High hepatic insulin resistance is linked to glucose and lipid profiles in Korean adults with type 2 diabetes

Aims To characterize the metabolic profiles associated with the Hepatic Insulin Resistance Index (HIRI), in Korean patients with type 2 diabetes mellitus. Methods This cross-sectional study analyzed 2,475 Korean adults with type 2 diabetes from the Korean National Diabetes Program cohort. Participants were categorized into HIRI tertiles based on oral glucose tolerance tests. We examined associations between HIRI and anthropometric measures, glycemic parameters, lipid profiles, liver function markers, and dietary intake. Logistic regression assessed the risk of dyslipidemia and metabolic syndrome components, adjusting for relevant confounders. Results High-HIRI participants demonstrated greater central obesity (waist circumference 90.92 vs. 85.52 cm, p < 0.0001) and distinctive glycemic profiles: elevated fasting glucose (153.26 vs. 147.53 mg/dL, p < 0.0001) but lower postprandial glucose (273.73 vs. 299.32 mg/dL, p = 0.0001) and HbA1c (7.8 vs. 8.2%, p = 0.0026). They exhibited dyslipidemia with higher triglycerides (190.71 vs. 141.41 mg/dL, p < 0.0001) and lower HDL cholesterol (45.29 vs. 48.40 mg/dL, p < 0.0001). Conclusions High hepatic insulin resistance in Korean patients with type 2 diabetes defines a phenotype characterized by central obesity, atherogenic dyslipidemia, and distinctive glycemic profiles. Recognition of this phenotype supports personalized diabetes management targeting hepatic IR.