimed to investigate the associations of waist-hip ratio(WHR)with risks of poor glycemic control,micro-and macro-vascular complications in Chinese type 2 diabetic patients.Methods: The study included T2 DM patients either previously diagnosed by questionnaire or newly diagnosed with fasting plasma glucose(FPG)≥ 7.0 mmol/L and/or 2 hour postprandial glucose(2h PG)≥ 11.1 mmol/L from residents older than 40 years from Jiading Community,Shanghai,China(N = 10,375).Personal information,life style and disease history were collected using standard protocols.Each participant had undergone anthropometric measurements,blood and urine test,oral glucose tolerance test,and vascular function tests including carotid intima-media thickness(CIMT),brachial-ankle pulse wave velocity(baPWV),ankle-brachial index(ABI)as well as carotid plaque.Ten-year cardiovascular risk was calculated using risk scores by American Heart Association(ASCVD risk score)and Framingham cohort risk score.Results: Each quartile increase in WHR was significantly associated with increased fasting plasma glucose(FPG ≥ 7.0 mmol/L)(OR [95% CI]: 1.13 [1.03 – 1.25]),HbA1c(HbA1c ≥ 7.0%)(1.20 [1.08 – 1.33])and HOMA-IR(HOMA-IR ≥ 2.5)(1.25 [1.12 – 1.40])after multivariate adjustments.A non-significant association was seen for elevated 2-hour postprandial glucose(1.12 [0.96 – 1.29]).Sex interactions with WHR were also found in associations with risks for higher HbA1c(P = 0.016)and HOMA-IR(P = 0.044).The physical activity level was also significantly interacted with WHR in the risk for higher insulin resistance(P = 0.006).In diabetic micro-vascular complications,the risk for albuminuria(UACR ≥ 10.18 mg/g)was also associated with higher WHR even after adjustment for HbA1c(1.13 [1.02 – 1.26]).No significant relationship was seen between WHR and eGFR decline.Sex interaction with WHR was also found in risk of albuminuria where men were more susceptible for having albuminuria compared to women having similar WHR(P = 0.005).In diabetic macro-vascular complications,WHR has no significant relations with risks of increased CIMT,abnormal ABI,increased baPWV or carotid plaques.However,WHR has significant relations with ten-year cardiovascular disease risks(ASCVD high risk: 1.17 [1.05 – 1.31];Framingham high risk: 1.13 [1.00 – 1.29]).Conclusions: In Chinese type 2 diabetic patients,abdominal adipose tissue has an independent role in risks of poor glycemic control,albuminuria,as well as high risk for ten-year cardiovascular diseases.However it has no relations with impaired kidney function,increased CIMT,abnormal ABI,increased baPWV,or carotid plaque.Interventions aiming to reduce abdominal adipose tissue may have additional benefits to lower risks of poor glycemic control,albuminuria as well as cardiovascular diseases for diabetic patients.