Investigating body composition and body mass index using oral hypoglycemic agents and insulin therapy in type 2 diabetes mellitus
Keywords:
diabetes mellitus, insulin therapy, oral hypoglycemic agents, body composition, BMIAbstract
Background and aim: Type 2 diabetes mellitus (T2DM) is increasingly prevalent worldwide, and pharmacological therapy is essential for glycemic control. Insulin therapy (IT) and oral hypoglycemic agents (OHA) are commonly used, but they may have different effects on body composition. This study aimed to compare body composition between patients with T2DM receiving IT and those receiving OHA.
Methods: A comparative cross-sectional study was conducted among 314 patients with T2DM at a tertiary hospital in Banda Aceh, Indonesia. Participants were divided equally into IT and OHA groups (n=157 each). Body composition was assessed using bioelectrical impedance analysis, and data were analyzed using independent t-tests, and multiple linear regression.
Results: Patients treated with IT had significantly higher body weight, BMI, body fat, muscle mass, bone mass, muscle quality score, physique rating, and visceral fat compared with those on OHA (all p<0.05). No significant differences were observed in basal metabolic rate, metabolic age, total body water, or body height. Regression analysis showed that BMI and gender were the strongest predictors of body fat, muscle mass, and visceral fat, while age was associated with muscle quality and metabolic age.
Conclusion: Insulin therapy in patients with T2DM was associated with higher adiposity and altered body composition compared with OHA use. Routine monitoring of body composition and targeted lifestyle interventions should be integrated into the management of T2DM patients receiving insulin.
References
1. Sun H, Saeedi P, Karuranga S, et al. IDF Diabetes Atlas: Global, regional, and country-level diabetes prevalence estimates for 2021 and projections for 2045. Diabetes Res Clin Pract. 2022;183:109119. doi: 10.1016/j.diabres.2021.109119. Erratum in: Diabetes Res Clin Pract. 2023 Oct;204:110945. doi: 10.1016/j.diabres.2023.110945.
2. Ministry of Health Republic of Indonesia. Profil Kesehatan Indonesia 2024 (Indonesia Health Profile 2024). Jakarta, Indonesia; 2024.
3. Whiting DR, Guariguata L, Weil C, Shaw J. IDF diabetes atlas: global estimates of the prevalence of diabetes for 2011 and 2030. Diabetes Res Clin Pract. 2011;94(3):311–21. doi: 10.1016/j.diabres.2011.10.029.
4. Mulyanto J, Wibowo Y, Ernawati DA, Lestari DWD, Kringos DS. Exploring Inequalities in the Use, Quality, and Outcome of the Diabetes Management Program of Indonesian National Health Insurance. Health Equity. 2023;7(1):644–52. doi: 10.1089/heq.2023.0025.
5. Soeatmadji DW, Rosandi R, Saraswati MR, Sibarani RP, Tarigan WO. Clinicodemographic Profile and Outcomes of Type 2 Diabetes Mellitus in the Indonesian Cohort of DISCOVER: A 3-Year Prospective Cohort Study. J ASEAN Fed Endocr Soc. 2023;38(1):68–74. doi: 10.15605/jafes.038.01.10.
6. Husna C, Akmal A, Syarif H, Agustina S. Exploring the connection between diabetes duration, HbA1c levels, and peripheral neuropathy in type 2 diabetes patients. International Journal of Advanced and Applied Sciences. 2024;11(4):236–40. doi: 10.21833/ijaas.2024.04.025.
7. American Diabetes Association Professional Practice Committee. Pharmacologic approaches to glycemic treatment: Standards of care in diabetes 2025. Diabetes Care. 2025;48(1 Suppl 1):S181–S206. doi: 10.2337/dc25-S009.
8. Haber R, Zarzour F, Ghezzawi M, et.al. The impact of metformin on weight and metabolic parameters in patients with obesity: A systematic review and meta-analysis of randomized controlled trials. Diabetes Obes Metab. 2024;26(5):1850–67. doi: 10.1111/dom.15501.
9. Arun N, Vettath RE. Adverse Events Due to Oral Hypoglycemic Drugs. In Abraham G, Kesavadev J, Govindan P, Arun N, Teckchandani S, editors. Management of Diabetic Complications. Singapore: Springer Nature Singapore; 2024. pp. 285–300. doi: 10.1007/978-981-97-6406-8_21.
10. Cheong AJY, Teo YN, Teo YH, et al. SGLT inhibitors on weight and body mass: A meta-analysis of 116 randomized-controlled trials. Obesity (Silver Spring). 2022; 30(1):117–28. doi: 10.1002/oby.23331.
11. Kim HS. Ideal Combination of Oral Hypoglycemic Agents for Patients with Type 2 Diabetes Mellitus. Diabetes Metab J. 2024;48(5):882–4. doi: 10.4093/dmj.2024.0479.
12. Per BL, Loeser S, Edwards S, Lee WS, Wilton LR, Clark SR. The Impact of Metformin on Weight and Waist Circumference in Patients Treated With Clozapine: A One‐Year Retrospective Cohort Study. Acta Psychiatr Scand. 2025;151(6):719–30. doi: 10.1111/acps.13796.
13. Xu C, Li Y, Liu L. Changes in Body Composition are Associated with Improvement of ß-Cell Function and Insulin Sensitivity after Short-Term Intensive Insulin Therapy in Patients with Newly Diagnosed Type 2 Diabetes. Diabetes. 2022;71(Supplement_1):1373-P. doi: 10.2337/db22-1373-P.
