Analysis of the Correlation Between Visceral Fat Area and Insulin Resistance in Patients with Type 2 Diabetes and Abdominal Obesity

Objective: To analyze the correlation between visceral fat area and insulin resistance index (HOMA-IR) in patients with type 2 diabetes mellitus (T2DM) and abdominal obesity and to provide a reference for screening and related research of such patients. Methods: Two hundred patients with T2DM admitted to Guandu People’s Hospital of Kunming were included. The study was carried out from October 2022 to December 2023. The patients were divided into three groups according to different abdominal visceral fat areas (VFA): Group A (n = 65) was less than 75cm2, Group B (n = 75) was 75-100 cm2, and Group C (n = 60) was greater than 100 cm2. The subjects in the three groups were all tested for glycated hemoglobin (HbA1c), fasting insulin (FINS), and fasting blood glucose (FPG). Height and weight were measured to calculate body mass index (BMI). The HOMA-IR and TYG (fasting triglyceride and glycemic index) were also calculated. Changes in the BMI, VFA, HOMA-IR, and TYG levels were observed in the three groups. Results: The VFA, BMI, HbA1c, FPG, FINS, HOMA-IR, and TYG of the patients all increased, with a more significant increase in the BMI, FINS, HOMA-IR, and TYG levels (P < 0.01). Multiple linear stepwise regression analyses used visceral fat area (VFA) as the dependent variable. The results showed that VFA was closely related to BMI, FINS, HOMA-IR, and TYG. Conclusion: Early reduction of VFA to reduce insulin resistance may be a better treatment and effective method for T2DM, providing powerful measures and new strategies for effective blood sugar control and early prevention in the treatment of metabolic diseases.

Effects of vitamin D supplementation on glucose and lipid metabolism in patients with type 2 diabetes mellitus and risk factors for insulin resistance

BACKGROUND Type 2 diabetes mellitus(T2DM)is a chronic metabolic disease featured by insulin resistance(IR)and decreased insulin secretion.Currently,vitamin D deficiency is found in most patients with T2DM,but the relationship between vitamin D and IR in T2DM patients requires further investigation.AIM To explore the risk factors of IR and the effects of vitamin D supplementation on glucose and lipid metabolism in patients with T2DM.METHODS Clinical data of 162 T2DM patients treated in First Affiliated Hospital of Harbin Medical University between January 2019 and February 2022 were retrospectively analyzed.Based on the diagnostic criteria of IR,the patients were divided into a resistance group(n=100)and a non-resistance group(n=62).Subsequently,patients in the resistance group were subdivided to a conventional group(n=44)or a joint group(n=56)according to the treatment regimens.Logistic regression was carried out to analyze the risk factors of IR in T2DM patients.The changes in glucose and lipid metabolism indexes in T2DM patients with vitamin D deficiency were evaluated after the treatment.RESULTS Notable differences were observed in age and body mass index(BMI)between the resistance group and the non-resistance group(both P<0.05).The resistance group exhibited a lower 25-hydroxyvitamin D_(3)(25(OH)D_(3))level,as well as notably higher levels of 2-h postprandial blood glucose(2hPG),fasting blood glucose(FBG),and glycosylated hemoglobin(HbA1c)than the non-resistance group(all P<0.0001).Additionally,the resistance group demonstrated a higher triglyceride(TG)level but a lower high-density lipoprotein-cholesterol(HDL-C)level than the non-resistance group(all P<0.0001).The BMI,TG,HDL-C,25(OH)D_(3),2hPG,and HbA1c were found to be risk factors of IR.Moreover,the posttreatment changes in levels of 25(OH)D_(3),2hPG,FBG and HbA1c,as well as TG,total cholesterol,and HDL-C in the joint group were more significant than those in the conventional group(all P<0.05).CONCLUSION Patients with IR exhibit significant abnormalities in glucose and lipid metabolism parameters compared to the noninsulin resistant group.Logistic regression analysis revealed that 25(OH)D_(3)is an independent risk factor influencing IR.Supplementation of vitamin D has been shown to improve glucose and lipid metabolism in patients with IR and T2DM.

