The Adipo-B Index as a Novel Integrator of Glycemic and Lipid Homeostasis: a Multiple-Therapy Validation Study

Abstract Objective To introduce and evaluate the clinical utility of the “adipo-B index” as a novel metric of the adipose tissue-pancreatic beta cell axis. To our knowledge, no prior clinical metric has integrated adipose tissue insulin resistance and pancreatic beta-cell function into a single index applicable across therapeutic classes. Methods Treatment-naïve subjects with T2DM received monotherapy with modified traditional diet for diabetes (MJDD, n=61), canagliflozin (n=67), pioglitazone (n=54), or sitagliptin (n=63). Correlations between the baseline and changes in adipo-IR or adipo-B and clinical parameters were analyzed. This is a prospective, non-randomized observational study. Results At baseline, among all the subjects, adipo-B significantly correlated with FBG, HbA1c and non-HDL-C, while adipo-IR did not. At 3 months, across all therapeutic strategies, significant negative correlations were observed between the changes in (Δ)adipo-B and baseline adipo-B. By contrast, in MJDD, canagliflozin and pioglitazone, significant negative correlations were seen between Δadipo-IR and baseline adipo-IR, while with sitagliptin, no correlations were noted. Δadipo-B, but not Δadipo-IR, correlated with the improvements of glycemic (FBG, HbA1c) and lipid (non-HDL-C) parameters across all these therapies. While significant correlations were seen between Δadipo-B and Δadipo-IR with MJDD, pioglitazone and sitagliptin, canagliflozin uniquely “decoupled” this axis. With sitagliptin and pioglitazone, adipo-B improved despite weight gain. Conclusion The adipo-B index is a superior indicator of systemic metabolic status and therapeutic response and could serve as a useful tool for precision therapy for diabetes.