Lipoatrophy, Lipodystrophy, and Insulin Resistance

Abstract

Editorials15 August 2000Lipoatrophy, Lipodystrophy, and Insulin ResistanceOm P. Ganda, MDOm P. Ganda, MDJoslin Diabetes Center; Boston, MA 02215 (Ganda)Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-133-4-200008150-00017 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail In 1946, R.D. Lawrence described the characteristics of lipoatrophic diabetes, an unusual constellation of generalized absence of adipose tissue, insulin-resistant diabetes mellitus, absence of ketosis, marked lipemia with hepatomegaly, and elevated basal metabolic rate (1). More than 100 cases with similar features have been reported in the literature thus far (2, 3). Although the syndrome is rare, its true prevalence in unknown because of the heterogeneity of clinical features in individual patients.The absence of adipose tissue, initially considered to be a sine qua non, does not affect all parts of the body in many patients (hence the term lipodystrophy), ...References1. Lawrence RD. Lipodystrophy and hepatomegaly with diabetes, lipemia and other metabolic disturbances: a case throwing new light on the action of insulin. Lancet. 1946;1:724-31. CrossrefMedlineGoogle Scholar2. Rossini AA. Lipoatrophic diabetes. In: Marble A, Krall LP, Bradley RF, Christlieb AR, Soeldner JS, eds. Joslin's Diabetes Mellitus. 12th ed. Philadelphia: Lea & Febiger; 1985:834-42. Google Scholar3. Seip M, Trygstad O. Generalized lipodystrophy, congenital and acquired (lipoatrophy). Acta Paediatr Suppl. 1996;413:2-28. CrossrefMedlineGoogle Scholar4. Burant CF, Sreenan S, Hirano K, Tai TA, Lohmiller J, Lukens J. Troglitazone action is independent of adipose tissue. 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Troglitazone: antihyperglycemic activity and potential role in the treatment of type 2 diabetes. Diabetes Care. 1999;22:1568-77. CrossrefMedlineGoogle Scholar10. Arioglu E, Duncan-Morin J, Sebring N, Rother KI, Gottlieb N, Lieberman J, et al . Efficacy and safety of troglitazone in the treatment of lipodystrophy syndromes. Ann Intern Med. 2000;133:263-74. LinkGoogle Scholar11. Montague CT, O'Rahilly S. The perils of portliness: causes and consequences of visceral adiposity. Diabetes. 2000;49:883-8. CrossrefMedlineGoogle Scholar12. Barzilai N, She L, Liu BQ, Vuguin P, Cohen P, Wang J, et al . Surgical removal of visceral fat reverses hepatic insulin resistance. Diabetes. 1999;48:94-8. CrossrefMedlineGoogle Scholar13. Kelly IE, Han TS, Walsh K, Lean ME. Effects of a thiazolidinedione compound on body fat and fat distribution of patients with type 2 diabetes. Diabetes Care. 1999;22:288-93. CrossrefMedlineGoogle Scholar14. Mori Y, Murakawa Y, Okada K, Horikoshi H, Yokoyama J, Tajima N, et al . Effect of troglitazone on body fat distribution in type 2 diabetic patients. Diabetes Care. 1999;22:908-12. CrossrefMedlineGoogle Scholar15. Kelley DE, Mandarino LJ. Fuel selection in human skeletal muscle in insulin resistance. A reexamination. Diabetes. 2000;49:677-83. CrossrefMedlineGoogle Scholar16. Carr A, Samaras K, Thorisdottir A, Kaufmann GR, Chisholm DJ, Cooper DA. Diagnosis, prediction, and natural course of HIV-1 protease-inhibitor-associated lipodystrophy, hyperlipidemia, and diabetes mellitus: a cohort study. Lancet. 1999;353:2093-9. CrossrefMedlineGoogle Scholar17. Yanovski JA, Miller KD, Kino T, Friedman TC, Chrousos GP, Tsigos C, et al . Endocrine and metabolic evaluation of human immunodeficiency virus-infected patients with evidence of protease inhibitor-associated lipodystrophy. J Clin Endocrinol Metab. 1999;84:1925-31. CrossrefMedlineGoogle Scholar18. Hadigan C, Corcoran C, Stanley T, Piecuch S, Klibanski A, Grinspoon S. Fasting hyperinsulinemia in human immunodeficiency virus-infected men: relationship to body composition, gonadal function, and protease inhibitor use. J Clin Endocrinol Metab. 2000;85:35-41. MedlineGoogle Scholar19. Persighen G, Meneghini E, Scifo P, Pagliato E, Mignogna G, Tambussi G, et al . Intramyocellular triglyceride content is increased in HIV-1 patients with peripheral lipodystrophy [Abstract]. Diabetes. 2000;49 Suppl 1 A71. Google Scholar20. Henry K, Melroe H, Huebesch J, Hermundson J, Simpson J. Atorvastatin and gemfibrozil for protease-inhibitor-related lipid abnormalities [Letter]. Lancet. 1998;352:1031-2. CrossrefMedlineGoogle Scholar Author, Article, and Disclosure InformationAuthors: Om P. Ganda, MDAffiliations: Joslin Diabetes Center; Boston, MA 02215 (Ganda)Grant Support: In part by National Center for Research Resources–National Institutes of Health grant 2 MO1-RR001032-25 to the Beth Israel Deaconess Medical Center, General Clinical Research Center.Corresponding Author: Om P. Ganda, MD, Joslin Diabetes Center, 1 Joslin Place, Boston, MA 02215; e-mail, om.ganda@joslin.harvard.edu. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoEfficacy and Safety of Troglitazone in the Treatment of Lipodystrophy Syndromes Elif Arioglu , Jennifer Duncan-Morin , Nancy Sebring , Kristina I. Rother , Nicole Gottlieb , Jay Lieberman , David Herion , David E. Kleiner , James Reynolds , Ahalya Premkumar , Anne E. Sumner , Jay Hoofnagle , Marc L. Reitman , and Simeon I. 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