| Objective:Diabetes is receiving increasing attention worldwide.Overweight/obesity is the major risk factor for type 2 diabetes(T2DM)and insulin resistance(IR).Obesity involves not only the increase of subcutaneous fat deposition,but also the accumulation of visceral fat.Body mass index(BMI)is widely used to evaluate the degree of obesity in the Body,but with the increasing awareness of obesity,visceral fat has gradually attracted attention.Visceral fat surrounds the internal organs and mainly exists in the abdominal cavity.visceral fat accumulation is closely associated with the occurrence and development of type 2 diabetes.This study aims to compare the differences in general clinical data of type 2 diabetes patients with different BMI and visceral fat content,and to explore the correlation between BMI,visceral fat content and insulin resistance,pancreaticβ-cell secretory function in patients with type 2 diabetes,and to explore the effect of BMI and visceral fat area(VFA)on the evaluation of insulin resistance in patients with type 2 diabetes,and to provide a simpler method for preliminary assessment of insulin resistance in type 2 diabetes patients.Methods:A total of 359 patients with type 2 diabetes who were admitted to the Department of Endocrinology of Chengde Central Hospital from November2019 to August 2020 were sequentially collected.According to the BMI level,the patients were divided into three groups:normal weight group(18.5kg/m~2≤BMI<24.0kg/m~2,n=101),overweightgroup(24.0kg/m~2≤BMI<28.0kg/m~2,n=165),and obesity group(BMI≥28.0kg/m~2,n=93).According to the area of visceral fat,the patients were divided into two groups:visceral obesity group(VFA≥100cm~2,n=170)and non-visceral obesity group(VFA<100cm~2,n=189).Rrecording the general clinical data:name,gender,age,height,weight,BMI,course of diabetes,smoking history,history of basic diseases(history of hypertension,cardiovascular and cerebrovascular diseases),systolic blood pressure(SBP),diastolic blood pressure(DBP),resting heart rate,and the relevant laboratory inspection indicators:fasting venous blood glucose(FPG),fasting C peptide(FCP),glycosylated hemoglobin(Hb A1c),blood uric acid(UA),blood creatinine(CR),triglycerides(TG),cholesterol(TC),high-density lipoprotein Cholesterol(HDL-C),low-density lipoprotein cholesterol(LDL-C),cystatin C(Cys-c),digestive ultrasound.The bioelectrical impedance analysis method was used to measure the visceral fat area(VFA)and subcutaneous fat area(SFA)of the patient.The modified HOMA model was used to calculate the patient’s insulin resistance index(HOMA-IR)and insulin secretion index(HOMA-β).SPSS26.0 statistical software was used to analyze the data,and the differences among the indicators were compared.Spearman correlation analysis was used to evaluate the correlation between the indicators.ROC curve was used to evaluate the diagnostic value of BMI and VFA for the degree of insulin resistance in patients with type 2 diabetes,and find the best diagnostic threshold,P<0.05 was considered statistically significant.Results:1.Comparison of clinical data of patients in different BMI groupsThere were 101 patients in the normal weight group(51 males and 50females),165 patients in the overweight group(93 males and 72 females),and 93 patients in the obesity group(59 males and 34 females).There were statistically significant differences in SBP,DBP,HDL-C,VFA,SFA,VFA/SFA,FCP,HOMA-IR,HOMA-β,hypertension,and non-alcoholic fatty liver between normal weight group and overweight group(P<0.05),There were statistically significant differences in SBP,DBP,FPG,TG,HDL-C,UA,VFA,SFA,VFA/SFA,FCP,HOMA-IR,Cys-c,hypertension,and non-alcoholic fatty liver between the normal weight group and the obesity group(P<0.05).There were statistically significant differences in DBP,FPG,TG,VFA,SFA,VFA/SFA,HOMA-IR,and HOMA-βbetween the overweight group and obesity group(P<0.05).There were no significant differences in gender,age,duration of diabetes,resting heart rate,Hb A1c,TC,LDL-C and 25(OH)D among the three groups(P>0.05).2.Comparison of clinical data of patients in different VFA groupsThere were 189 patients in the non-visceral obesity group(93 males and96 females),and 170 patients in the visceral obesity group(110 males and 60females).There were statistically significant differences in SBP,DBP,TG,HDL-C,TG/HDL-C,UA,VFA,SFA,Cys-c,FCP,and HOMA-IR,HOMA-β,hypertension,non-alcoholic fatty liver between the two groups(P<0.05).There were no significant differences in age,gender,course of disease,resting heart rate,FPG,Hb A1C,TC,LDL-C,LDL-C/HDL-C,25(OH)D between the two groups(P>0.05).3.Correlation analysis of BMI,VFA,SFA,VFA/SFA with HOMA-IR and HOMA-βin patients with type 2 diabetesSpearman correlation analysis showed that BMI(r=0.375,P<0.001),VFA(r=0.453,P<0.001),SFA(r=0.350,P<0.001),VFA/SFA(r=0.271,P<0.001)were positively correlated with HOMA-IR.VFA/SFA(r=0.118,P=0.025)was correlated with HOMA-β,while BMI,VFA,SFA were not significantly correlated with HOMA-β.4.The diagnostic value of BMI and VFA for insulin resistance in type 2diabetes patientsThe area under the ROC curve for VFA to assess insulin resistance in type 2 diabetic patients was 0.781(95%CI:0.668-0.790,P<0.01),and the best cut point was 82.5cm~2(sensitivity was 73.8%,specificity was 63.5)%);The area under the ROC curve for BMI to assess the degree of insulin resistance in type 2 diabetic patients was 0.679(95%CI:0.615-0.744,P<0.01),and the best cut point was 24.8kg/m~2(the sensitivity was 77.9%,and the specificity was 54.2%).Conclusion:1.BMI and VFA were positively correlated with insulin resistance in patients with type 2 diabetes.VFA/SFA was correlated with the secretory function of isletβcells.2.BMI and VFA can be used to initially evaluate the degree of insulin resistance in patients with type 2 diabetes,and VFA is of higher diagnostic value.3.Patients with type 2 diabetes combined with weight gain,especially increased visceral fat content,are more likely to have hypertension,hyperlipidemia and other metabolic disorders. |
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