High circulating plasma dipeptidyl peptidase- 4 levels in non-obese Asian Indians with type 2 diabetes correlate with fasting insulin and LDL-C levels, triceps skinfolds, total intra-abdominal adipose tissue volume and presence of diabetes: a case–control study

Aim To evaluate circulating plasma dipeptidyl peptidase-4 (DPP4) levels in non-obese Asian Indians with type 2 diabetes mellitus (T2DM), and to correlate these with metabolic profile and measures of anthropometry, skinfolds, abdominal adipose tissue depots, pancreatic volume, and liver span. Methodology Non-obese (body mass index (BMI) <25 kg/m2) patients with T2DM (cases, n=93), diagnosed within 1 year from recruitment, on metformin therapy and BMI-matched, and non-diabetic subjects (controls, n=40) were compared. Measurements of blood glucose, glycosylated hemoglobin, plasma insulin levels, lipid profile, hepatic transaminases and plasma DPP4 levels, and quantification of abdominal fat depots, pancreatic volume and liver span (MRI scan), were done. Results Significantly higher (p<0.001) circulating plasma DPP4 levels were observed in cases as compared to controls. Specifically, in patients with T2DM with non-alcoholic fatty liver disease (NAFLD) (n=48), the mean plasma DPP4 level (52.6±27.8 ng/mL) was significantly higher (p<0.05) as compared with those without NAFLD (n=43; 47±28.3 ng/mL). Significant positive correlation was observed for circulating plasma DPP4 levels with waist-to-hip ratio, total intra-abdominal adipose volume, and liver span. Fasting serum insulin, low-density lipoprotein cholesterol (LDL-C), triceps skinfolds, total intra-abdominal adipose tissue volume and presence of T2DM were significant determinants of circulating plasma DPP4 levels. Conclusion Non-obese Asian Indian patients with T2DM and on metformin therapy have significantly higher circulating plasma DPP4 levels as compared to non-obese non-diabetic controls, and these levels correlate with fasting insulin and LDL-C levels, upper limb subcutaneous adipose tissue, intra-abdominal adiposity and presence of diabetes.