title: Use of a reference four-component model to define the effects of insulin treatment on body composition in type 2 diabetes: the 'Darwin study'.
abstract: OBJECTIVE
  To define the effects of insulin treatment on body composition and fat distribution, and investigate the potential role of body weight (BWt) gain predictors in patients with poorly controlled type 2 diabetes.
  
  
  METHODS
  Assessments of body composition, using a four-component model, and biochemical indices were obtained in 19 patients [mean (SD): age, 60 (8.3) years; BMI, 25.3 (3.3) kg/m(2)] with poorly controlled type 2 diabetes, despite maximal oral hypoglycaemic agents, receiving insulin [40 (12.2) units/day] at baseline and after 1, 3 and 6 months.
  
  
  RESULTS
  Insulin therapy significantly reduced plasma glucose [-6.0 (4.3) mmol/l], improved [HbA(1)c [-1.9 (1.8)%], and reversed the BWt lost [3.3 (1.8) kg] before treatment. The 6-month BWt gain [+5.2 (2.7) kg] consisted of body fat [+2.9 (2.7) kg] and fat-free mass [FFM; +2.3 (1.8) kg], with the FFM increase due solely to total body water [TBW; +2.4 (1.5) l], as there were no detectable changes in total body protein or bone mineral, thereby increasing FFM hydration by 1.3%. More body fat was deposited centrally in patients receiving insulin alone than those receiving insulin with an oral hypoglycaemic agent (metformin). Daily insulin dose, HbA(1)c and hip circumference were independent predictors of BWt gain.
  
  
  CONCLUSIONS
  Insulin treatment increased fat and FFM similarly in poorly controlled type 2 diabetes patients, with the FFM gain due entirely to TBW. The possible role of metformin in reducing central fat accumulation following insulin treatment warrants further investigation into its mechanism and potential long-term benefits.
authors.affiliation: Wellcome Trust Clinical Research Facility and Department of Endocrinology and Diabetes, Addenbrookes Hospital, Hills Road, Cambridge, CB1 2QQ, UK.
authors.forename: I C
authors.initials: IC
authors.lastname: Packianathan
authors.forename: N J
authors.initials: NJ
authors.lastname: Fuller
authors.forename: D B
authors.initials: DB
authors.lastname: Peterson
authors.forename: A
authors.initials: A
authors.lastname: Wright
authors.forename: W A
authors.initials: WA
authors.lastname: Coward
authors.forename: N
authors.initials: N
authors.lastname: Finer
mesh_terms: D000273:Adipose Tissue / Q000033:anatomy & histology; D001823:Body Composition / Q000187:drug effects*; D015992:Body Mass Index; D001835:Body Weight; D003924:Diabetes Mellitus, Type 2 / Q000188:drug therapy* / Q000503:physiopathology*; D006801:Humans; D007004:Hypoglycemic Agents / Q000627:therapeutic use; D007328:Insulin / Q000031:analogs & derivatives* / Q000627:therapeutic use*; D061268:Insulin Lispro; D008954:Models, Biological; D011446:Prospective Studies; D015430:Weight Gain
chemical_list: D007004:Hypoglycemic Agents; D007328:Insulin; D061268:Insulin Lispro