Type 2 DiabetesWith Partial Lipodystrophy of the Limbs A new lipodystrophy phenotype

OBJECTIVEdLipodystrophies are categorized by the extent of fat loss (generalized vs. partial) and by inheritance (congenital vs. acquired). We examined whether a group of patients with partial lipodystrophy of the limbs (PLL), type 2 diabetes mellitus (T2DM), and an absence of a family history of lipodystrophy constitute a new clinical subtype. RESEARCH DESIGN AND METHODSdTen women with T2DM and PLL were iden-tified in academic diabetes clinics and were matched by age, sex, BMI, ethnicity, and diabetes status with 10womenwith control T2DMwithout lipodystrophy. All patients were characterized by clinical evaluation and hyperinsulinemic clamp. RESULTSdPatients with T2DM and PLL exhibited symmetrical loss of subcutaneous fat in forearms, or forearms plus calves, and acanthosis nigricans. Maximally stimulated glucose dis-posal rates were markedly reduced by 56 % in the T2DM with PLL group compared with the control T2DM patients, whether normalized by body weight or surface area. Most PLL patients exhibited little or no insulin-mediated glucose uptake after subtraction of non-insulin–mediated glucose uptake. The T2DM with PLL group also had greater elevations in hepatic transaminases and triglycerides and earlier onset of diabetes compared with control T2DM