Assessment of cardiometabolic risk and prevalence of meeting treatment guidelines among patients with type 2 diabetes stratified according to their use of insulin and/or other diabetic medications: results from INSPIRE ME IAA.
OBJECTIVE
Visceral adipose tissue (VAT) and liver fat (LF) are strongly associated with type 2 diabetes. It is not known, however, how diabetes treatment and/or risk factor management modulates the association between VAT, LF and diabetes. The aim was to determine the level of VAT and LF in patients with type 2 diabetes according to their treatment status and achievement of the American Diabetes Association's (ADA) diabetes management goals.


METHODS
We performed a cross-sectional analysis of the baseline data of the International Study of the Prediction of Intra-Abdominal Adiposity and its Relationship with Cardiometabolic risk/Intra-Abdominal Adiposity (INSPIRE ME IAA), a 3-year prospective cardiometabolic imaging study conducted in 29 countries. Patients (n = 3991) were divided into four groups: (i) those without type 2 diabetes (noT2D n = 1003 men, n = 1027 women); (ii) those with type 2 diabetes but not treated with diabetes medications (T2Dnomeds n = 248 men, n = 198 women); (iii) those with type 2 diabetes and treated with diabetes medications but not yet using insulin (T2Dmeds-ins n = 591 men, n = 484 women) and (iv) those with type 2 diabetes and treated with insulin (T2Dmeds+ins n = 233 men, n = 207 women). Abdominal and liver adiposity were measured by computed tomography.


RESULTS
Fewer patients with high VAT or LF achieved the ADA's goals for high-density lipoprotein cholesterol (HDL-C) or triglycerides compared to patients with low VAT or LF. Visceral adiposity (p = 0.02 men, p = 0.003 women) and LF (p = 0.0002 men, p = 0.0004 women) increased among patients who met fewer of the ADA treatment criteria, regardless of type 2 diabetes treatment.


CONCLUSIONS
Residual cardiometabolic risk exists among patients with type 2 diabetes characterized by elevated VAT and LF.
Centre de recherche de l'Institut universitaire de cardiologie et de pneumologie de Québec, Québec, QC, Canada.
J
J
Smith
J-A
JA
Nazare
A-L
AL
Borel
P
P
Aschner
P J
PJ
Barter
L
L
Van Gaal
Y
Y
Matsuzawa
T
T
Kadowaki
R
R
Ross
C
C
Brulle-Wohlhueter
N
N
Alméras
S M
SM
Haffner
B
B
Balkau
J-P
JP
Després
D050154:Adiposity; D000328:Adult; D000368:Aged; D015331:Cohort Studies; D003131:Combined Modality Therapy; D003430:Cross-Sectional Studies; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000188:drug therapy* / Q000473:pathology / Q000628:therapy; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D006949:Hyperlipidemias / Q000209:etiology / Q000517:prevention & control; D007004:Hypoglycemic Agents / Q000627:therapeutic use*; D007328:Insulin / Q000627:therapeutic use*; D050152:Intra-Abdominal Fat / Q000000981:diagnostic imaging / Q000473:pathology; D050356:Lipid Metabolism; D008099:Liver / Q000000981:diagnostic imaging / Q000473:pathology; D008297:Male; D055118:Medication Adherence; D024821:Metabolic Syndrome / Q000453:epidemiology / Q000503:physiopathology / Q000517:prevention & control*; D008875:Middle Aged; D017410:Practice Guidelines as Topic; D011859:Radiography; D012307:Risk Factors
D007004:Hypoglycemic Agents; D007328:Insulin