Published online Nov 15, 2026. doi: 10.4239/wjd.124565
Revised: August 3, 2026
Accepted: October 8, 2026
Published online: November 15, 2026
Processing time: 139 Days and 21.6 Hours
Abdominal ectopic fat deposition is closely associated with type 2 diabetes mellitus (T2DM). However, whether there are distinct fat-distribution phenotypes across different organs, and how these phenotypes relate to changes in blood glucose, remains unclear, particularly given the potential impact of disease du
To investigate site specific and duration associated phenotypes of abdominal fat distribution and their associations with glycemic indicators in patients with T2DM of different disease durations, using non-contrast computed tomography (CT) and cluster analysis. The goal was to identify imaging based phenotypes that may inform future risk stratification.
Between September 2019 and December 2024, we enrolled 130 patients with prediabetes and 398 patients with T2DM (207 with disease duration < 5 years, and 191 with disease duration ≥ 5 years), along with 150 age- and sex-matched healthy controls. All participants underwent non-contrast abdominal CT. CT attenuation values were measured for the liver, pancreas, kidneys, and psoas muscles, and the areas of visceral adipose tissue, subcutaneous adipose tissue, and renal sinus fat were quantified. K-means clustering was used to identify fat-distribution phenotypes across disease durations, and multiple linear regression was performed to examine their relationships with glycemic indices.
Site-specific and durationassociated heterogeneity. Liver fat was associated with blood glucose throughout the disease course. Pancreatic fat was concentrated predominantly in the tail (P < 0.05). Pancreatic and renal sinus fat were correlated with blood glucose in both the < 5-year and ≥ 5-year groups, whereas psoas muscle fat was evident only in the ≥ 5-year group (P < 0.05 for all). Fat-distribution phenotypes. The prediabetes group comprised “liver-dominant” (higher fasting plasma glucose, 2 hours oral glucose tolerance test, triglyceride, and male predominance) and “pancreas-dominant” phenotypes. The < 5-year T2DM group included “visceral/subcutaneous” (predominantly male, lower blood glucose), “liver-dominant”, and “pancreas-dominant” phenotypes; the latter two showed higher blood glucose, and the liver-dominant phenotype also showed elevated triglyceride, alanine aminotransferase, and aspartate aminotransferase. The ≥ 5-year T2DM group yielded four phenotypes: “Liver-dominant” (dyslipidemia, and elevated liver enzymes), “pancreas-dominant” (highest blood glucose), “renal-dominant” (male predominance, older age, longer disease duration, elevated serum creatinine and blood urea nitrogen, and decreased estimated glomerular filtration rate), and “psoas major-dominant” (no significant clinical differences).
Our cross-sectional data show that fat distribution differs across disease durations: pancreatic fat is more prominent in shorter durations, whereas renal and skeletal muscle fat are more prominent in longer durations. CT-based quantification combined with K-means clustering reveals distinct fat-distribution phenotypes. These exploratory findings provide a foundation for future hypothesis-driven studies to assess the clinical utility of CT-based phenotyping.
Core Tip: This study identifies computed tomography based abdominal fat distribution phenotypes in type 2 diabetes mellitus that vary with disease duration. Cross sectionally observed pattern shows: Liver fat persists across all disease durations, pancreatic fat appears in shorter durations, and renal and skeletal muscle fat emerge in longer durations. These details are missed by conventional duration based classification. This imaging based approach provides a foundation for phenotype driven risk stratification.