Complement activation in obesity, insulin resistance, and type 2 diabetes mellitus

Amplified inflammatory reaction has been observed to be involved in cardiometabolic diseases such as obesity,insulin resistance,diabetes,dyslipidemia,and atherosclerosis.The complement system was originally viewed as a supportive first line of defense against microbial invaders,and research over the past decade has come to appreciate that the functions of the complement system extend beyond the defense and elimination of microbes,involving in such diverse processes as clearance of the immune complexes,complementing T and B cell immune functions,tissue regeneration,and metabolism.The focus of this review is to summarize the role of the activation of complement system and the initiation and progression of metabolic disorders including obesity,insulin resistance and diabetes mellitus.In addition,we briefly describe the interaction of the activation of the complement system with diabetic complications such as diabetic retinopathy,nephropathy and neuropathy,highlighting that targeting complement system therapeutics could be one of possible routes to slow down those aforementioned diabetic complications.

The Effect of Tuberculosis Infection on Pancreatic Beta-Cell Function in Patients with Type 2 Diabetes Mellitus

Objective: The aim of this study is to investigate how individuals with type 2 diabetes mellitus’ pancreatic β-cell function index and insulin resistance index are affected by tuberculosis infection. Methods: The study group consisted of 89 patients with type 2 diabetes mellitus and tuberculosis infection who were admitted to Jingzhou Chest Hospital between March 2019 and March 2021. Gender and duration of diabetes were matching conditions. The control group was made up of 89 patients with type 2 diabetes who were admitted to Jingzhou Central Hospital’s endocrinology department during the same period. The two patient groups provided general information such as gender, age, length of diabetes, and blood biochemical indexes such as glycosylated hemoglobin (HbA1c), fasting glucose (FPG), and fasting C-peptide (FC-P). The HOMA calculator was used to calculate the HOMA-β and the HOMA-IR, and intergroup comparisons and correlation analyses were carried out. Results: Regarding gender, age, disease duration, FC-P, and HbA1c, the differences between the two groups were not statistically significant (P > 0.05). However, BMI, FPG, HOMA-β, and HOMA-IR showed statistically significant differences (P < 0.05). In comparison to the control group, the study group’s HOMA-β was lower and its HOMA-IR was greater. According to Spearman’s correlation analysis, HOMA-β had a negative association (P th FPG, HbA1c, and the length of the disease, and a positive correlation with BMI and FC-P. A positive correlation was found between HOMA-IR and BMI, FPG, and FC-P (P < 0.01), as well as a correlation with the length of the disease (P > 0.05) and HbA1c. Conclusions: In type 2 diabetes mellitus combined with tuberculosis infection, the patients had higher FPG levels and lower FC-P levels, the secretory function of pancreatic β-cells was more severely impaired, and insulin resistance was more obvious.

Oxidative stress,insulin resistance,dyslipidemia and type 2 diabetes mellitus

Oxidative stress is increased in metabolic syndrome and type 2 diabetes mellitus(T2DM) and this appears to underlie the development of cardiovascular disease,T2 DM and diabetic complications.Increased oxidative stress appears to be a deleterious factor leading toinsulin resistance,dyslipidemia,β-cell dysfunction,impaired glucose tolerance and ultimately leading to T2 DM.Chronic oxidative stress,hyperglycemia and dyslipidemia are particularly dangerous for β-cells from lowest levels of antioxidant,have high oxidative energy requirements,decrease the gene expression of key β-cell genes and induce cell death.If β-cell functioning is impaired,it results in an under production of insulin,impairs glucose stimulated insulin secretion,fasting hyperglycemia and eventually the development of T2 DM.

Molecular mechanisms of insulin resistance in type 2 diabetes mellitus

Free fatty acids are known to play a key role in promoting loss of insulin sensitivity in type 2 diabetes mellitus but the underlying mechanism is still unclear.It has been postulated that an increase in the intracellular concentration of fatty acid metabolites activates a serine kinase cascade,which leads to defects in insu-lin signaling downstream to the insulin receptor.In addition,the complex network of adipokines released from adipose tissue modulates the response of tissues to insulin.Among the many molecules involved in the intracellular processing of the signal provided by insulin,the insulin receptor substrate-2,the protein kinase B and the forkhead transcription factor Foxo 1a are of particular interest,as recent data has provided strong evidence that dysfunction of these proteins results in insulin resistance in vivo.Recently,studies have revealed that phosphoinositidedependent kinase 1-independent phosphorylation of protein kinase Cε causes a reduction in insulin receptor gene expression.Additionally,it has been suggested that mitochondrial dysfunction triggers activation of several serine kinases,and weakens insulin signal transduction.Thus,in this review,the current developments in understanding the pathophysiological processes of insulin resistance in type 2 diabetes have been summarized.In addition,this study provides potential new targets for the treatment and prevention of type 2 diabetes.

