Sex Differences in the Associations Between Visceral Adiposity and Hepatic Insulin Clearance in Type 2 Diabetes Mellitus: A Quantitative CT Study.

AIMS: To investigate sex-related differences in the association of body fat distribution with hepatic insulin clearance (HIC) in type 2 diabetes mellitus (T2DM), determining whether HIC associates more strongly with static hepatic steatosis or visceral adiposity.

METHODS

We retrospectively analyzed 234 inpatients with T2DM (146 men, 88 women). Regional and ectopic fat were quantified via deep-learning computed tomography (CT). HIC was derived from oral glucose tolerance tests. Multivariable regression and propensity score matching (PSM) identified independent HIC determinants.

RESULTS

Men had larger visceral adipose tissue (VAT) areas; women had higher hepatic fat. VAT was independently associated with systemic insulin resistance. After adjusting for insulin resistance, VAT was positively associated with HIC in women (β = 0.395, P = 0.008), but not men (β = -0.047, P = 0.636). These patterns persisted in the PSM cohort (P for interaction = 0.025), even after additional adjustment for insulin resistance (P for interaction = 0.07). CT-assessed hepatic fat showed no independent association with HIC.

CONCLUSIONS

The association between visceral adiposity and HIC is sex-related, with preserved adaptation in women but not in men. Visceral adiposity is more strongly associated with clearance dynamics than static hepatic steatosis, improving the pathophysiological characterization of T2DM.