Relationship between abdominal fat area and first-phase insulin secretion function of pancreatic β-cells in patients with type 2 diabetes

doi:10.3969/j.issn.1674-8115.2025.01.005

Abstract

Abstract:

Objective ·To explore the relationship between abdominal fat area and the first-phase insulin secretion function of pancreatic β-cells in patients with type 2 diabetes, and to establish predictive models of nomogram. Methods ·From October 2020 to February 2024, a total of 120 patients with type 2 diabetes, who were hospitalized in the Department of Endocrinology, Zhongshan Hospital, Fudan University, and underwent the arginine stimulation test, were recruited for the study. Patients were categorized into an insulin secretion function-preserved group (i.e. preserved group) and a depleted group according to the results of the arginine stimulation test. General information and laboratory parameters were collected. Subcutaneous fat area (SFA) and visceral fat area (VFA) were non-invasively measured by abdominal fat detector. The variables were screened by univariate analysis, and multivariate Logistic regression was used to identify the influencing factors, followed by the establishment of predictive models of nomogram. The area under the receiver operating characteristic curve (ROC curve) and concordance index (C-index) were used to evaluate the predictive performance of the models. Results ·Seventy-four patients (61.7%) were assigned to the preserved group, and 46 patients (38.3%) to the depleted group. Patients in the depleted group had a longer diabetes duration, lower waist circumference, hip circumference, body mass index (BMI), uric acid, free triiodothyronine (FT₃), adipose tissue insulin resistance (Adipo-IR), ankle brachial index (ABI), SFA and VFA, and higher brachial ankle pulse wave velocity (baPWV). Multivariate Logistic regression showed that SFA, VFA, FT₃, baPWV, and ABI were independent risk factors for the depleted insulin secretion function. Nomogram models were constructed based on the above risk factors. Among them, the model comprising VFA, FT₃, ABI, and baPWV showed the best predictive performance with a C-index of 0.81. Conclusion ·SFA and VFA are lower in patients with depleted first-phase insulin secretion function of pancreatic β-cells. The nomogram model, including SFA or VFA, can be used to predict first-phase insulin secretion function of pancreatic β-cells in patients with type 2 diabetes.

Key words: type 2 diabetes, abdominal fat area, insulin secretion function, nomogram

CLC Number:

R587.1

LU Jiaping, LIU Xing, ZHANG Linshan, ZHAO Lin, ZHANG Min, LI Xiaoying, LIU Yuejun. Relationship between abdominal fat area and first-phase insulin secretion function of pancreatic β-cells in patients with type 2 diabetes[J]. Journal of Shanghai Jiao Tong University (Medical Science), 2025, 45(1): 42-50.

