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The normal-weight type 2 diabetes phenotype revisited.

Michel P Hermans1, K Daniel Amoussou-Guenou2, Evariste Bouenizabila3

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Diabetes & Metabolic Syndrome
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Summary

Metabolically obese normal-weight (MONW) individuals with type 2 diabetes (T2DM) are a significant minority with increased cardiometabolic risks. These patients exhibit higher rates of vascular damage despite a normal body mass index (BMI).

Keywords:
Atherogenic dyslipidemiaDiabetesHandednessMetabolic syndromeObesity

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Area of Science:

  • Endocrinology
  • Metabolic Health
  • Cardiovascular Disease

Background:

  • Type 2 diabetes (T2DM) is linked to obesity, insulin resistance, and metabolic syndrome (MetS).
  • Metabolically obese normal-weight (MONW) individuals, characterized by normal weight but metabolic dysfunction, are recognized in non-diabetic populations.
  • The cardiometabolic profile of MONW individuals within the T2DM population remains under-characterized.

Purpose of the Study:

  • To determine the prevalence and cardiometabolic features of MONW individuals among T2DM patients.
  • To compare the clinical and biochemical characteristics of MONW patients with metabolically healthy normal-weight (NW-MetS[-]) T2DM patients.

Main Methods:

  • Analysis of 1244 T2DM patients to identify MONW (BMI <25.0 and MetS score ≥3/5).
  • Comparison of normal-weight (NW) T2DM patients with and without MetS (NW-MetS[+] vs. NW-MetS[-]).
  • Assessment of anthropometric, metabolic, and vascular parameters, including macro- and microvascular complications.

Main Results:

  • MONW individuals constituted approximately 9% of the T2DM cohort.
  • NW-MetS[+] patients exhibited higher BMI, waist circumference, fat mass, liver steatosis, HbA1c, apoB100, and triglycerides, alongside lower insulin sensitivity, HDL-C, and LDL size compared to NW-MetS[-].
  • Significantly higher prevalence of macrovascular (39% vs. 22%) and microvascular (54% vs. 32%) complications, including coronary artery disease, peripheral artery disease, retinopathy, and neuropathy, was observed in NW-MetS[+] patients.

Conclusions:

  • MONW represents a significant subgroup within T2DM patients, often overlooked due to normal BMI.
  • These individuals face a substantially elevated risk of cardiometabolic comorbidities and vascular damage.
  • The findings underscore the importance of assessing metabolic health beyond BMI in T2DM management to identify at-risk individuals.