title: Optimal Waist Circumference Cutoff Value Based on Insulin Resistance and Visceral Obesity in Koreans with Type 2 Diabetes.
abstract: BACKGROUND
  Visceral obesity is the most powerful contributor to the development of metabolic syndrome (MetS) and cardiovascular diseases. In light of visceral obesity, however, there is a paucity of data on the appropriate cutoff point of waist circumference (WC) in subjects with type 2 diabetes. The aim of this study was to investigate the optimal cutoff value for WC that signals insulin resistance (IR) and visceral obesity in Koreans with type 2 diabetes.
  
  
  METHODS
  We evaluated 4,252 patients with type 2 diabetes (male 2,220, female 2,032, mean age 57.24 years) who visited our clinic between January 2003 and June 2009. WC was measured at the midpoint between the lower rib and the iliac crest, and insulin sensitivity was assessed by the rate constant of plasma glucose disappearance (Kitt %/min) using an insulin tolerance test. Visceral fat thickness was measured using ultrasonography. Statistical analysis was performed using receiver operating characteristic curve.
  
  
  RESULTS
  The optimal cutoff points for WC for identifying the presence of IR and visceral obesity, as well as two or more metabolic components, were 87 cm for men and 81 cm for women. Moreover, these cutoff points had the highest predictive powers for the presence of visceral obesity. The MetS defined by new criteria correlated with the increased carotid intima-media thickness in female subjects.
  
  
  CONCLUSIONS
  Our results suggest that the optimal cutoff values for WC in Koreans with type 2 diabetes should be reestablished based on IR and visceral obesity.
authors.affiliation: Division of Endocrinology, Department of Internal Medicine, Yonsei University Wonju College of Medicine, Wonju, Korea.
authors.forename: Jung Soo
authors.initials: JS
authors.lastname: Lim
authors.affiliation: Huh's Diabetes Center and the 21C Diabetes and Vascular Research Institute, Seoul, Korea.
authors.forename: Young Ju
authors.initials: YJ
authors.lastname: Choi
authors.affiliation: Department of Internal Medicine, CHA Bundang Medical Center, CHA University, Seongnam, Korea.
authors.forename: Soo-Kyung
authors.initials: SK
authors.lastname: Kim
authors.affiliation: Huh's Diabetes Center and the 21C Diabetes and Vascular Research Institute, Seoul, Korea.
authors.forename: Byoung Wook
authors.initials: BW
authors.lastname: Huh
authors.affiliation: Division of Endocrinology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea.
authors.forename: Eun Jig
authors.initials: EJ
authors.lastname: Lee
authors.affiliation: Huh's Diabetes Center and the 21C Diabetes and Vascular Research Institute, Seoul, Korea.
authors.forename: Kap Bum
authors.initials: KB
authors.lastname: Huh
keywords: Diabetes mellitus, type 2; Insulin resistance; Obesity, abdominal; Waist circumference