Is Type 2 Diabetes Mellitus One Disease? Subtype Classification and Clinical Implications | Chapter 13 | Medical Science: Recent Advances and Applications Vol. 11

This review aims to describe the four metabolic subtypes or clusters of Type 2 DM. It summarises these different subtypes based on clinical and laboratory features—such as glutamic acid decarboxylase antibodies (GAD), age at onset, HbA1c, body mass index (BMI), and measures of insulin resistance and secretion—helping to characterise them. The main goal of identifying these clusters is to improve treatment personalisation and prevent complications that differ among these groups. The severe insulin-deficient group at diagnosis resembles Type 1 diabetes but lacks autoantibodies against beta cells and has different genetic markers. Microvascular complications like diabetic neuropathy and retinopathy are most common in this subtype, along with cardiovascular issues. Insulin therapy should be started early in this group. The insulin-resistant subtype is linked to the highest risk of diabetic nephropathy. Efforts to reduce insulin resistance and protect kidney function are essential for this cluster. The mild obesity-related and mild age-related subtypes usually have a lower risk of complications and respond well to lifestyle changes and weight loss. Recognising these subtypes of Type 2 DM allows for a personalised approach to disease management based on different metabolic profiles. For example, the insulin-deficient metabolic subtype carries the highest risk of microvascular complications, while the insulin-resistant subtype carries the greatest risk of diabetic kidney disease.

 

Author(s) Details

A. Manov
Internal Medicine and Transitional Year Residency Program, Mountain View Hospital, Las Vegas, Nevada, USA.

 

S. Shehnaz
Sunrise Health GME Consortium, Las Vegas, Nevada, USA.

 

Please see the book here :- https://doi.org/10.9734/bpi/msraa/v11/6348

Evaluating the Relationship of Visceral Adiposity Index with Different Metabolic Phenotypes and Cardiovascular Markers in Non-Diabetic Subjects | Chapter 5 | Medical Science: Trends and Innovations Vol. 9

Background: The visceral adiposity index (VAI) is a gender-specific mathematical model, which originates from observation in a healthy normal/overweight population of a linear relationship between body mass index (BMI) and waist circumference (WC). VAI provides information of visceral adipose tissue function and insulin sensitivity.

Aim: This study aims to evaluate the relationship of VAI with different metabolic phenotypes and cardio metabolic risk markers in non-diabetic subjects.

Methods: A total of 183 health clinical subjects from 30 to 50 years of age, with normal weight and with obesity grade I were recruited. Anthropometric measures were taken and quantified glucose, lipids, insulin, high-sensitivity C-reactive protein (hs-CRP) and adiponectin concentrations. Unhealthy phenotype was defined according to the criteria; Visceral Adiposity index (VAI) was calculated. To analyze the differences between VAI quartiles and the metabolic variable, one-way ANOVA and post-hoc test were used. Furthermore, a multiple regression analysis was conducted to evaluate the association between VAI with insulin levels, the Homeostasis Model Assessment of Insulin Resistance (HOMA-IR) and glucose, adjusted by sex and BMI.

Results: In the study group, four groups were found according to their metabolic state, which includes MHNO (metabolically healthy non-obesity), MUNO (Metabolically unhealthy non-obese subject), MUO (metabolically unhealthy obese subject) and MHO (metabolically healthy obese). Among others, 40% were MHO, they showed lower serum glucose, triglycerides, insulin, hs-CRP levels, systolic and diastolic blood pressure, HOMA-IR than MUO. Metabolically unhealthy non-obese subjects (MUNO) showed higher serum triglycerides, insulin levels, HOMA-IR than the metabolically healthy non-obesity (MHNO) subjects. MUNO and MUO subjects had higher VAI values than MHNO and MHO subjects. In a logistic regression analysis using the cut-offs of VAI quartile 4, >2.25 in women and >1.86 in men found a strong association with glucose, HOMA-IR and adiponectin concentrations. In ROC analysis using these cut-off determined for glucose concentrations >100 mg/dL, an area under the curve of 0.83 in men and 0.71 in women; for HOMA-IR 0.78 only in men, and for adiponectin 0.69 in men and 0.91 in women.

Conclusion: VAI estimates visceral fat distribution, and it is a useful determinant of the phenotype change and substituted the necessity to take high-cost imaging studies, thereby making the prediction much more practical in daily clinical practice and population studies for the assessment of cardiometabolic risk associated with visceral obesity. Therefore, VAI is a useful indicator to evaluate the metabolic risk both of non-obese and obese individuals.

 

Author (s) Details

Monica I Cardona-Alvarado
Division of Health Sciences, Department of Medical Science, Campus Leon, University of Guanajuato, Leon, Mexico.

 

Gabriela Lopez-Moreno
Division of Health Sciences and Engineering, Campus Celaya-Salvatierra, University of Guanajuato, Celaya, Mexico.

 

Herlinda Aguilar-Zavala
Division of Health Sciences and Engineering, Campus Celaya-Salvatierra, University of Guanajuato, Celaya, Mexico.

 

Nicte FigueroaVega
Division of Health Sciences, Department of Medical Science, Campus Leon, University of Guanajuato, Leon, Mexico.

 

Elva Perez-Luque
Division of Health Sciences, Department of Medical Science, Campus Leon, University of Guanajuato, Leon, Mexico.

 

Please see the book here:- https://doi.org/10.9734/bpi/msti/v9/4590