Insulin resistance, beta cell dysfunction and visceral adiposity as predictors of incident diabetes: the Insulin Resistance Atherosclerosis Study (IRAS) Family study - PubMed (original) (raw)

Insulin resistance, beta cell dysfunction and visceral adiposity as predictors of incident diabetes: the Insulin Resistance Atherosclerosis Study (IRAS) Family study

A J G Hanley et al. Diabetologia. 2009 Oct.

Abstract

Aims/hypothesis: Central obesity, insulin resistance and beta cell dysfunction are independent risk factors for incident type 2 diabetes, although few studies have used detailed measures of these disorders. Our objective was to study the association of directly measured visceral and subcutaneous adipose tissue (VAT, SAT), insulin sensitivity (S (I)) and the acute insulin response (AIR) with incident type 2 diabetes.

Methods: Participants were 1,230 Hispanic-Americans and African-Americans in the Insulin Resistance Atherosclerosis Study (IRAS) Family Study who were free of type 2 diabetes at baseline (2000-2002). S (I) and AIR were determined from frequently sampled IVGTTs with minimal model analysis. VAT and SAT were determined by computed tomography. Impaired fasting glucose and type 2 diabetes were defined according to American Diabetes Association criteria.

Results: Incident type 2 diabetes was diagnosed in 90 participants after 5 years. After adjustment for age, sex, ethnicity, centre, impaired fasting glucose, triacylglycerol, HDL-cholesterol and systolic BP, both S(I) and AIR were inversely associated with type 2 diabetes (S (I), OR 0.53, 95% CI 0.39-0.73; AIR, OR 0.22, 95% CI 0.14-0.34 per SD; both p < 0.001), while both VAT and SAT were positively associated with type 2 diabetes (VAT, OR 1.68, 95% CI 1.22-2.33; SAT, OR 1.49, 95% CI 1.13-1.99; both p < 0.01). In a model including all four factors, S (I) and AIR (S (I), OR 0.55, 95% CI 0.37-0.80; AIR, OR 0.21, 95% CI 0.13-0.33; both p < 0.01) were significant predictors of type 2 diabetes, although associations with VAT and SAT were no longer significant. A significant sex x VAT interaction indicated a stronger association of VAT with type 2 diabetes in women than in men.

Conclusions/interpretation: Insulin resistance, beta cell dysfunction and VAT predicted incident type 2 diabetes, with evidence of a stronger association of VAT with type 2 diabetes among women.

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Conflict of interest statement

Duality of interest statement The authors declare that there is no duality of interest associated with this manuscript.

Figures

Fig. 1

Fig. 1

Incidence of type 2 diabetes according to quartiles (Q) of SAT (black columns) and VAT (white columns)

Fig. 2

Fig. 2

Associations of tertiles of VAT and SAT with incident diabetes mellitus at the 5 year follow-up examination. Odds ratios (with 95% CI) were adjusted for age, sex, ethnicity and clinic, and indicate the risk of diabetes mellitus among subjects in the 2nd and 3rd tertiles of VAT or SAT compared with those in the 1st tertile (serving as the reference category)

Fig. 3

Fig. 3

Associations of baseline VAT and SAT with incident diabetes mellitus at the 5 year follow-up examination, overall and stratified by sex, in the IRAS Family Study. Odds ratios (with 95% CI) refer to 1 SD changes. Overall models were adjusted for age, sex and ethnicity (minimally adjusted, model A); and age, sex, ethnicity, IFG, triacylglycerol, HDL-cholesterol and systolic BP (fully adjusted, model B). Sex-specific models were adjusted for age and ethnicity (minimally adjusted, model A); and age, ethnicity, IFG, triacylglycerol, HDL-cholesterol and systolic BP (fully adjusted, model B)

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