Adipose tissue distribution is associated with glycaemic control and microalbuminuria in Chinese patients with type 2 diabetes: a cross-sectional study

Abstract

BackgroundAbdominal adipose tissue has an important role in the development of type 2 diabetes. It has also been suggested to be involved in the prognosis of the disease. Therefore, this study aimed to investigate the association between adipose tissue distribution by anthropometric measures, glycaemic control, and microalbuminuria in Chinese patients with type 2 diabetes. MethodsA cross-sectional study was done in 1738 patients with clinically diagnosed and new-onset type 2 diabetes (aged 40 years or older) from Shanghai, China. Anthropometric measures and personal information were collected using a standard protocol. Blood samples were obtained for biochemical measurement, and first-voided early-morning spot urine samples were collected for urinary albumin-to-creatinine ratio measurement. This study was approved by the institutional review board of Rui-Jin Hospital affiliated to Shanghai Jiao-Tong University School of Medicine, Shanghai, China. All participants signed consent forms before recruitment. FindingsBoth waist-to-hip ratio (WHR) and waist-to-height ratio (WHtR) were significantly associated with fasting (WHR standardised β=0·122 [p<0·0001], WHtR standardised β=0·139 [p=0·003]), 2-hour postprandial plasma glucose (WHR standardised β=0·121 [p<0·0001], WHtR standardised β=0·181 [p=0·0001]), and HbA1c concentrations (WHR standardised β=0·135 [p<0·0001], WHtR standardised β=0·206 [p<0·0001]), independently of body-mass index. Stepwise linear regression showed that WHR was independently associated with HbA1c concentrations in patients with previously diagnosed (standardised β=0·105 [p=0·003]) and new-onset (standardised β=0·143 [p<0·0001]) disease. Overall, high WHR (>0·93 in men and >0·89 in women) increased the risk of poor glycaemic control (HbA1c >6·5%) by 63% (95% CI 1·31–2·03 [p<0·0001]). After further adjustment for HbA1c concentrations, WHR (standardised β=0·041 [p=0·040]) and WHtR (standardised β=0·172 [p<0·0001]) remained significantly associated with urinary albumin-to-creatinine ratio. WHtR was independently associated with urinary albumin-to-creatinine ratio in patients with previously diagnosed (standardised β=0·221; p<0·0001) and new-onset (standardised β=0·074; p=0·019) disease. InterpretationAbdominal adipose tissue has an independent role in the prognoses of type 2 diabetes irrespective of drugs and other intervention. The data also provided evidence on the value of clinical screening by anthropometric measures for identification of patients with type 2 diabetes who are more susceptible to poor glycaemic control and early-stage nephropathy. FundingThis study was supported by grants from the National Clinical Research Center for Metabolic Diseases, the National Key New Drug Creation and Manufacturing Program of Ministry of Science and Technology, the National High Technology Research and Development Program of China (863 Program), and the National Natural Science Foundation of China.