A Study of Clinical Utility of Acanthosis Nigricans and Acrochordons in Predicting Insulin Resistance, Adipocytokines Levels and Adiposity in Asisn Indian T2DM Patients

Presentation Number: MON 622
Date of Presentation: April 3rd, 2017

Arpana Soni1, Poonam Punjabi2, Praveen Choudhary3, Pradeep Tiwari1, Deepak Kumar Gupta4 and Sandeep Kumar Mathur*5
1S.M.S Medical College, Jaipur, 2SMS Medical College, Jaipur, Rajasthan, India, 3S.M.S Medical College, Jaipur, INDIA, 4University of Rajasthan, Jaipur, India, 5SMS Medical College, Jaipur, India

Abstract

Background: Acanthosis Nigricans (AN) and Acrochordon (AC) have been found to be associated with obesity, insulin resistance, metabolic syndrome, and altered levels of adipocytokines in previous studies. Their relative importance as clinical sign of adiposity, insulin resistance and altered levels of adipocytokines in Asian Indian diabetics remains more and less un-explored.

Aim: (1) To find association among AN and AC and various parameters of adiposity, levels of adipocytokines and insulin resistance by factor analysis, (2) To find the predictive value of these clinical sign for insulin resistance and adipocytokine levels.

Methods: Subjects: 112 T2DM (DM) patients (age, 51.13 ± 9.96 years) and 61 non-diabetics (ND) (age, 58.77 ± 10.53 years) participated in the study. Following parameters were estimated in all participants: Clinical: BMI, waist circumference (WC), W:H ratio, presence of AN and AC. Biochemical: glucose, lipid profile, HOMA-R, HOMA-β, adipocytokines: leptin, adiponectin, hsCRP, NEFA, IL-6, TNF-alpha.

Results: Out of 112 (DM) subjects 19,16, 34 and 44 were respectively AC +, AN +, both AC and AN + (+/+) and both AC and AN – (-/-). Among ND 43 subjects were AC and AN - (-/-). The -/- DM subjects when compared to the -/- ND subjects, they had higher weight, WC and insulin level, but comparable HOMA-R and lower HOMA- β level. AN + DM subjects when compared to -/- DM subjects, they had comparable BMI, but had lower HOMA-R, HOMA- β, and adiponectin level. AC + and +/+ DM subjects had higher BMI, Insulin, HOMA-R level and comparable HOMA- β level then -/-DM subjects. We have done factor analysis to show association of various correlated factors. Following pairs of parameters contributed majorly to single factor: (1) BMI, HOMA –R, AC, AN (2) IL-6 and TNF alpha, (3) adiponectin and W: H ratio (4) hsCRP and leptin. The cut offs for HOMA-R were calculated for AN and AC using ROC curves. In diabetics the cut off value for AN was insignificant and AC was 2.33 (sensitivity 75%, specificity 53.3%). In ND the cut off value for AN was 2.11 (sensitivity 83.3%, specificity 70.9%) and for AC was insignificant.

Conclusions: AC is a better marker of insulin resistance in DM patients and its presence is indicative of HOMA-R more than 2.33.

 

Nothing to Disclose: AS, PP, PC, PT, DKG, SKM