The relationship between insulin resistance/β-cell dysfunction and diabetic retinopathy in Chinese patients with type 2 diabetes mellitus： the Desheng Diabetic Eye Study

AIM： To investigate the relationship between insulin resistance （IR）/β-cell dysfunction and diabetic retinopathy （DR） in Chinese patients with type 2 diabetes mellitus （T2DM）, and to explore further whether there were differences in the relationship among diabetic patients with higher and lower body mass index （BMI）. METHODS： Cross-sectional study. A total of 1466 subjects with T2DM were recruited in a local Desheng Community of urban Beijing from November 2009 to June 2012 for the cohort of Beijing Desheng Diabetic Eye Study. Standardized evaluation was carried out for each participant, including questionnaire, ocular and anthropometric examinations, and laboratory tests. Seven fields 30° color fundus photographs were used for DR grading according to the Early Treatment Diabetic Retinopathy Study protocols. Homeostatis Model Assessment （HOMA） method was employed for IR and β-cell function assessment. RESULTS： After excluding those participants who were treated with insulin （n=352） or had missing data of fasting insulin （n=96）, and further excluding those with poor quality of retinal photographs （n=10）, a total of 1008 subjects were included for the final analysis, 406 （40.3%） were men and 602 （59.7%） were women, age ranging fiom 34 to 86 （64.87±8.28）y. Any DR （levels 14 and above） was present in 278 （27.6%） subjects. After adjusting for possible covariates, the presence of any DR did not correlate with HOMA IR [odds ratio （OR） 1.51, 95% confidence interval （Cl） 0.87-2.61, P=0.14] or HOMA β-cell （OR 0.71, 95%CI 0.40-1.26, P=0.25）. After stratification by BMI, the presence of any DR was associated positively with HOMA IR （OR 2.46, 95%CI： 1.18-5.12, P=0.016）, and negatively with HOMA β-cell （OR 0.40, 95%CI： 0.19-0.87, P=0.021） in the group of patients with higher BMI （225 kg/m2）. In the group of patients with lower BMI （〈25 kg/m2）, the presence of any DR was not associated with HOMA IR （OR 1.00, 95%C1： 0.43-2.33, P=I.00） or HOMA β-cell （OR 1.41, 95%CI： 0.60-3.32, P=0.43）. CONCLUSION： The data suggest that higher IR and lower 13-cell function are associated with the presence of DR in the subgroup of diabetic patients with higher BMI. However, this association is not statistically significant in diabetic patients with lower BMI.

Effects of Portulaca Oleracea on Insulin Resistance in Rats with Type 2 Diabetes Mellitus

Objective: To study the effects of Portulaca oler acea, a Chinese medicinal herb, on insulin resistance in rats with type 2 diabet es mellitus (T2DM). Methods: Experimental model of T2DM was established by injection of streptozotocin (25mg/kg) and feeding with high calorie forage. The effects o f Portulaca oleracea on oral glucose tolerance, serum levels of insulin, triglyc eride, total cholesterol, high density lipoproteins cholesterol and free f atty acids, and insulin sensitivity index were all observed. Results: Portulaca oleracea could reduce the body weight, improve the impaired glucose tolerance and lipid metabolism, decrease serum free fatty acids, attenuate hyperinsulinemia and elevate insulin sensitivity. Conclusion: Portulaca oleracea could improve insulin resistance i n rats with T2DM, and the mechanism might be related to its actions in improving lipid metabolism and decreasing free fatty acids.

