Cluster analysis of computed tomography identifies duration-associated abdominal fat deposition in type 2 diabetes mellitus

BACKGROUNDAbdominal ectopic fat deposition is closely associated with type 2 diabetes mellitus (T2DM).However, whether there are distinct fatdistribution phenotypes across different organs, and how these phenotypes relate to changes in blood glucose, remains unclear, particularly given the potential impact of disease duration. AIMTo 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. METHODSBetween 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 noncontrast 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. RESULTSSite-specific and duration-associated heterogeneity.Liver fat was associated with blood glucose throughout the disease course.