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Background: Little is known about the subtypes of type 2 diabetes (T2D) and their association with clinical outcomes in Asians., Methods: We performed data-driven cluster analysis in patients with newly diagnosed drug-naive T2D (n = 756) from the Korean Genome and Epidemiology Study. Clusters were based on five variables (age at diagnosis, BMI, HbA1c, and HOMA2 β-cell function, and insulin resistance)., Results: We identified four clusters of patients with T2D according to k-means clustering: cluster 1 (22.4 %, severe insulin-resistant diabetes [SIRD]), cluster 2 (32.7 %, mild age-related diabetes [MARD]), cluster 3 (32.7 %, mild obesity-related diabetes [MOD]), and cluster 4 (12.3 %, severe insulin-deficient diabetes [SIDD]). During 14 years of follow-up, individuals in the SIDD cluster had the highest risk of initiation of glucose-lowering therapy compared to individuals in the other three clusters. Individuals in the MARD and SIDD clusters showed the highest risk of chronic kidney disease and cardiovascular disease, and individuals in the MOD clusters showed the lowest risk after adjusting for other risk factors (P < 0.05)., Conclusions: Patients with T2D can be categorized into four subgroups with different glycemic deterioration and risks of diabetes complications. Individualized management might be helpful for better clinical outcomes in Asian patients with different T2D subgroups., Competing Interests: Declaration of competing interest The authors declare that they have no conflicts of interest to this work., (Copyright © 2023 Elsevier Inc. All rights reserved.)

Aims: This study was designed to investigate the association between pancreatic fat content (PFC) and insulin secretory capacity as well as glucose tolerance in Korean adults., Materials: A total of 39 participants (mean age 49.9 years, 53% males) without a previous history of diabetes, or those previously diagnosed as having diabetes but with less than 10 years of disease duration and no medication history were included. They were stratified according to the results of the oral glucose tolerance test (OGTT): normal glucose tolerance, prediabetes, and diabetes., Methods: All participants underwent the proton magnetic resonance spectroscopy ( 1 H-MRS) to assess PFC. Insulin sensitivity and β-cell function were measured by the frequently sampled intravenous glucose tolerance tests (FSIVGTT) and OGTT-derived indices., Results: As glucose tolerance deteriorated, parameters such as Stumvoll index, oral glucose insulin sensitivity index, homeostatic model assessment (HOMA)-β, insulinogenic index and oral disposition index from the OGTT, and acute insulin response to glucose (AIR) and disposition index (DI) from the FSIVGTT were decreased. PFC increased with deterioration in glucose tolerance (NGT: 12.0%, prediabetes: 23.7%, and diabetes: 31.9%). Correlation analysis indicated that glucose levels at 60 and 120 min during the OGTT were positively correlated with PFC. Also, there was a significant negative correlation between PFC and DI as well as AIR derived from the FSIVGTT., Conclusions: PFC evaluated by 1 H-MRS in Korean adults was higher in those diagnosed with diabetes than those with normal glucose tolerance status. PFC also showed a significant negative correlation with indices reflecting beta cell function., (© 2020 John Wiley & Sons Ltd.)

Both IFG and IGT are prediabetic conditions that can progress to type 2 DM. However, previous studies have shown that these are not identical. This study was conducted on 307 drug naïve prediabetic adults who did not meet the diagnostic criteria for diabetes based on the OGTT. According to the OGTT, the subjects were divided into isolated IFG (i-IFG), isolated IGT (i-IGT), and combined glucose intolerance (CGI) group. We also measured insulin resistance indices (HOMA-IR, WBISI), an insulin secretion indices (insulinogenic index [IGI], AUC I/G(0-120), disposition index [DI]), and compared each of the three groups. The OGTT measurements showed that 87 subjects were diagnosed with i-IFG, 75 subjects had i-IGT, and 145 subjects had CGI. With respect to the insulin resistance indices, HOMA-IR and WBISI were not significantly different. However, insulin secretory capacity, the IGI and DI were significantly higher for the i-IFG group. Moreover, after confounders were adjusted, HOMA-IR, IGI, AUC I/G(0-120), and the DI were significantly higher for the i-IFG group and WBISI was significantly higher for the i-IGT group. These results demonstrate that the pathogenesis of IFG is more closely associated with insulin resistance, and the pathogenesis of IGT is more closely associated with impaired insulin secretion., (Copyright (c) 2010 Elsevier Ireland Ltd. All rights reserved.)

