Background: Since the triglyceride glucose (TyG) index can reflect insulin resistance, it has been proven to be an efficient predictor of glycolipid-metabolism-related diseases. Therefore, this study aimed to investigate the predictive value of the TyG index for visceral obesity (VO) and body fat distribution in patients with type 2 diabetes mellitus (T2DM). Methods: Abdominal adipose tissue characteristics in patients with T2DM, including visceral adipose area (VAA), subcutaneous adipose area (SAA), VAA-to-SAA ratio (VSR), visceral adipose density (VAD), and subcutaneous adipose density (SAD), were obtained through analyses of computed tomography images at the lumbar 2/3 level. VO was diagnosed according to the VAA (> 142 cm² for males and > 115 cm² for females). Logistic regression was performed to identify independent factors of VO, and receiver operating characteristic (ROC) curves were used to compare the diagnostic performance according to the area under the ROC curve (AUC). Results: A total of 976 patients were included in this study. VO patients showed significantly higher TyG values than non-VO patients in males (9.74 vs. 8.88) and females (9.59 vs. 9.01). The TyG index showed significant positive correlations with VAA, SAA, and VSR and negative correlations with VAD and SAD. The TyG index was an independent factor for VO in both males (odds ratio [OR] = 2.997) and females (OR = 2.233). The TyG index ranked second to body mass index (BMI) for predicting VO in male (AUC = 0.770) and female patients (AUC = 0.720). Patients with higher BMI and TyG index values showed a significantly higher risk of VO than the other patients. TyG-BMI, the combination index of TyG and BMI, showed significantly higher predictive power than BMI for VO in male patients (AUC = 0.879 and 0.835, respectively) but showed no significance when compared with BMI in female patients (AUC = 0.865 and 0.835, respectively). Conclusions: . TyG is a comprehensive indicator of adipose volume, density, and distribution in patients with T2DM and is a valuable predictor for VO in combination with anthropometric indices, such as BMI.

Aims: Glucagon‑like peptide 1 receptor agonist (GLP-1RA) treatment can improve adipose distribution. We performed this meta-analysis to investigate whether GLP-1RAs preferentially reduce visceral adipose tissue (VAT) over subcutaneous adipose tissue (SAT) in patients with type 2 diabetes.Materials and methods: We searched MEDLINE and the Cochrane Library for randomised controlled trials explicitly reporting changes in VAT and SAT. A random-effects model was performed to estimate the weighted mean difference (MD) for VAT and SAT. Heterogeneity among the studies was assessed usingI²statistics, and publication bias was assessed using Egger’s tests. Meta-regression was performed to identify the correlation between changes in adipose tissues and changes in body weight and glycated haemoglobin level.Results: Ten trials with 924 patients were enrolled in the meta-analysis. GLP-1RA treatment led to similar absolute area (cm²) reductions in VAT (MD -21.13 cm², 95% CI [-29.82, -12.44]) and SAT (MD -22.89 cm², 95% CI [-29.83, -15.95]). No significant publication bias was detected, and this result was stable in the sensitivity and subgroup analyses. Moreover, GLP-1RA treatment resulted in a greater reduction in VAT and SAT in the subgroup with a greater reduction in body weight. The absolute area reduction in VAT was significantly correlated with the reduction in body weight (r = 6.324, p = 0.035).Conclusions: GLP-1RA treatment leads to significant and similar absolute reductions in VAT and SAT, and the reduction in adipose tissues may be correlated with the reduction in body weight.

Background: Patients with Type 2 diabetes mellitus (T2DM) have elevated late‐night cortisol levels and a flattened circadian rhythm. Cortisol oversecretion mediates muscle breakdown and reduces muscle strength and mass, thus possibly leading to sarcopenia. This study first investigated the association between cortisol circadian rhythm and sarcopenia in patients with T2DM. Methods: Patients with T2DM and adrenal nodules were screened for eligibility. Skeletal muscle index (SMI) and skeletal muscle density (SMD) were obtained by analysing computed tomography images at Lumbar 3 level. Sarcopenia was defined as the presence of both myopenia and myosteatosis. Cortisol and adrenocorticotropic hormone levels at 8 AM, 4 PM and 0 AM were measured. The cumulative logit models and receiver operating characteristic (ROC) curve analyses were performed to evaluate the association between cortisol circadian rhythm and sarcopenia. Results: In total, 128 patients with T2DM and nonfunctional adrenal adenomas were enrolled in this study, of whom 25 were diagnosed with sarcopenia. The mean age was 54.4 years, and 83 (64.8%) patients were male. Patients with sarcopenia showed higher nighttime cortisol levels at 0 AM (Cor 0 AM) (4.91 [4.05, 9.95] vs. 2.44 [1.55, 4.77] μg/dL, p < 0.001) than those without. The Cor 0 AM was negatively correlated with both SMI and SMD ( r = −0.318, p < 0.001 and −0.284, p < 0.001, respectively). As the Cor 0 AM tertiles increased, the odds ratios (ORs) for sarcopenia consistently increased (OR = 4.69 [0.93, 23.53], p = 0.061, for the intermediate group and OR = 11.39 [2.41, 53.84], p = 0.002, for the high group). After adjustment for multiple risk factors, the high Cor 0 AM group still showed a significantly higher risk of sarcopenia than the low group (OR = 7.92 [1.45, 43.29], p = 0.017). ROC curve analyses showed that Cor 0 AM had the highest predictive power for sarcopenia, with an area under the ROC curve (AUC) of 0.760, compared to haemoglobin, age, alanine transaminase and sex (AUC = 0.703, 0.695, 0.679, and 0.633, respectively). Conclusions: The cortisol circadian rhythm is associated with sarcopenia in patients with T2DM. Patients with higher levels of nighttime cortisol, rather than morning or afternoon cortisol, have a higher risk of sarcopenia. This result offers a new strategy for the further research of sarcopenia.

Background Once‐weekly glucagon‐like peptide‐1 receptor agonists (GLP‐1RAs) have shown promising results in the treatment of type 2 diabetes. Herein, we compared the efficacy and safety of once‐weekly GLP‐1RAs with exenatide and liraglutide separately. Methods We systematically surveyed the pertinent literature using various databases. The randomised controlled trials that compared once‐weekly GLP‐1RAs with exenatide and liraglutide in type 2 diabetes were included. Our main end‐points were control of glycaemia, body weight, hypoglycaemia and gastrointestinal adverse events (AEs). Results Our analysis included eight trials involving 5531 patients. Exenatide‐long‐acting release (LAR), dulaglutide and taspoglutide were more effective than twice‐daily exenatide in reducing glycosylated haemoglobin A1c (HbA1c) and fasting blood glucose (FBG) levels and achieving HbA1c targets (< 7.0% and ≤ 6.5%). Liraglutide was as effective as dulaglutide and more effective than exenatide‐LAR and albiglutide in controlling glycaemia. With regard to the effectiveness in decreasing body weight, exenatide‐LAR, dulaglutide and taspoglutide were similar to exenatide whereas exenatide‐LAR, dulaglutide and albiglutide were inferior to liraglutide. Once‐weekly GLP‐1RAs, exenatide and liraglutide resulted in a similar incidence of hypoglycaemia and of gastrointestinal, serious, or other AEs. Conclusions Once‐weekly GLP‐1RAs were more effective in controlling glycaemia and equally effective in decreasing body weight than twice‐daily exenatide but were inferior to liraglutide in controlling these two parameters (dulaglutide was similar with liraglutide in controlling glycaemia). Once‐weekly GLP‐1RAs, exenatide and liraglutide had a similar risk of causing AEs.