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Abstract

Millions of Americans are afflicted by obesity and type 2 diabetes mellitus. Obesity is characterized by increased body adiposity and leads to insulin resistance. Paradoxically, some conditions that are characterized by a paucity of fat also cause insulin resistance, namely the syndromes of lipoatrophy (Fig. 1). The resemblance between the metabolic abnormalities of these two extreme states of adiposity emphasizes the importance of fat tissue in energy homeostasis. This review focuses on the syndromes of lipodystrophy and lipoatrophy that are at the lean extreme of the spectrum and which are characterized by near-complete absence of fat.

Long-term effectiveness and safety of metreleptin in the treatment of patients with generalized lipodystrophy

“…Lipodystrophy can be classified according to etiology and distribution of fat loss, leading to four main categories: congenital or acquired generalized lipodystrophy (GL) and familial or acquired partial lipodystrophy [1, 4]. Congenital GL has been ascribed to multiple genetic causes, whereas acquired GL may result from the autoimmune destruction of adipocytes and has been associated with several autoimmune disorders [1, 5, 6]. In some cases, genetic forms of lipodystrophy may only become clinically evident after infancy, and thus may be misdiagnosed as acquired GL (EAO and RB, unpublished observations).…”

Application of Nanoparticles: Diagnosis, Therapeutics, and Delivery of Insulin/Anti-Diabetic Drugs to Enhance the Therapeutic Efficacy of Diabetes Mellitus

“…According to several kinds of literature most DM cases fall into three main categories: (i) Type 1 diabetes (insulin-dependent DM, due to β-cell destruction, usually leading to absolute insulin deficiency); (ii) Type 2 diabetes (non-insulin-dependent DM, due to insulin resistance in peripheral organs) and (iii) Gestational diabetes mellitus (GDM) (diabetes diagnosed in the 2nd or 3rd trimester of pregnancy). In addition to those major categories, there are also minor types of diabetes due to other causes, including, diseases of the exocrine pancreas (such as cystic fibrosis, pancreatitis, pancreatectomy), a genetic defect of β-cell function (such as neonatal diabetes and maturity-onset diabetes of the young) [13], a genetic defect of insulin action (such as leprechaunism, Rabson-Mendenhall syndrome, lipoatrophic diabetes) [14][15][16], endocrinopathies (such as acromegaly, Cushing's syndrome, glucagonoma, pheochromocytoma, hyperthyroidism, somatostatinoma, aldosteronoma) [17] and drug or chemical-induced diabetes (such as glucocorticoids, statins, nicotinic acid, calcineurin inhibitors) [18].…”

The subtleties of insulin treatment in patients with lipodystrophy

“…Lipodystrophy (LD) is a rare metabolic disease characterized by congenital or acquired loss of subcutaneous fat tissue which is generalized or partial in the body and it results in metabolic complications and specific clinical findings (1). Subcutaneous tissue is located between the skin (epidermis and dermis) and muscle.…”

“…Among these possible mechanisms are adipogenesis disorder due to blockade of preadipocyte-adipocyte differentiation, decreased lipid storage capacity of adipocytes, increased loss of adipocytes as a result of adipocyte apoptosis, deficiency of mature functional adipocytes or abnormal adipocytes. As a result of this pathogenesis, partial or generalized fat tissue loss occurs in the body (1,2). Correct insulin administration in lipodystrophy syndromes with high insulin needs has been insufficiently evaluated in the literature.…”