Figures/Tables 5

TrendMD

References 24

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Item	Preserved group (n=74)	Depleted group (n=46)	P value
Age/year	54.0 (47.8, 64.0)	60.0 (50.5, 67.3)	0.096
Male/n(%)	52 (70.3)	26 (56.5)	0.125
Hypertension/n(%)	36 (48.6)	26 (56.5)	0.401
Dyslipidemia/n(%)	64 (86.5)	37 (80.4)	0.529
Abdominal obesity/n(%)	57 (77.0)	22 (47.8)	<0.001
MetS score/n(%)			0.036
1 point or 2 points	15 (20.3)	19 (41.3)
3 points	31 (41.9)	12 (26.1)
4 points	28 (37.8)	15 (32.6)
Diabetes duration/year	5.00 (0, 10.00)	10.00 (4.00, 20.00)	<0.001
Treated with insulin/n(%)	21 (28.4)	21 (45.7)	0.054
Waist circumference/cm	93.20±8.46	88.47±8.75	0.004
Hip circumference/cm	99.74±6.05	94.98±7.83	<0.001
Waist-to-hip ratio	0.93±0.06	0.93±0.06	0.848
Weight/kg	74.22±10.75	67.40±11.33	0.001
BMI/(kg·m^-2)	25.46 (24.10, 27.75)	23.71 (22.70, 25.99)	0.002
FPG/(mmol·L^-¹)	7.60 (6.30, 9.90)	8.15 (6.28, 10.90)	0.492
Fasting insulin/(pmol·L^-1)	64.58 (38.19, 88.89)	42.36 (18.40, 64.24)	0.006
Fasting C-peptide/(ng·mL^-¹)	2.31 (1.62, 2.86)	1.78 (1.09, 2.26)	0.003
HOMA-IR	2.73 (1.96, 4.60)	1.82 (1.19, 2.63)	0.016
HOMA-β	44.64 (25.29, 73.03)	26.32 (8.80, 66.71)	0.082
2 h-PG/(mmol·L^-1)	11.10 (8.90, 14.20)	11.20 (9.05, 14.45)	0.779
2 h-insulin/(pmol·L^-1)	165.58 (81.94, 254.17)	138.89 (57.99, 211.46)	0.268
2 h-C-peptide/(ng·mL^-1)	4.61 (2.89, 6.43)	3.29 (2.10, 5.03)	0.120
GA/%	22.05 (17.93, 28.55)	25.80 (20.20, 31.20)	0.086
HbA_1C/%	9.35 (7.68, 10.78)	9.90 (8.45, 11.40)	0.089
ALT/(U·L^-1)	18.50 (13.75, 33.50)	17.00 (10.75, 25.25)	0.075
AST/(U·L^-1)	18.00 (14.00, 27.35)	15.00 (12.00, 23.25)	0.068
GGT/(U·L^-1)	26.50 (18.75, 47.50)	22.00 (15.00, 32.50)	0.091
TBA/(μmol·L^-¹)	3.30 (2.15, 5.20)	3.10 (1.80, 4.33)	0.444
Scr/(μmol·L^-¹)	68.00 (60.00, 81.00)	68.50 (56.75, 82.00)	0.885
eGFR/[mL·(min·1.73m²)^-1]	98.00 (83.00, 108.00)	92.00 (80.00, 102.75)	0.232
UA/(μmol·L^-¹)	337.00 (274.00, 403.00)	284.00 (241.75, 354.00)	0.049
24 h-UAE/[mg·(24 h)^-¹]	15.85 (8.99, 24.19)	19.75 (11.26, 32.99)	0.125
TC/(mmol·L^-¹)	4.57±1.11	4.56±0.92	0.956
TAG/(mmol·L^-¹)	1.62 (1.27, 2.26)	1.55 (1.05, 2.17)	0.473
LDL-C/(mmol·L^-¹)	2.67±0.96	2.66±0.86	0.934
NHDL-C/(mmol·L^-¹)	3.34 (2.82, 4.17)	3.52 (2.64, 4.04)	0.987
HDL-C/(mmol·L^-¹)	1.05 (0.91, 1.18)	1.08 (0.96, 1.24)	0.308
FFA/(mmol·L^-¹)	0.54 (0.43, 0.61)	0.47 (0.33, 0.62)	0.088
Adipo-IR	4.22 (2.71, 7.11)	3.11 (1.45,6.25)	0.040
FT₃/(pmol·L^-1)	4.50 (4.10, 4.90)	4.20 (3.65, 4.55)	0.001
FT₄/(pmol·L^-1)	16.59±2.78	16.99±2.10	0.405
TSH/(mIU·L^-1)	1.76 (1.10, 2.08)	1.43 (1.06, 2.36)	0.359
CRP/(mg·L^-1)	1.05 (0.53, 2.08)	0.90 (0.58, 2.25)	0.871
SAA/(mg·L^-1)	3.50 (3.33, 4.25)	3.50 (3.20, 5.43)	0.993
ESR/(mm·h^-1)	7.00 (4.00, 13.00)	10.00 (3.50, 15.00)	0.385
IMT≥1.0 mm/n(%)	14 (22.2)	10 (26.3)	0.640
baPWV/(m·s^-1)	15.41 (13.57, 17.83)	17.63 (14.18, 22.19)	0.009
ABI	1.16 (1.08, 1.22)	1.12 (1.06, 1.17)	0.033
CAP/(dB·m^-1)	275.68±52.84	267.00±59.18	0.478
LSM/kPa	5.65 (4.50, 6.55)	5.25 (4.33, 6.23)	0.415
VFA/cm²	81.91±30.81	64.50±29.21	0.003
SFA/cm²	186.30 (156.40, 227.70)	151.95 (127.15, 190.55)	<0.001