Correlation of serum vitamin E content with insulin resistance and oxidative stress response in patients with type 2 diabetes mellitus

Objective: To study the correlation of serum vitamin E content with insulin resistance and oxidative stress response in patients with type 2 diabetes mellitus. Methods: Patients who were diagnosed with type 2 diabetes mellitus in Xining Second People's Hospital between February 2016 and February 2017 were selected as T2DM group, healthy volunteers who received physical examination during the same period were selected as control group, oral glucose tolerance test was conducted to detect insulin resistance indexes, and fasting venous blood was collected to detect oxidative stress indicators. Results: Serum VitE, 2 h-Ins, 2 h-CP, Trx, Txnip, SOD and GSH-Px levels of T2DM group were significantly lower than those of control group while F-Ins, F-CP, MDA, AOPP, 8-OHdG, AGEs and LOX-1 levels were significantly higher than those of control group;serum VitE level in T2DM patients was positively correlated with serum 2 h-Ins, 2 h-CP, Trx, Txnip, SOD and GSH-Px levels, and negatively correlated with serum F-Ins, F-CP, MDA, AOPP, 8-OHdG, AGEs and LOX-1 levels. Conclusion: The decrease of serum vitamin E in patients with type 2 diabetes mellitus can lead to the aggravation of insulin resistance and the activation of oxidative stress response.

Relationship between β3-AR Gene and Obesity, Type 2 Diabetes, Insulin Resistance in Chinese Han Population

Objective: To explore the relationship between the β3-adrenergic receptor(β3-AR)gene and obesity, T2DM. insulin resistance in Chinese Han population. Methods: Fifty-three healthy subjects, 105 subjects with simple obesity, 63 type 2 diabetic patients without obesity, and 114 type 2 diabetic patients with obesity were studied with the technique of PCR-RFLP in codon 64 of the exon region of β3-AR gene representing the variation Trp/Arg. Results:Compared with the subjects of Trp homozygous group, the individuals with Arg allele were more elevated in WHR,MBP,SBP,DBP,FBS,PBS, FINS,PINS, FCP,PCP and lower in ISI. Frequency of Arg allele was higher in HINS sub-group without T2DM. Cnclusion: The results indicate that the Trp/Arg variation might lead to insulin resistance, obesity and T2DM.β3-AR gene is supposed to be the candidate gene of insulin resistance, obesity and T2DM in ChineseHan population.

Research progress on mechanism of Chinese material medica in preventing and treating insulin resistance and type 2 diabetes mellitus

Insulin resistance(IR)is a significant feature and one of the basic links in the pathogenesis of type 2 diabetes mellitus(T2DM).Chinese material medica(CMM)has promoted the development of traditional Chinese medicine due to its definite clinical efficacy in the treatment of IR and T2DM.However,owing to the fact that the mechanism of CMM is characterized by“multiple components and multiple targets”,which has not been effectively interpreted,result in the scientificity of clinical efficacy with CMM is controversial.Therefore,this article summarized the mechanisms of CMM and its main active components in improving IR and preventing and treating T2DM,whose aim is to provide valuable reference for the research mechanism on the treatment of IR and T2DM.

Effect of exenatide combined with metformin therapy on insulin resistance,liver function and inflammatory response in patients with type 2 diabetes mellitus combined with NAFLD

Objective: To study the effect of exenatide combined with metformin therapy on insulin resistance, liver function and inflammatory response in patients with type 2 diabetes mellitus combined with NAFLD. Methods: A total of 98 patients with type 2 diabetes mellitus combined with NAFLD who were treated in the hospital between February 2015 and January 2017 were divided into control group and observation group by random number table, each with 49 cases. Control group received metformin therapy, and observation group received exenatide combined with metformin therapy. Serum levels of insulin resistance indexes, liver function indexes and inflammatory factors of two groups of patients were detected before treatment and after 12 weeks of treatment. Results: Before treatment, serum levels of insulin resistance indexes, liver function indexes and inflammatory factors were not significantly different between the two groups of patients;after 12 weeks of treatment, serum INS and HOMA-IR levels as well as AST, ALT, GGT, ALP, hs-CRP, IL-1β and IL-6 contents of observation group were lower than those of control group. Conclusion: Exenatide combined with metformin therapy can effectively reduce insulin resistance, reduce liver function injury and inhibit systemic inflammatory response in patients with type 2 diabetes mellitus combined with NAFLD.