Background: This study examined whether defects in insulin secretion contribute to the development and progression of type 2 diabetes mellitus (T2DM)., Methods: Plasma insulin and glucose were measured after a glucose tolerance test to calculate the insulinogenic index (IGI) and the HOMA-IR Homeostasis model assessment of insulin resistance in subjects with normal glucose tolerance (NGT), prediabetes (preDM, n = 49), and T2DM patients with disease duration < 1 year (n = 84), 1 approximately 5 years (n = 45), or > 5 years (n = 37). Plasma proinsulin and adiponectin levels were also measured as a parameter of insulin secretion and resistance., Results: The mean HOMA-IR increased and the adiponectin levels decreased relative to the deterioration of glucose tolerance in NGT and preDM subjects. However, differences in the HOMA-IR were not related to disease duration in T2DM subjects. The mean IGI was similar in NGT and preDM subjects, but there were significant deteriorations in IGI relative to the duration of diabetes., Conclusions: Defects in both insulin sensitivity and insulin secretion contribute to T2DM, but decreased insulin secretion may be more important in the development and progression of T2DM.

Objective: To determine whether sarcopenia was associated with metabolic phenotype in subjects with and without obesity.Methods: A total of 6,021 participants (2,592 men, 3,429 women) aged 30 to 93 years were assessed using data from the 2009 Korea National Health and Nutrition Examination Survey. Sarcopenia was defined as appendicular skeletal muscle mass divided by weight (%) that is <1 SD below the sex-specific mean for young adults. Metabolically unhealthy was defined as ≥2 components of metabolic syndrome or the presence of hypertension, diabetes, or cardiovascular disease. Obesity was defined as body mass index ≥25.0 kg/m2 .Results: Sarcopenia was associated with a metabolically unhealthy phenotype in nonobese men independent of age, smoking, regular physical activity, daily energy intake, total body fat, fasting insulin, non-HDL cholesterol, white blood cell count, ferritin level, and 25(OH) vitamin D level (OR per 1 SD increment (95% CI) 1.88 (1.28-2.75), P < 0.01), but this association was confounded by and not independent of total body fat in nonobese women. Sarcopenia was not associated with a metabolically unhealthy phenotype in subjects with obesity.Conclusions: Sarcopenia was independently associated with a metabolically unhealthy phenotype in nonobese men, but this association was not evident in nonobese women or subjects with obesity. [ABSTRACT FROM AUTHOR]

Impaired fasting glucose (IFG) and impaired glucose tolerance (IGT) are pre-diabetes states that can progress to type 2 diabetes mellitus. However, it has been shown that only 29 - 76% of pre-diabetic subjects diagnosed satisfy the definition of IFG and IGT simultaneously, and it appears that a significant difference between them is also present. We performed an oral glucose tolerance test (OGTT) on 528 subjects who had no history of the medication that affect on glucose tolerance, and the patients were classified into four groups: the normal glucose tolerance, the isolated IFG, the isolated IGT, and the combined glucose intolerance (CGI) group satisfying IFG and IGT conditions simultaneously. The characteristics of each group were compared. In addition, for all subjects, the insulin resistance indices HOMA-IR, WBISI, and the insulin secretion indices insulinogenic index (IGI), and AUC insulin[sub 0-120]/AUC glucose[sub 0-120] (AUC I/G 120) were determined. The OGTT measurements showed that 87 subjects were diagnosed as having isolated IFG, 75 subjects as having isolated IGT, and 145 subjects as having CGI, and 43.2% of the pre-diabetes subjects were placed in the CGI group. Comparing the isolated IFG and the isolated IGT group, the isolated IFG group was relatively young (49.9±11.3 years vs. 51.4±14.4 years, p=0.038), the percentage of male was higher (56.3% vs. 40%, p=0.028), and the isolated IFG group subjects showed a trend to be leaner. In addition, the HOMA-IR of the isolated IFG group was significantly higher (2.30±0.12 vs. 1.89±0.13, p=0.028), the WBISI between two groups was not different (10.8±0.67 vs. 12.4±0.78, p=0.123), and these findings suggest that the difference in insulin resistance between two groups was mainly caused by hepatic resistance. For the insulin secretory indices, the IGI (140.3±10.6 vs. 91.0±11.5, p=0.002) and the AUC I/G 120 (65.2±3.4 vs. 54.0±4.0, p=0.037) were significantly higher for the isolated IFG group. This significance of the insulin secretory capacity between each group did not change after an adjustment for insulin resistance (IGI/WBISI) or the disposition index (IGI X WBISI). In conclusion, following the use of the OGTT, it was found that significant metabolic differences in insulin sensitivity and insulin the secretory capacity between the isolated IFG group and the isolated IGT group exist. [ABSTRACT FROM AUTHOR]