Item	Preserved group (n=74)	Depleted group (n=46)	P value
Age/year	54.0 (47.8, 64.0)	60.0 (50.5, 67.3)	0.096
Male/n(%)	52 (70.3)	26 (56.5)	0.125
Hypertension/n(%)	36 (48.6)	26 (56.5)	0.401
Dyslipidemia/n(%)	64 (86.5)	37 (80.4)	0.529
Abdominal obesity/n(%)	57 (77.0)	22 (47.8)	<0.001
MetS score/n(%)			0.036
1 point or 2 points	15 (20.3)	19 (41.3)
3 points	31 (41.9)	12 (26.1)
4 points	28 (37.8)	15 (32.6)
Diabetes duration/year	5.00 (0, 10.00)	10.00 (4.00, 20.00)	<0.001
Treated with insulin/n(%)	21 (28.4)	21 (45.7)	0.054
Waist circumference/cm	93.20±8.46	88.47±8.75	0.004
Hip circumference/cm	99.74±6.05	94.98±7.83	<0.001
Waist-to-hip ratio	0.93±0.06	0.93±0.06	0.848
Weight/kg	74.22±10.75	67.40±11.33	0.001
BMI/(kg·m^-2)	25.46 (24.10, 27.75)	23.71 (22.70, 25.99)	0.002
FPG/(mmol·L^-¹)	7.60 (6.30, 9.90)	8.15 (6.28, 10.90)	0.492
Fasting insulin/(pmol·L^-1)	64.58 (38.19, 88.89)	42.36 (18.40, 64.24)	0.006
Fasting C-peptide/(ng·mL^-¹)	2.31 (1.62, 2.86)	1.78 (1.09, 2.26)	0.003
HOMA-IR	2.73 (1.96, 4.60)	1.82 (1.19, 2.63)	0.016
HOMA-β	44.64 (25.29, 73.03)	26.32 (8.80, 66.71)	0.082
2 h-PG/(mmol·L^-1)	11.10 (8.90, 14.20)	11.20 (9.05, 14.45)	0.779
2 h-insulin/(pmol·L^-1)	165.58 (81.94, 254.17)	138.89 (57.99, 211.46)	0.268
2 h-C-peptide/(ng·mL^-1)	4.61 (2.89, 6.43)	3.29 (2.10, 5.03)	0.120
GA/%	22.05 (17.93, 28.55)	25.80 (20.20, 31.20)	0.086
HbA_1C/%	9.35 (7.68, 10.78)	9.90 (8.45, 11.40)	0.089
ALT/(U·L^-1)	18.50 (13.75, 33.50)	17.00 (10.75, 25.25)	0.075
AST/(U·L^-1)	18.00 (14.00, 27.35)	15.00 (12.00, 23.25)	0.068
GGT/(U·L^-1)	26.50 (18.75, 47.50)	22.00 (15.00, 32.50)	0.091
TBA/(μmol·L^-¹)	3.30 (2.15, 5.20)	3.10 (1.80, 4.33)	0.444
Scr/(μmol·L^-¹)	68.00 (60.00, 81.00)	68.50 (56.75, 82.00)	0.885
eGFR/[mL·(min·1.73m²)^-1]	98.00 (83.00, 108.00)	92.00 (80.00, 102.75)	0.232
UA/(μmol·L^-¹)	337.00 (274.00, 403.00)	284.00 (241.75, 354.00)	0.049
24 h-UAE/[mg·(24 h)^-¹]	15.85 (8.99, 24.19)	19.75 (11.26, 32.99)	0.125
TC/(mmol·L^-¹)	4.57±1.11	4.56±0.92	0.956
TAG/(mmol·L^-¹)	1.62 (1.27, 2.26)	1.55 (1.05, 2.17)	0.473
LDL-C/(mmol·L^-¹)	2.67±0.96	2.66±0.86	0.934
NHDL-C/(mmol·L^-¹)	3.34 (2.82, 4.17)	3.52 (2.64, 4.04)	0.987
HDL-C/(mmol·L^-¹)	1.05 (0.91, 1.18)	1.08 (0.96, 1.24)	0.308
FFA/(mmol·L^-¹)	0.54 (0.43, 0.61)	0.47 (0.33, 0.62)	0.088
Adipo-IR	4.22 (2.71, 7.11)	3.11 (1.45,6.25)	0.040
FT₃/(pmol·L^-1)	4.50 (4.10, 4.90)	4.20 (3.65, 4.55)	0.001
FT₄/(pmol·L^-1)	16.59±2.78	16.99±2.10	0.405
TSH/(mIU·L^-1)	1.76 (1.10, 2.08)	1.43 (1.06, 2.36)	0.359
CRP/(mg·L^-1)	1.05 (0.53, 2.08)	0.90 (0.58, 2.25)	0.871
SAA/(mg·L^-1)	3.50 (3.33, 4.25)	3.50 (3.20, 5.43)	0.993
ESR/(mm·h^-1)	7.00 (4.00, 13.00)	10.00 (3.50, 15.00)	0.385
IMT≥1.0 mm/n(%)	14 (22.2)	10 (26.3)	0.640
baPWV/(m·s^-1)	15.41 (13.57, 17.83)	17.63 (14.18, 22.19)	0.009
ABI	1.16 (1.08, 1.22)	1.12 (1.06, 1.17)	0.033
CAP/(dB·m^-1)	275.68±52.84	267.00±59.18	0.478
LSM/kPa	5.65 (4.50, 6.55)	5.25 (4.33, 6.23)	0.415
VFA/cm²	81.91±30.81	64.50±29.21	0.003
SFA/cm²	186.30 (156.40, 227.70)	151.95 (127.15, 190.55)	<0.001

