Diabesity

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Diabesity is a global epidemic characterized by the co-ocurrence of obesity and type 2 diabetes; excess body fat is the most significant risk factor for type 2 diabetes. [1]

Contents

Description

The global disease burden of obesity and type 2 diabetes has greatly increased since the twentieth century and is projected to continue to increase in the twenty-first century. [1] Although it is not fully understood how insulin resistance develops, lifestyle factors are crucial to the development of both illnesses [2] and excess body fat is the most significant risk factor for type 2 diabetes. [1] Common comorbidities include non-alcoholic fatty liver disease, dyslipidemia, high blood pressure, cardiovascular disease, obstructive sleep apnea, and chronic kidney disease. [2]

Gestational diabetes in women whose pre-pregnancy weight was normal is metabolically distinct from the case where obesity existed prior to pregnancy (termed "gestational diabesity" in one review article). [3]

While altered gut microbiota can lead to the development of diabesity, the reverse is also the case. Therapies aimed at altering gut microbiota are a target of drug discovery [4] and lifestyle interventions. [2]

Management

It is recommended to manage diabesity by a low calorie diet, increased exercise, and where indicated, bariatric surgery. Weight loss of 15 kilograms (33 lb) can reverse type 2 diabetes in around 70 percent of patients. This is difficult for most patients to achieve in practice, but even smaller losses of 5 kilograms (11 lb) can improve diabetes. While some antidiabetic drugs such as insulin can cause weight gain and worsen diabesity, others such as metformin, SGLT-2 inhibitors, and GLP-1 receptor agonists reduce body weight and hyperglycemia. Therefore, the latter are recommended for patients with diabesity. [2]

Cannabinoid receptor antagonists have been developed for diabesity but none are currently approved because of safety concerns. [5]

Related Research Articles

<span class="mw-page-title-main">Metabolic syndrome</span> Medical condition

Metabolic syndrome is a clustering of at least three of the following five medical conditions: abdominal obesity, high blood pressure, high blood sugar, high serum triglycerides, and low serum high-density lipoprotein (HDL).

<span class="mw-page-title-main">Type 2 diabetes</span> Type of diabetes mellitus with high blood sugar and insulin resistance

Type 2 diabetes (T2D), formerly known as adult-onset diabetes, is a form of diabetes mellitus that is characterized by high blood sugar, insulin resistance, and relative lack of insulin. Common symptoms include increased thirst, frequent urination, fatigue and unexplained weight loss. Symptoms may also include increased hunger, having a sensation of pins and needles, and sores (wounds) that do not heal. Often symptoms come on slowly. Long-term complications from high blood sugar include heart disease, strokes, diabetic retinopathy which can result in blindness, kidney failure, and poor blood flow in the limbs which may lead to amputations. The sudden onset of hyperosmolar hyperglycemic state may occur; however, ketoacidosis is uncommon.

<span class="mw-page-title-main">Metformin</span> Medication used to treat diabetes by reducing glucose levels

Metformin, sold under the brand name Glucophage, among others, is the main first-line medication for the treatment of type 2 diabetes, particularly in people who are overweight. It is also used in the treatment of polycystic ovary syndrome. It is sometimes used as an off-label adjunct to lessen the risk of metabolic syndrome in people who take antipsychotics. Metformin is not associated with weight gain and is taken by mouth.

Human body weight is a person's mass or weight.

<span class="mw-page-title-main">Gestational diabetes</span> Medical condition

Gestational diabetes is a condition in which a woman without diabetes develops high blood sugar levels during pregnancy. Gestational diabetes generally results in few symptoms; however, it increases the risk of pre-eclampsia, depression, and of needing a Caesarean section. Babies born to mothers with poorly treated gestational diabetes are at increased risk of macrosomia, of having hypoglycemia after birth, and of jaundice. If untreated, diabetes can also result in stillbirth. Long term, children are at higher risk of being overweight and of developing type 2 diabetes.

