Insulin resistance as a potential mediator between central obesity and diabetic kidney disease risk in type 2 diabetes

A study of 4,674 patients with type 2 diabetes mellitus (T2DM) in Kaihua County, Zhejiang Province, examined the relationship between central obesity, insulin resistance (IR), and diabetic kidney disease (DKD) risk. Central obesity, as opposed to generalized obesity, was hypothesized to be more significantly associated with DKD risk in T2DM patients.

The prevalence of DKD in the patient group was 52.439%, while the overall obesity prevalence was 42.790%, with central obesity being the more common form. Results showed that central obesity, both isolated and combined with generalized obesity, was significantly linked to higher DKD risk after adjusting for various factors. However, the association weakened when metabolic factors like insulin resistance, glycemic parameters, and lipid profiles were taken into account.

Mediation analysis indicated that insulin resistance, as measured by the HOMA-IR index, accounted for 22.484% of the link between central obesity and DKD risk in the initial model, and this explanatory power reduced to 9.715% after accounting for BMI and other variables. These findings suggest that metabolic disturbances, including IR, may contribute to the connection between central obesity and DKD risk in T2DM patients.

Measurement of waist circumference (WC) could potentially be used alongside BMI to assess DKD risk in such populations.