Abstract
Aims. To determine the progression of body weight (BW) and body composition (BC) in patients with type 2 diabetes mellitus (T2D) on insulin therapy and the consequences on muscle strength (MS) as a reflect of free fat mass increases. Research design and methods. We analysed BC using air displacement plethysmography and MS by hand grip dynamometry in 40 T2D before and after three (M3) and six months (M6) of insulin therapy. Results. at baseline HbA1c was 9.76 ±1.6% and BW was stable with fat mass (FM) 28 ± 10.7 kg; and fat free mass (FFM) 52.4 ± 11 kg; at M6, HbA1c improved to 7.56 ± 0.8%; insulin doses tended to increase. BW gain at M6 was + 3.2 ± 4.2 kg and with an increase of only 25% by M3; it was composed of FM, whereas FFM was unchanged. MS did not increase on insulin therapy. Conclusions. In T2D, BW gain was composed exclusively of FM with no improvement in MS.
Highlights
Insulin is a major therapeutic tool for insulin-deficient patients with type 1 diabetes mellitus, and for patients with type 2 diabetes mellitus (T2D), with both insulin resistance and a relative insulin deficiency [1]
We studied the progression of body weight (BW), body composition (BC), and muscle strength (MS) during six months after starting insulin therapy in 40 T2D
All the weight gain was due to fat mass (FM) (+3.1 ± 2.7 kg), whereas fat-free mass (FFM) was unchanged (−0.1 ± 1.6 kg) and T2D did not gain MS on insulin therapy
Summary
Insulin is a major therapeutic tool for insulin-deficient patients with type 1 diabetes mellitus, and for patients with type 2 diabetes mellitus (T2D), with both insulin resistance and a relative insulin deficiency [1]. Its effects on glucose metabolism are well known, but insulin influences lipid and protein metabolism with anabolic and anticatabolic effects. These have been less studied despite body weight (BW) gain being an important consequence of insulin therapy, identified in both the DCCT [2] and UKPDS [3] studies. Analysis of body composition (BC) changes can help determine whether insulin-induced BW gain can be considered as beneficial or not, by distinguishing the accumulation of fat (FM) from that of fat-free mass (FFM). Air displacement plethysmography is a new, safe, quick, and valid technique, providing accurate measurements of body density [6] and discriminating moderate changes in FM and FFM [7]. Some uncertainties due to the hydration of FFM may influence any two-compartment model-based analysis [8], the simultaneous measurement of muscle strength (MS) by dynamometry can be used to confirm the results of FFM: a correlation between FFM and MS has been previously demonstrated [9,10,11]
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