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OBJECTIVE -The purpose of this study was to determine whether type 2 diabetic patients have more liver fat than age-, sex-, and BMI-matched nondiabetic subjects and whether liver enzymes (serum alanine aminotransferase [S-ALT] and serum aspartate aminotransferase) are similarly related to liver fat in type 2 diabetic patients and normal subjects. RESEARCH DESIGN AND METHODS -Seventy type 2 diabetic patients and 70nondiabetic subjects matched for BMI, age, and sex were studied. Liver fat ( 1 H-magnetic resonance spectroscopy), body composition (magnetic resonance imaging), and biochemical markers of insulin resistance were measured.RESULTS -The type 2 diabetic patients had, on average, 80% more liver fat and 16% more intra-abdominal fat than the nondiabetic subjects. The difference in liver fat between the two groups remained statistically significant when adjusted for intra-abdominal fat (P Ͻ 0.05). At any given BMI or waist circumference, the type 2 diabetic patients had more liver fat than the nondiabetic subjects. The difference in liver fat between the groups rose as a function of BMI and waist circumference. Fasting serum insulin (r ϭ 0.55, P Ͻ 0.0001), fasting plasma glucose (r ϭ 0.29, P ϭ 0.0006), A1C (r ϭ 0.34, P Ͻ 0.0001), fasting serum triglycerides (r ϭ 0.36, P Ͻ 0.0001), and fasting serum HDL cholesterol (r ϭ Ϫ0.31, P ϭ 0.0002) correlated with liver fat similarly in both groups. The slopes of the relationships between S-ALT and liver fat were significantly different (P ϭ 0.004). Liver fat content did not differ between the groups at low S-ALT concentrations (10 -20 units/l) but was 70 -200% higher in type 2 diabetic patients compared with control subjects at S-ALT concentrations of 50 -200 units/l. CONCLUSIONS -Type 2 diabetic patients have 80% more liver fat than age-, weight-, and sex-matched nondiabetic subjects. S-ALT underestimates liver fat in type 2 diabetic patients. Diabetes Care 31:165-169, 2008I t has been estimated that ϳ70 -80% of type 2 diabetic patients have nonalcoholic fatty liver disease (1,2). In addition, 9 of 12 prospective epidemiological studies have shown that elevated serum liver enzyme concentrations predict type 2 diabetes independent of obesity (3). These data thus suggest that liver fat content is increased in patients with type 2 diabetes compared with equally obese nondiabetic subjects. To date, only one study has addressed this question (4). In this study, liver fat was measured qualitatively using the liver-to-spleen attenuation ratio (4). Liver fat was increased in type 2 diabetic patients compared with 10 weight-matched normal subjects (4). The small number of normal subjects, however, prevents any firm conclusions from being drawn.Clinically, it would be helpful to have a simple measure of liver fat in patients with type 2 diabetes, as liver fat is closely correlated with insulin requirements (5,6) and may be an important parameter to consider when choosing patients for peroxisome proliferator-activated receptor-␥ agonist therapy (7,8). Serum alanine aminotransfera...

OBJECTIVE -Insulin is often postponed for years because initiation is time-consuming. We sought to compare initiation of insulin individually and in groups with respect to change in A1C and several other parameters in type 2 diabetic patients. RESEARCH DESIGN AND METHODS-A randomized (1:1), multicenter, two-arm, parallel design study with a recruiting period of up to 14 weeks and a 24-week treatment period. Either in groups of 4 -8 or individually, using the same personnel and education program, 121 insulin-naive type 2 diabetic patients with an A1C of 7.0 -12.0% were randomized to initiate bedtime insulin glargine. The patients visited the treatment center before and at the time of insulin initiation and at 6, 12, and 24 weeks. Patients self-adjusted the insulin dose to achieve a fasting plasma glucose 4.0 -5.5 mmol/l. RESULTS -At 24 weeks, mean Ϯ SE A1C had decreased from 8.7 Ϯ 0.2 to 6.9 Ϯ 0.1% in those treated individually and from 8.8 Ϯ 0.2 to 6.8 Ϯ 0.1% in those in groups (not significant [NS]). Insulin doses averaged 62 Ϯ 5 IU and 56 Ϯ 5 IU at 24 weeks (NS), respectively. The frequency of hypoglycemia was similar. The total time (visits and phone calls) spent in initiating insulin in the patients in groups (2.2 Ϯ 0.1 h) was 48% less than in those treated individually (4.2 Ϯ 0.2 h). Diabetes treatment satisfaction improved significantly in both sets of patients.CONCLUSIONS -Similar glycemic control and treatment satisfaction can be achieved by initiating insulin in groups and individually. Starting insulin in groups takes one-half as much time as individual initiation.

insulin therapy improves hepatic insulin sensitivity and slightly but significantly reduces liver fat content, independent of serum adiponectin.