Visceral obesity is a better predictor than generalized obesity for basal insulin requirement at the initiation of insulin therapy in patients with type 2 diabetes

Aims

Basal insulin requirement in patients with type 2 diabetes is difficult to determine because of individual variability in insulin sensitivity and secretion. We aimed to identify factors that influence basal insulin requirement in insulin-naïve patients with type 2 diabetes.

Methods

We studied 50 insulin-naïve patients with type 2 diabetes. Their basal insulin requirement was calculated by 8 h overnight intravenous insulin infusion. Patients underwent abdominal computed tomography; subcutaneous and visceral fat areas were measured.

Results

The basal insulin requirement was 31.3 ± 16.9 units/day, and it varied widely from 0.2 to 1.4 units/kg. It was positively correlated with visceral fat area (γ = 0.485, P < 0.001), body mass index (BMI, γ = 0.339, P = 0.008), glycated hemoglobin (HbA1C, γ = 0.327, P = 0.019), alanine aminotransferase (ALT, γ = 0.310, P = 0.027), and triglyceride (γ = 0.305, P = 0.032). However, body weight, waist circumference and total fat mass were not related to basal insulin requirement. Multiple linear regression analysis showed that visceral fat area, HbA1C, and ALT are independent predictors of basal insulin requirement.

Conclusions

Visceral obesity was a better predictor than generalized obesity for basal insulin requirement at the initiation of insulin therapy in patients with type 2 diabetes.