Effect of doubling-dose atorvastatin intervention on lipid metabolism, insulin resistance and carotid atherosclerosis in patients with type 2 diabetes mellitus

Objective:To study the effect of doubling-dose atorvastatin intervention on lipid metabolism, insulin resistance and carotid atherosclerosis in patients with type 2 diabetes mellitus. Methods:A total of 118 patients with type 2 diabetes mellitus treated in our hospital between May 2013 and December 2016 were collected, random number table was used to divide them into the single dose group (n=59) who received single-dose atorvastatin (20 mg/time, 1 times/d) therapy and the double dose group (n=59) who received doubling-dose atorvastatin (40 mg/time, 1 times/d) therapy, and both therapies lasted for 3 months. Serum levels of lipid metabolism indexes, insulin resistance indexes and carotid atherosclerosis-related indexes were compared between the two groups of patients before and after treatment.Results: Before treatment, differences in serum levels of lipid metabolism indexes, insulin resistance indexes and carotid atherosclerosis-related indexes were not statistically significant between two groups of patients. After treatment, serum lipid metabolism indexes TC, TG, FFA and LDL-C contents of observation group were lower than those of control group while HDL-C content was higher than that of control group;serum insulin resistance indexes INS and HOMA-IR levels were lower than those of control group while HOMA-β level was higher than that of control group;serum carotid atherosclerosis-related indexes visfatin, OPG, CysC and HMGB1 contents were lower than those of control group.Conclusions: Doubling-dose atorvastatin may be more effective in decreasing the hyperlipidemia and reducing the insulin resistance and carotid atherosclerosis in patients with type 2 diabetes mellitus.

Relationship between DEXA bone mineral density measurement results and serum cytokines as well as insulin resistance in patients with type 2 diabetes mellitus and osteoporosis

Objective:To study the relationship between DEXA bone mineral density measurement results and serum cytokines as well as insulin resistance in patients with type 2 diabetes mellitus and osteoporosis.Methods:Patients newly diagnosed with type 2 diabetes were selected and divided into normal bone mass group, osteopenia group and osteoporosis group according to the DEXA femoral neck bone mineral density measurement results, the bone mineral density of all parts in of three groups of patients were measured, and serum was collected to determine the levels of bone metabolism indexes, cytokines and insulin.Results:Femoral trochanter, Ward's area as well as the 2-4th lumbar vertebra bone mineral density values of osteopenia group and osteoporosis group were significantly lower than those of normal bone mass group, and the femoral trochanter, Ward's area as well as the 2-4th lumbar vertebra bone mineral density values of osteoporosis group were significantly lower than those of osteopenia group;serum N-MID, PINP and BGP levels of osteopenia group and osteoporosis group were significantly lower than those of normal bone mass group whileβ-CTX, TRACP5b, Ins, Chemerin, TNF-α, IL-1β and MCP-1 levels were significantly higher than those of normal bone mass group;serum N-MID, PINP and BGP levels of osteoporosis group were significantly lower than those of osteopenia group whileβ-CTX, TRACP5b, Ins, Chemerin, TNF-α, IL-1β and MCP-1 levels were significantly higher than those of osteopenia group;serum Ins, Chemerin, TNF-α, IL-1β and MCP-1 levels were negatively correlated with N-MID, PIN and BGP levels, and positively correlated with serumβ-CTX and TRACP5b levels.Conclusion:Excessively synthesized inflammatory factors and compensatory hyperinsulinemia in patients with type 2 diabetes mellitus and osteoporosis can promote bone resorption and inhibit bone formation, thus resulting in the osteopenia in multiple areas of the body.

Gut microbiota: a potential target for insulin resistance and type 2 diabetes mellitus

Insulin resistance(IR)runs through the whole process of occurrence and development of type 2 diabetes mellitus.Gut microbiota is the largest micro-ecosystem in human body,which has an important influence on the metabolism of material and energy.Recent studies have shown that besides genetic and islet dysfunction,disorders of the gut microbiota induced by dietary imbalance may lead to IR,which influence health.Here,we reviewed the research status of the correlation between IR and gut microbiota,and summarized the relationship between IR and gut microbiota,metabolites of gut microbiota and IR,and possible mechanism of gut microbiota participating in IR,which provides theoretical basis and literature reference for the treatment of IR and type 2 diabetes mellitus by gut microbiota regulation.

