Type 2 diabetes with partial lipodystrophy of the limbs: A new lipodystrophy phenotype

Leah R. Strickland, Fangjian Guo, Kerry Lok, W. Timothy Garvey

Research output: Contribution to journalArticle

9 Citations (Scopus)

Abstract

OBJECTIVE-Lipodystrophies are categorized by the extent of fat loss (generalized vs. partial) and by inheritance (congenital vs. acquired). We examined whether a group of patients with partial lipodystrophy of the limbs (PLL), type 2 diabetes mellitus (T2DM), and an absence of a family history of lipodystrophy constitute a new clinical subtype. RESEARCH DESIGN AND METHODS-Ten women with T2DM and PLL were identified in academic diabetes clinics and were matched by age, sex, BMI, ethnicity, and diabetes status with 10 womenwith control T2DMwithout lipodystrophy. All patients were characterized by clinical evaluation and hyperinsulinemic clamp. RESULTS-Patients with T2DM and PLL exhibited symmetrical loss of subcutaneous fat in forearms, or forearms plus calves, and acanthosis nigricans. Maximally stimulated glucose disposal rates were markedly reduced by 56% in the T2DM with PLL group compared with the control T2DM patients, whether normalized by body weight or surface area. Most PLL patients exhibited little or no insulin-mediated glucose uptake after subtraction of non-insulin-mediated glucose uptake. The T2DM with PLL group also had greater elevations in hepatic transaminases and triglycerides and earlier onset of diabetes compared with control T2DM. CONCLUSIONS-T2DM with PLL represents a previously unrecognized phenotype of lipodystrophy and of T2DM. These T2DM patients exhibit symmetrical lipodystrophy of the distal limbs, acanthosis nigricans, marked insulin resistance with little insulin-mediated glucose uptake, hypertriglyceridemia, and hepatic transaminase elevations, which are greater in severitythan observed in patients with common T2DM.

Original languageEnglish (US)
Pages (from-to)2247-2253
Number of pages7
JournalDiabetes Care
Volume36
Issue number8
DOIs
StatePublished - 2013
Externally publishedYes

Fingerprint

Lipodystrophy
Type 2 Diabetes Mellitus
Extremities
Phenotype
Acanthosis Nigricans
Glucose
Transaminases
Forearm
Insulin
Hypertriglyceridemia
Subcutaneous Fat
Liver
Insulin Resistance
Triglycerides
Research Design

ASJC Scopus subject areas

  • Internal Medicine
  • Endocrinology, Diabetes and Metabolism
  • Advanced and Specialized Nursing
  • Medicine(all)

Cite this

Type 2 diabetes with partial lipodystrophy of the limbs : A new lipodystrophy phenotype. / Strickland, Leah R.; Guo, Fangjian; Lok, Kerry; Garvey, W. Timothy.

In: Diabetes Care, Vol. 36, No. 8, 2013, p. 2247-2253.

Research output: Contribution to journalArticle

Strickland, Leah R. ; Guo, Fangjian ; Lok, Kerry ; Garvey, W. Timothy. / Type 2 diabetes with partial lipodystrophy of the limbs : A new lipodystrophy phenotype. In: Diabetes Care. 2013 ; Vol. 36, No. 8. pp. 2247-2253.
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AU - Garvey, W. Timothy

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N2 - OBJECTIVE-Lipodystrophies are categorized by the extent of fat loss (generalized vs. partial) and by inheritance (congenital vs. acquired). We examined whether a group of patients with partial lipodystrophy of the limbs (PLL), type 2 diabetes mellitus (T2DM), and an absence of a family history of lipodystrophy constitute a new clinical subtype. RESEARCH DESIGN AND METHODS-Ten women with T2DM and PLL were identified in academic diabetes clinics and were matched by age, sex, BMI, ethnicity, and diabetes status with 10 womenwith control T2DMwithout lipodystrophy. All patients were characterized by clinical evaluation and hyperinsulinemic clamp. RESULTS-Patients with T2DM and PLL exhibited symmetrical loss of subcutaneous fat in forearms, or forearms plus calves, and acanthosis nigricans. Maximally stimulated glucose disposal rates were markedly reduced by 56% in the T2DM with PLL group compared with the control T2DM patients, whether normalized by body weight or surface area. Most PLL patients exhibited little or no insulin-mediated glucose uptake after subtraction of non-insulin-mediated glucose uptake. The T2DM with PLL group also had greater elevations in hepatic transaminases and triglycerides and earlier onset of diabetes compared with control T2DM. CONCLUSIONS-T2DM with PLL represents a previously unrecognized phenotype of lipodystrophy and of T2DM. These T2DM patients exhibit symmetrical lipodystrophy of the distal limbs, acanthosis nigricans, marked insulin resistance with little insulin-mediated glucose uptake, hypertriglyceridemia, and hepatic transaminase elevations, which are greater in severitythan observed in patients with common T2DM.

AB - OBJECTIVE-Lipodystrophies are categorized by the extent of fat loss (generalized vs. partial) and by inheritance (congenital vs. acquired). We examined whether a group of patients with partial lipodystrophy of the limbs (PLL), type 2 diabetes mellitus (T2DM), and an absence of a family history of lipodystrophy constitute a new clinical subtype. RESEARCH DESIGN AND METHODS-Ten women with T2DM and PLL were identified in academic diabetes clinics and were matched by age, sex, BMI, ethnicity, and diabetes status with 10 womenwith control T2DMwithout lipodystrophy. All patients were characterized by clinical evaluation and hyperinsulinemic clamp. RESULTS-Patients with T2DM and PLL exhibited symmetrical loss of subcutaneous fat in forearms, or forearms plus calves, and acanthosis nigricans. Maximally stimulated glucose disposal rates were markedly reduced by 56% in the T2DM with PLL group compared with the control T2DM patients, whether normalized by body weight or surface area. Most PLL patients exhibited little or no insulin-mediated glucose uptake after subtraction of non-insulin-mediated glucose uptake. The T2DM with PLL group also had greater elevations in hepatic transaminases and triglycerides and earlier onset of diabetes compared with control T2DM. CONCLUSIONS-T2DM with PLL represents a previously unrecognized phenotype of lipodystrophy and of T2DM. These T2DM patients exhibit symmetrical lipodystrophy of the distal limbs, acanthosis nigricans, marked insulin resistance with little insulin-mediated glucose uptake, hypertriglyceridemia, and hepatic transaminase elevations, which are greater in severitythan observed in patients with common T2DM.

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