Item	β	OR (95%CI)	P value
Model 1
Diabetes duration	0.052	1.053 (0.986‒1.124)	0.121
ABI×10	-0.600	0.549 (0.321‒0.939)	0.028
baPWV	0.149	1.160 (1.011‒1.331)	0.034
SFA	-0.012	0.988 (0.978‒0.997)	0.012
Model 2
Diabetes duration	0.052	1.054 (0.979‒1.135)	0.166
Fasting C-peptide	-0.396	0.673 (0.385‒1.177)	0.165
UA	-0.002	0.998 (0.993‒1.003)	0.425
FT₃	-1.098	0.333 (0.145‒0.769)	0.010
ABI×10	-0.622	0.537 (0.303‒0.951)	0.033
baPWV	0.185	1.203 (1.029‒1.406)	0.020
SFA	-0.010	0.990 (0.980‒1.001)	0.076
Model 3
Diabetes duration	0.056	1.057 (0.990‒1.129)	0.096
ABI×10	-0.695	0.499 (0.285‒0.874)	0.015
baPWV	0.159	1.172 (1.020‒1.347)	0.025
VFA	-0.026	0.974 (0.957‒0.992)	0.005
Model 4
Diabetes duration	0.058	1.060 (0.983‒1.143)	0.130
Fasting C-peptide	-0.459	0.632 (0.361‒1.108)	0.109
UA	-0.001	0.999 (0.994‒1.004)	0.753
FT₃	-1.057	0.348 (0.154‒0.783)	0.011
ABI×10	-0.689	0.502 (0.279‒0.903)	0.021
baPWV	0.198	1.219 (1.040‒1.428)	0.015
VFA	-0.022	0.978 (0.957‒0.999)	0.036

Item	β	OR (95%CI)	P value
Model 1
Diabetes duration	0.052	1.053 (0.986‒1.124)	0.121
ABI×10	-0.600	0.549 (0.321‒0.939)	0.028
baPWV	0.149	1.160 (1.011‒1.331)	0.034
SFA	-0.012	0.988 (0.978‒0.997)	0.012
Model 2
Diabetes duration	0.052	1.054 (0.979‒1.135)	0.166
Fasting C-peptide	-0.396	0.673 (0.385‒1.177)	0.165
UA	-0.002	0.998 (0.993‒1.003)	0.425
FT₃	-1.098	0.333 (0.145‒0.769)	0.010
ABI×10	-0.622	0.537 (0.303‒0.951)	0.033
baPWV	0.185	1.203 (1.029‒1.406)	0.020
SFA	-0.010	0.990 (0.980‒1.001)	0.076
Model 3
Diabetes duration	0.056	1.057 (0.990‒1.129)	0.096
ABI×10	-0.695	0.499 (0.285‒0.874)	0.015
baPWV	0.159	1.172 (1.020‒1.347)	0.025
VFA	-0.026	0.974 (0.957‒0.992)	0.005
Model 4
Diabetes duration	0.058	1.060 (0.983‒1.143)	0.130
Fasting C-peptide	-0.459	0.632 (0.361‒1.108)	0.109
UA	-0.001	0.999 (0.994‒1.004)	0.753
FT₃	-1.057	0.348 (0.154‒0.783)	0.011
ABI×10	-0.689	0.502 (0.279‒0.903)	0.021
baPWV	0.198	1.219 (1.040‒1.428)	0.015
VFA	-0.022	0.978 (0.957‒0.999)	0.036

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