Influence of berberine on protein tyrosine kinase of erythrocyte insulin receptors from type 2 diabetes mellitus

Objective： Bererine has been used to treat type 2 diabetes mellitus in Chinese traditional medicine because of its hypoglycemic effect. In this report, we compared the intrinsic tyrosine kinase activities of erythrocyte insulin receptors from type 2 diabetes mellitus with or without stimulation by berberine in vitro. Methods- Preparations containing insulin receptors were obtained from soluble human erythrocytes, and the insulin receptors were partially purified by affinity chromatography. The tyrosine kinase activity was measured by the exogenous substrate phosphorylation. Results： Both the membrane tyrosine kinase activity and the purified receptor tyrosine kinase activity from diabetics decreased significantly compared with those of normal individuals （reduced by 67.4% and 47.2%, respectively）. After incubation with berbefine, there is a statistical difference in the activity of membrane tyrosine kinase for diabetic patients （ a 150% increase）. Berefine had no effect on the tyrosine kinase activity of purified insulin receptors. Conclusion： We concluded from these results that berbefine was able to improve the insulin sensitivity by increasing the protein tyrosine kinase activity of membrane-bound insulin receptors from type 2 diabetes mellitus.

Mechanism of immune attack in the progression of obesity-related type 2 diabetes

Obesity and overweight are widespread issues in adults,children,and adolescents globally,and have caused a noticeable rise in obesity-related complications such as type 2 diabetes mellitus(T2DM).Chronic low-grade inflammation is an important promotor of the pathogenesis of obesity-related T2DM.This proinflammatory activation occurs in multiple organs and tissues.Immune cellmediated systemic attack is considered to contribute strongly to impaired insulin secretion,insulin resistance,and other metabolic disorders.This review focused on highlighting recent advances and underlying mechanisms of immune cell infiltration and inflammatory responses in the gut,islet,and insulin-targeting organs(adipose tissue,liver,skeletal muscle)in obesity-related T2DM.There is current evidence that both the innate and adaptive immune systems contribute to the development of obesity and T2DM.

Challenges and pitfalls of youth-onset type 2 diabetes

The incidence and prevalence of youth-onset type 2 diabetes mellitus(T2DM)are increasing.The rise in frequency and severity of childhood obesity,inclination to sedentary lifestyle,and epigenetic risks related to prenatal hyperglycemia exposure are important drivers of the youth-onset T2DM epidemic and might as well be responsible for the early onset of diabetes complications.Indeed,youth-onset T2DM has a more extreme metabolic phenotype than adult-onset T2DM,with greater insulin resistance and more rapid deterioration of beta cell function.Therefore,intermediate complications such as microalbuminuria develop in late childhood or early adulthood,while end-stage complications develop in mid-life.Due to the lack of efficacy and safety data,several drugs available for the treatment of adults with T2DM have not been approved in youth,reducing the pharmacological treatment options.In this mini review,we will try to address the present challenges and pitfalls related to youth-onset T2DM and summarize the available interventions to mitigate the risk of microvascular and macrovascular complications.

Role of adiponectin and some other factors linking type 2 diabetes mellitus and obesity

Because of the intimate association of obesity with type 2 diabetes mellitus(T2DM), during the last two decades, extensive research work is being conducted to find out whether the coexistence of the two is a simple association or there is a positive correlating link between the two. In this article, an attempt has been made to collect and analyse the recent developments in this field and to arrive at a conclusion on the subject. The possible role of several important factors(obtained from adipocytes/not of adipocyte origin) in linking the two has been discussed in detail. Some of the agents, specifically adiponectin, are beneficial(i.e., reduce the incidence of both), while others are harmful(i.e., increase their incidence). From the analysis, it appears that obesity and T2 DM are intimately linked.

Type 2 Diabetes Meilitus Easily Develops into Alzheimer’s Disease via Hyperglycemia and Insulin Resistance

With the acceleration of population aging,the incidence of type 2 diabetes mellitus(T2DM)and Alzheimer’s disease(AD)is progressively increasing due to the age-relatedness of these two diseases.The association between T2DM and AD-like dementia is receiving much attention,and T2DM is reported to be a significant risk factor for AD.The aims of this review were to reveal the brain changes caused by T2DM as well as to explore the roles of hyperglycemia and insulin resistance in the development of AD.