| Background and ObjectiveWith the development of the society,type 2 diabetes mellitus incidence increased year by year,according to the international diabetes federation globally in 2017 diabetic patients according to the survey about 451 million,will reach 693 million by 2045.In an observational study of 28 countries in Asia,Africa,South America and Europe,about half of those with type 2 diabetes developed microvascular complications and about 27 percent developed macrovascular complications.Diabetes and its complications pose a great threat to global health and a huge economic burden on families and societies.Studies have shown that abdominal obesity(central obesity)is associated with a variety of metabolic diseases,such as insulin resistance,metabolic syndrome,T2DM,and cardiovascular disease.In general,the risk of metabolic disease is proportional to the amount of total body fat,but studies have shown that accumulation of fat in the upper body or trunk regions(especially the abdomen)is more likely to cause metabolic diseases such as insulin resistance,and less likely to cause metabolic disorders in the limbs or other areas.Obesity is characterized by excessive accumulation of fat,including visceral fat and subcutaneous fat.Although subcutaneous fat is the main part of the body to store lipid,its storage capacity is limited.When excess body fat exceeds the storage capacity of subcutaneous fat,lipids are deposited in ectopic adipose tissue,such as the liver,heart,skeletal muscle,and visceral adipose tissue.The metabolic characteristics of fat tissue in different regions are different,so understanding the regional distribution of fat tissue is an important part of the study of metabolic diseases,which is conducive to correctly understanding the characteristics of fat redistribution under pathological conditions.Body mass index(BMI)and waist circumference are clinically easy to measure and are often used as an assessment of obesity,but they are limited because they reflect overall abdominal fat.QCT is the gold standard for measuring abdominal fat distribution,with high resolution,accurate positioning and quantification,high repeatability,safety and convenience.Currently,there are few studies on the distribution of abdominal fat and the complications of diabetes.Are T2DM patients more likely to have complications with higher abdominal fat?Therefore,this paper measured abdominal fat by quantitative CT(QCT),and analyzed the correlation between the distribution of abdominal fat,glucose and lipid metabolism and diabetes complications in T2DM patients.Object and MethodMedical records of 369 T2DM patients hospitalized in the department of endocrinology of the first affiliated hospital of Zhengzhou university from August 2018 to October 2019 with quantitative CT were collected for analysis.All the research objects in lung CT examination at the same time line of the lumbar spine QCT determination of L2/L3 levels of visceral adipose tissue(VAT),subcutaneous adipose tissue(SAT),and bone mineral density.According to the value of VAT,it was divided into T1 group(VAT<155.8cm),T2 group(155.8cm ≤VAT<216.4cm)and T3 group(VAT≥ 216.4cm)by the quantile method.Meanwhile,clinical test results of all subjects were collected.Including fasting plasma glucose(FPG),fasting C peptide(FCP),glycosylated hemoglobin(HbAlc),blood total cholesterol(TC),triglyceride(TG),high density lipoprotein cholesterol(HDL-C)and low density lipoprotein cholesterol(LDL-C).Since the included patients may use insulin to control blood glucose,c-peptide was used instead of insulin to evaluate the function of pancreatic islet cells.Among them,318 patients with T2DM were tested for oral glucose tolerance and c-peptide release.Blood samples were taken at 0,30,60,120 and 180min to determine blood glucose and plasma c-peptide levels.The modified HOMA formula was used to evaluate insulin resistance and islet cell function.HOMA-IR=1.5+FPG*FC-P/2800,HOMA-β=0.27*FC-P/(FPG-3.5),GLUAuc=1/4(FPG+2*PG30+3*PG60+4*PG120+2*PG180),C-PAUC=1/4(FC-P+2*C-P30+3*C-P60+4*C-P120+2*C-P180).Diabetic kidney disease(DKD),diabetic retinopathy(DR),diabetic peripheral neuropathy(DPN),peripheral atherosclerosis(PAS)and Cardiovascular and cerebrovascular disease(CCVD)were assessed in all subjects.ResultsBoth the male and BMI of T2 and T3 groups were higher than that of T1 group,and T3 group was higher than that of T2 group(P<0.05).Age,systolic and diastolic blood pressure in the T2 and T3 groups were all higher than that in the T1 group(P<0.05),while there was no statistically significant difference between the T2 and T3 groups(P>0.05).There was no significant difference in disease course between the three groups(P>0.05).HbA1c in T1 group was higher than that in T3 group(P<0.05),while there was no statistically significant difference between T1 group and T2 group,T2 group and T3 group(P>0.05).GLUZUC and HDL-C in T1 group were higher than those in T2 and T3 group(P<0.05),but there was no statistically significant difference between T2 and T3 groups(P>0.05).TG in T2 and T3 groups was higher than that in group T1(P<0.05),but there was no statistically significant difference between groups T2 and T3(P>0.05).HOMA-IR and HOMA-β in T2 and T3 groups were all higher than that in T1 group,and T3 group was higher than that in T2 group(P<0.05).Both FC-P and C-PAUC in T3 group were higher than those in T1 and T2 group(P<0.05),but the difference between T1 and T2 group was not statistically significant(P>0.05).There was no significant difference in FBG,TC and LDL-C between the three groups(P>0.05).Bone mineral density in T1 group was higher than that in T3 group(P<0.05),while there was no statistically significant difference between T1 group,T2 group,T2 group and T3 group(P>0.05).With the increase of VAT quantile,the proportion of diabetic nephropathy also increased significantly(P<0.05),while there was no significant difference in the proportion of diabetic retinopathy,peripheral neuropathy,peripheral atherosclerosis,and cardiovascular and cerebrovascular diseases(P>0.05).VAT and SAT were positively correlated with BMI,FC-P,C-PAUC,HOMA-IR and HOMA-β(P<0.05),VAT was positively correlated with age,systolic blood pressure,diastolic blood pressure and TG(P<0.05),and negatively correlated with HbAlc,GLUAUC,HDL-C and bone mineral density(P<0.05),and SAT was positively correlated with TC and LDL-C(P<0.05).VAT was positively correlated with 24h urinary albumin and diabetic nephropathy(P<0.05),and negatively correlated with glomerular filtration rate(P<0.05).Multiple linear regression analysis of HOMA-IR and various influencing factors showed that the course of disease and VAT had statistically significant effects on HOMA-IR(P<0.05),while SBP,DBP,SAT,TC,TG,HDL-C and LDL-C had no statistically significant effects on HOMA-IR(P>0.05).Logistic regression analysis of diabetic nephropathy showed that age,BMI,SBP,FPG and VAT were all influencing factors of diabetic nephropathy.After further adjustment for the above confounding factors,VAT was still a risk factor for the development of diabetic nephropathy(OR=1.006,P=0.009).VAT and SAT were not the influencing factors of diabetic retinopathy,peripheral neuropathy,peripheral atherosclerosis and cardiovascular and cerebrovascular diseases.ConclusionThe increase of VAT and SAT is the influencing factor of insulin resistance and blood lipid,while VAT is the main risk factor of insulin resistance.VAT is a risk factor for diabetic nephropathy in patients with type 2 diabetes,while VAT and SAT are not influential factors for diabetic retinopathy,peripheral neuropathy,peripheral atherosclerosis and cardiovascular and cerebrovascular diseases. |
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