Obesity Related to Insulin Response and Counterregulatory Hormones in NIDDM Patients

Lee, Jae Woo; Shin, Geun Wook; Ji, Hwang Yong; Song, Myong June; Kim, Jung Min; Chung, Min Young; Lee, Tai Hee

Abstract

Obese subjects are at an increased risk of diabetes mellitus, hyperlipidemia, hypertension, coronary artery disease, and the frequency of this complications are different according to body fat distribution. In android and visceral obese type, metabolic abnormalities are more common, It is suggested that massive obesity is always accompanied by insulin resistance with hyperinsulinemia in proportion to the amount of visceral fat, and the visceral fat accumulation may then amplify the metabolic aberrations via hepatic effects of excess concentration of portal free fatty acid. Also the increase in plasma concentrations of counterregulatory hormones could play a role in states of insulin resistance like obesity and diabetes. In this study the relationship between body mass index(BMI) and other obesity indices(skin fold thickness, waist-hip ratio, and visceral fat/subcutaneous fat area ratio), and association between various obesity indices and insulin resistance state were observed in NIDDM patients. The obese-group and the non-obese group were classified on basis of BMI(obese group: over 26 in men, over 25 in women), and the BMI compared with other obesity indies. Also th basal levels of serum counterrgulatory hormones were assayed and changes in FFA and insulin levels after 75g oral glucose ldagings were observed. The results were as follows: 1) There were no differences in age, DM duration, HbA1c between two groups, but serum total cholesterol(p<0.01) and triglyceride levels(p<0.05) were higher in obese groups. 2) BMI correlated with skinfold thickness(r=0.80, p<0.001), but not with WHR, V/S ratio, and the majority of diabetic patients had visceral obesity. 3) There were no difference in free fatty acid and insulin levels at basal state, but FFA and insulin responses after glucose loading were significantly higher in obese group. 4) Basal counterregulatory hormone levels were not different in both groups, and showed no correlationships with WHR or V/S ratios. The above results indicated that majority of the NIDDM patients had visceral obesity which did not show any relationships with other obesity indices. Although insulin and FFA responses after glucose loading were eleveated in obese NIDDM patients, they did not show any relationships with counterregulatory hormones.