인슐린 비의존형 당뇨병 환자의 체지방 분포와 인슐린 저항성과의 상관성 = The Correlation between Insulin Resistance and the Pattern of Body Fat Distribution in Korean Patients with Non-insulin Dependent Diabetes Mellitus

다국어 초록 (Multilingual Abstract)

Background : The role of insulin resistance is known to be very important in the pathogenesis and clinical courses of human diseases such as diabetes mellitus, hypertension, atherosclerotic coronary vascular disease, and dyslipoproteinemia. Methods : To investigate the correlation between insulin resistance and the pattern of body fat distribution in Korean patients with non-insulin dependent diabetes mellitus (NIDDM), dietary survey, anthropometry, CT scan, measurement of body fat by body composition analyzer, oral glucose tolerance test and measurement of glucose uptake rate by euglycemic hyperinsulinemic glucose clamp technique were performed in 6 normal weight patients and 12 overweight-obese NIDDM patients. Six of 12 overweight-obese patients are centrally obese with waist to hip circumference ratio : WHR?1 and 6 cases are peripherally obese with WHR<1. Results : 1) There was no difference between the mean body weigh of centrally obese patients and peripherally obese patients but WHR and body fat content of centrally obese patients were significantly higher than those of peripherally obese patients. 2) In the centrally obese patients visceral fat area measured by CT scan was significantly wider than in the peripherally obese patients but subcutaneous fat area was not different between the two groups. 3) Plasma glucose levels on oral glucose tolerance tests were not different among the three groups but plasma C-peptide and insulin levels at 2 hour after glucose load were significantly higher in centrally obese patients than in peripherally obese patients. 4) Glucose uptake rate (M/I ratio) of centrally obese patients was significantly lower than that of peripherally obese patients. 5) The WHR showed the highest negative correlation with M/I ratio in the all patients and waist thigh circumference ratio (WTR) showed the highest negative correlation with M/I ratio in overweight-obese patients. 6) Insulin area and fasting level of free fatty acid showed significant positive correlation with WHR and significant negative correlation with M/I ratio. Conclusion : It could be concluded that the pattern of body fat distribution rather than the relative body weight for height or body fat content has a greater role in determining the degree of insulin resistance in Korean patients with NIDDM. And further a change of the body configuration through adequate diet and exercise is highly recommended for overweight-obese NIDDM patients.