Prevalence and Clinicopathological Characteristics of Islet Amyloid in Chinese Patients With Type 2 Diabetes

Prevalence and Clinicopathological Characteristics of Islet Amyloid in Chinese Patients With Type 2 Diabetes Hai-Lu Zhao 1 , Fernand M.M. Lai 2 , Peter C.Y. Tong 1 , Ding-Rong Zhong 3 , Di Yang 4 , Brian Tomlinson 1 and Juliana C.N. Chan 1 1 Department of Medicine and Therapeutics, The Prince of Wales Hospital, Chinese University of Hong Kong, Shatin, Hong Kong SAR, China 2 Department of Anatomical and Cellular Pathology, The Prince of Wales Hospital, Chinese University of Hong Kong, Shatin, Hong Kong SAR, China 3 Department of Pathology, Chinese PLA General Hospital, Beijing, China 4 Department of Pathology, Peking Union College Hospital, Beijing, China Address correspondence and reprint requests to Hai-Lu Zhao, MD, Department of Medicine and Therapeutics, The Prince of Wales Hospital, Chinese University of Hong Kong, Shatin, N.T., Hong Kong. E-mail: zhaohailu{at}cuhk.edu.hk Abstract Islet amyloid has been suggested to be an important link between insulin resistance and β-cell dysfunction in type 2 diabetes. To investigate the prevalence and clinicopathological characteristics of islet amyloid, we examined consecutive autopsies of 235 Chinese patients with type 2 diabetes and 533 nondiabetic subjects. Islet amyloid deposits were identified using Congo red staining and quantitated by image analysis. We found that 3.0% of the nondiabetic subjects versus 39.6% of the diabetic patients displayed islet amyloid ( P < 0.001). In diabetic patients, the amyloid deposits occupied a mean islet area of 36.2%, which was positively associated with BMI, blood pressure, and glycemic control. Pancreatic fibrosis and fat infiltration were more frequently found in diabetic patients with islet amyloid than those without islet amyloid, whereas pancreatic arteriosclerosis was identified in all diabetic patients. These findings suggest that islet amyloid deposits reflect greater insulin resistance and islet failure in a subgroup of type 2 diabetic patients. Islet failure may also have been exacerbated by fat infiltration, fibrosis, and arteriosclerosis. Optimal blood pressure and metabolic control may reduce these pathological changes and help preserve islet cell mass. H-E, hematoxylin-eosin IAPP, islet amyloid polypeptide PAS, periodic acid Schiff Footnotes Accepted July 30, 2003. Received March 18, 2003. DIABETES