NSULIN RESISTANCE IN RELATION TO OBESITY, NON- ALCOHOLIC FATTY LIVER DISEASE, SEXUAL DYSFUNCTION AND DYSLIPIDAEMIA AMONG MEN CLINICALLY DIAGNOSED WITH TYPE 2 DIABETES

Abstract

From a pathophysiological standpoint, type 2 diabetes can result from insulin resistance or insulin insufficiency alone. It is unclear which of the two is linked to adverse health outcomes. Therefore, the objective of this study was to evaluate the relationship between insulin resistance (IR) and obesity, dyslipidaemia, non-alcoholic fatty liver disease (NAFLD), and sexual dysfunction (SD) in men with type 2 diabetes mellitus as well as the interaction between IR and obesity on adverse cardiometabolic outcomes. One hundred twenty-one (121) type 2 diabetic men participated in this cross-sectional study, which was conducted between September 2018 and September 2019. To collect sociodemographic information, a self-made questionnaire was used. Anthropometric measures were also taken and blood samples collected for measurement of insulin, glucose and other biochemical parameters. Sexual dysfunction was assessed using a GRISS questionnaire and non-alcoholic fatty liver disease, using the fatty liver index. HOMA-IR was calculated from the fasting insulin and glucose values and a HOMA-IR ≥2 was considered as insulin resistance. Of the 121 participants, 39.7% were classified as insulin resistant. Anthropometric markers of obesity and prevalence of obesity were higher in the insulin resistant group, whiles adiponectin was lower in the insulin resistant group. Similarly, LDL-c and total cholesterol were higher in the insulin resistance group with LDL but were not independently associated with insulin resistance. Fatty liver index and AST were higher and independently associated with insulin resistance. Even though the sexual dysfunction score was higher in the insulin resistance, only non-communication and infrequency were independently associated with insulin resistance. BMI, LDL-c, AST and stanine score for infrequency of sex, were found to better classify subjects as insulin resistance and may prove useful in risk stratification. A comorbidity of obesity and insulin resistance were seen to reflect higher levels total cholesterol, LDL-cholesterol, fatty liver index and testosterone levels than in isolated cases of the two abnormalities. Insulin resistance among type two diabetics is thus independently associated with obesity, low adiponectin levels, high risk of non-alcoholic fatty liver disease and higher testosterone. Estimation of c-peptide instead of insulin in the assessment of insulin resistance may prove useful in future studies.