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Annaswamy Raji, Ellen W. Seely, Ronald A. Arky, Donald C. Previous studies have shown that Asian Indians AIs are insulin resistant and at high risk for developing diabetes and coronary heart disease, compared with Caucasians. To examine whether differences in body fat distribution contribute to this risk, 12 healthy AIs and 12 Caucasians matched for age and body mass index BMI underwent a g oral glucose tolerance test, 2-h euglycemic hyperinsulinemic clamp, abdominal L2—3 computed tomography scan, and fasting lipid and plasminogen activator inhibitor-1 PAI-1 levels. For comparable BMI and age, healthy AIs have physiologic markers for insulin resistance, dyslipidemia, and increased cardiovascular risk, compared with Caucasians.
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The rates of coronary disease have accelerated dramatically amongst South Asians, driven to an important extent by the atherogenic dyslipidemia and type 2 diabetes that have become so common amongst them. These precursors of vascular disease appear at lower absolute amounts of adipose tissue in South Asians than in whites. In this paper, we set out a new hypothesis—the adipose tissue overflow hypothesis—to account for these findings. The adipose tissue mass within our bodies can be divided into three different compartments: superficial subcutaneous adipose tissue, deep subcutaneous adipose tissue and visceral adipose tissue. The superficial subcutaneous adipose tissue compartment is the primary compartment, is present throughout the body, and constitutes the vast majority of the adipose tissue in the lower limb. With energy excess, the secondary adipose tissue compartments—the deep subcutaneous mainly upper body and the visceral adipose tissue compartments—become more prominent. Superficial subcutaneous adipose tissue is relatively inert metabolically, whereas the other two compartments are characterized by higher transmembrane fatty acid flux rates and thus are more closely linked to dyslipidemia and dysglycemia.
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And treatments for each, especially the many categories lumped under type 2 needs to vary from patient to patient. Most general physicians, especially in India, will be unfamiliar with the heterogeneous nature of type 2 diabetes, especially with the different responses to insulin among different patients, said Dr. The current five classifications are Severe Insulin-Resistant Diabetes SIRD , which results in the highest levels of insulin resistance and highest risk of kidney disease. This, said Mohan, happens to more obese patients.
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