Maturity-onset diabetes of the young (MODY) refers to any of several hereditary forms of diabetes mellitus caused by mutations in an autosomal dominant gene disrupting insulin production. Along with neonatal diabetes, MODY is a form of the conditions known as monogenic diabetes. While the more common types of diabetes involve more complex combinations of causes involving multiple genes and environmental factors, each forms of MODY are caused by changes to a single gene (monogenic). GCK-MODY and HNF1A-MODY are the most common forms.

<span class="mw-page-title-main">Weight gain</span> Increase in a persons total body mass

Weight gain is an increase in body weight. This can involve an increase in muscle mass, fat deposits, excess fluids such as water or other factors. Weight gain can be a symptom of a serious medical condition.

A complication in medicine, or medical complication, is an unfavorable result of a disease, health condition, or treatment. Complications may adversely affect the prognosis, or outcome, of a disease. Complications generally involve a worsening in the severity of the disease or the development of new signs, symptoms, or pathological changes that may become widespread throughout the body and affect other organ systems. Thus, complications may lead to the development of new diseases resulting from previously existing diseases. Complications may also arise as a result of various treatments.

Thrifty phenotype refers to the correlation between low birth weight of neonates and the increased risk of developing metabolic syndromes later in life, including type 2 diabetes and cardiovascular diseases. Although early life undernutrition is thought to be the key driving factor to the hypothesis, other environmental factors have been explored for their role in susceptibility, such as physical inactivity. Genes may also play a role in susceptibility of these diseases, as they may make individuals predisposed to factors that lead to increased disease risk.

<span class="mw-page-title-main">Pramlintide</span> Diabetes medication

Pramlintide is an injectable amylin analogue drug for diabetes, developed by Amylin Pharmaceuticals. Pramlintide is sold as an acetate salt.

<span class="mw-page-title-main">Gut microbiota</span> Community of microorganisms in the gut

Gut microbiota, gut microbiome, or gut flora, are the microorganisms, including bacteria, archaea, fungi, and viruses, that live in the digestive tracts of animals. The gastrointestinal metagenome is the aggregate of all the genomes of the gut microbiota. The gut is the main location of the human microbiome. The gut microbiota has broad impacts, including effects on colonization, resistance to pathogens, maintaining the intestinal epithelium, metabolizing dietary and pharmaceutical compounds, controlling immune function, and even behavior through the gut–brain axis.

The term "infectobesity" refers to the hypothesis that obesity in humans can be caused by pathogenic organisms, and the emerging field of medical research that studies the relationship between pathogens and weight gain. The term was coined in 2001 by Dr. Nikhil V. Dhurandhar, at the Pennington Biomedical Research Center.

Bariatric surgery is a medical term for surgical procedures used to manage obesity and obesity-related conditions. Long term weight loss with bariatric surgery may be achieved through alteration of gut hormones, physical reduction of stomach size, reduction of nutrient absorption, or a combination of these. Standard of care procedures include Roux en-Y bypass, sleeve gastrectomy, and biliopancreatic diversion with duodenal switch, from which weight loss is largely achieved by altering gut hormone levels responsible for hunger and satiety, leading to a new hormonal weight set point.

<span class="mw-page-title-main">Prediabetes</span> Predisease state of hyperglycemia with high risk for diabetes

Prediabetes is a component of the metabolic syndrome and is characterized by elevated blood sugar levels that fall below the threshold to diagnose diabetes mellitus. It usually does not cause symptoms but people with prediabetes often have obesity, dyslipidemia with high triglycerides and/or low HDL cholesterol, and hypertension. It is also associated with increased risk for cardiovascular disease (CVD). Prediabetes is more accurately considered an early stage of diabetes as health complications associated with type 2 diabetes often occur before the diagnosis of diabetes.

<span class="mw-page-title-main">GPR119</span> Protein-coding gene in humans

G protein-coupled receptor 119 also known as GPR119 is a G protein-coupled receptor that in humans is encoded by the GPR119 gene.