14. Kim HJ, Lee HW, Kang MK, Leem GH, Kim MH, Song TJ. Association of Body Composition Changes with the Development of Diabetes Mellitus: A Nation-Wide Population Study. Diabetes Metab J. 2024;48(6):1093–104. doi: 10.4093/dmj.2023.0243.
15. Kim J, Kim S, Hwang HK, Kang CM, Kim KS, Kim SH. Body composition assessment using bioelectrical impedance analysis and computed tomography in patients who underwent pancreatoduodenectomy in Korea: a before and after study. Annals of Clinical Nutrition and Metabolism. 2023;15(3):72–80. doi: 10.15747/acnm.2023.15.3.72.
16. Sırıken F, Ertekin E, Ünsal C, et. al. Comparison of Body Mass Index and Bioelectric Impedance Analysis Methods in the Evaluation of Body Composition and Obesity in Women. Bagcilar Medical Bulletin. 2022;7(1):43–9. doi: 10.4274/bmb.galenos.2022.2021-12-124.
17. Zeng YH, Liu SC, Lee CC, Sun FJ, Liu JJ. Effect of empagliflozin versus linagliptin on body composition in Asian patients with type 2 diabetes treated with premixed insulin. Sci Rep. 2022;12(1):17065. doi: 10.1038/s41598-022-21486-9.
18. Papakonstantinou I, Tsioufis K, Katsi V. Spotlight on the Mechanism of Action of Semaglutide. Curr Issues Mol Biol. 2024;46(12):14514–41. doi: 10.3390/cimb46120872.
19. Mourougavelou V, Chowdhury TA. Management of hyperglycaemia in people with obesity. Clin Med (Lond). 2023;23(4):364–71. doi: 10.7861/clinmed.2023-0135.
20. Pan R, Zhang Y, Wang R, Xu Y, Ji H, Zhao Y. Effect of SGLT-2 inhibitors on body composition in patients with type 2 diabetes mellitus: A meta-analysis of randomized controlled trials. PLOS ONE. 2022;17(12):e0279889. doi: 10.1371/journal.pone.0279889.
21. de Ritter R, Sep SJS, van Greevenbroek MMJ, et. al. Sex differences in body composition in people with prediabetes and type 2 diabetes as compared with people with normal glucose metabolism: the Maastricht Study. Diabetologia. 2023;66(5):861–72. doi: 10.1007/s00125-023-05880-0.
22. Després J. Visceral Obesity with Excess Ectopic Fat: A Prevalent and High-Risk Condition Requiring Concerted Clinical and Public Health Actions. CardioMetabolic Syndrome Journal. 2021;1(1):1–17. doi: 10.51789/cmsj.2021.1.e11.
23. Alfadhli E, Darandari I, Altaweel M, et. al. Body composition patterns among type 2 diabetes mellitus patients versus nondiabetic adults in Saudi Arabia. Front Endocrinol (Lausanne). 2025;16:1494452. doi: 10.3389/fendo.2025.1494452.
24. Ma M, Jiang T, Wen Z, Zhang D, Xiu L. Gender Differences in Relation to Body Composition, Insulin Resistance, and Islet Beta Cell Function in Newly Diagnosed Diabetic or Pre-Diabetic Patients. Diabetes, Metab Syndr Obes. 2023;16:723–32. doi: 10.2147/DMSO.S397528.
25. Santoro A, McGraw TE, Kahn BB. Insulin action in adipocytes, adipose remodeling, and systemic effects. Cell Metab. 2021;33(4):748–57. doi: 10.1016/j.cmet.2021.03.019.
26. Edens MA, van Dijk PR, Hak E, Bilo HJG. Determinants of excessive weight gain after the initiation of insulin therapy in type 2 diabetes mellitus: Retrospective inception cohort study (ZODIAC 60). Diabetes Res Clin Pract. 2023;200:110719. doi: 10.1016/j.diabres.2023.110719.
27. Lee SH, Park SY, Choi CS. Insulin Resistance: From Mechanisms to Therapeutic Strategies. Diabetes Metab J. 2022;46(1):15–37. doi: 10.4093/dmj.2021.0280.
28. Nsamba J, Mathews E, Buyinza R. Insulin dependent diabetes and anthropometric assessment: Understanding the rationale for body composition measurement. Afr J Diabetes Med. 2022;30(6):30-6-1. doi: 10.54931/2053-4787.30-6-1.
29. Wang M, Tan Y, Shi Y, Wang X, Liao Z, Wei P. Diabetes and Sarcopenic Obesity: Pathogenesis, Diagnosis, and Treatments. Front Endocrinol (Lausanne). 2020;11:568. doi: 10.3389/fendo.2020.00568.
30. Oh CM, Bang JI, Lee SY, Lee JK, Chai JW, Oh SW. An Analysis of Age-Related Body Composition Changes and Metabolic Patterns in Korean Adults Using FDG-PET/CT Health Screening Data. Diabetes Metab J. 2025;49(1):92–104. doi: 10.4093/dmj.2024.0057.
Downloads
Published
Issue
Section
License
Copyright (c) 2026 Cut Husna, Darmawati Darmawati, Sarah Firdausa, Ahyana Ahyana, Irfanita Nurhidayah
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Transfer of Copyright and Permission to Reproduce Parts of Published Papers.
Authors retain the copyright for their published work. No formal permission will be required to reproduce parts (tables or illustrations) of published papers, provided the source is quoted appropriately and reproduction has no commercial intent. Reproductions with commercial intent will require written permission and payment of royalties.
How to Cite