The diet-induced obesity model is an animal model used to study obesity using animals that have obesity caused by being fed high-fat or high-density diets. It is intended to mimic the most common cause of obesity in humans. Typically mice, rats, dogs, or non-human primates are used in these models. These animals can then be used to study in vivo obesity, obesity's comorbidities, and other related diseases. Users of such models must take into account the duration and type of diet as well as the environmental conditions and age of the animals, as each may promote different bodyweights, fat percentages, or behaviors.

Glucagon-like peptide-1 (GLP-1) receptor agonists, also known as GLP-1 analogs, are a class of drugs that reduce blood sugar and energy intake by activating the GLP-1 receptor. They mimic the actions of the endogenous incretin hormone GLP-1 that is released by the gut after eating.

<span class="mw-page-title-main">Sweetened beverage</span> Type of beverage

A sweetened beverage is any beverage with added sugar. It has been described as "liquid candy". Consumption of sweetened beverages has been linked to weight gain, obesity, and associated health risks. According to the CDC, consumption of sweetened beverages is also associated with unhealthy behaviors like smoking, not getting enough sleep and exercise, and eating fast food often and not enough fruits regularly.

<span class="mw-page-title-main">Diabetes</span> Group of endocrine diseases characterized by high blood sugar levels

Diabetes mellitus, often known simply as diabetes, is a group of common endocrine diseases characterized by sustained high blood sugar levels. Diabetes is due to either the pancreas not producing enough insulin, or the cells of the body becoming unresponsive to the hormone's effects. Classic symptoms include thirst, polyuria, weight loss, and blurred vision. If left untreated, the disease can lead to various health complications, including disorders of the cardiovascular system, eye, kidney, and nerves. Untreated or poorly treated diabetes accounts for approximately 1.5 million deaths every year.

Diabetes mellitus (DM) is a type of metabolic disease characterized by hyperglycemia. It is caused by either defected insulin secretion or damaged biological function, or both. The high-level blood glucose for a long time will lead to dysfunction of a variety of tissues.

References

  1. 1 2 3 Ng, Arnold C. T.; Delgado, Victoria; Borlaug, Barry A.; Bax, Jeroen J. (April 2021). "Diabesity: the combined burden of obesity and diabetes on heart disease and the role of imaging". Nature Reviews Cardiology. 18 (4): 291–304. doi:10.1038/s41569-020-00465-5. ISSN   1759-5010.
  2. 1 2 3 4 Michaelidou, Maria; Pappachan, Joseph M; Jeeyavudeen, Mohammad Sadiq (15 April 2023). "Management of diabesity: Current concepts". World Journal of Diabetes. 14 (4): 396–411. doi: 10.4239/wjd.v14.i4.396 . ISSN   1948-9358.
  3. Cornejo, Marcelo; Fuentes, Gonzalo; Valero, Paola; Vega, Sofía; Grismaldo, Adriana; Toledo, Fernando; Pardo, Fabián; Moore‐Carrasco, Rodrigo; Subiabre, Mario; Casanello, Paola; Faas, Marijke M; van Goor, Harry; Sobrevia, Luis (2021). "Gestational diabesity and foetoplacental vascular dysfunction". Acta Physiologica. 232 (4). doi:10.1111/apha.13671.
  4. Sharma, Arun K.; Sharma, Akash; Lal, Samridhi; Kumar, Ashish; Yadav, Nirmala K.; Tabassum, Fauzia; Sayeed Akhtar, Md.; Tarique Imam, Mohammad; Saeed Almalki, Ziyad; Mukherjee, Monalisa (1 May 2023). "Dysbiosis versus diabesity: Pathological signaling and promising therapeutic strategies". Drug Discovery Today. 28 (5): 103558. doi:10.1016/j.drudis.2023.103558. ISSN   1359-6446.
  5. Deeba, Farah; Kumar, Ashish; Mukherjee, Monalisa; Sharma, Arun K.; Sharma, Manju (1 July 2021). "Targeting the endocannabinoid system in diabesity: Fact or fiction?". Drug Discovery Today. 26 (7): 1750–1758. doi:10.1016/j.drudis.2021.03.022. ISSN   1359-6446.