Diabesity

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Diabesity is a global epidemic characterized by the co-occurrence 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> Form of diabetes mellitus

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. Other symptoms include increased hunger, having a sensation of pins and needles, and sores (wounds) that heal slowly. Symptoms often develop slowly. Long-term complications from high blood sugar include heart disease, stroke, diabetic retinopathy, which can result in blindness, kidney failure, and poor blood flow in the lower-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

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, and is sometimes used as an off-label adjunct to lessen the risk of metabolic syndrome in people who take antipsychotic medication. It has been shown to inhibit inflammation, and is not associated with weight gain. Metformin is taken by mouth.

<span class="mw-page-title-main">Gestational diabetes</span> High blood sugar levels during pregnancy

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, obesity increases the rate of pre-eclampsia, cesarean sections, and embryo macrosomia, as well as gestational diabetes. Babies born to individuals 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). 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">Large for gestational age</span> Medical condition

Large for gestational age (LGA) is a term used to describe infants that are born with an abnormally high weight, specifically in the 90th percentile or above, compared to other babies of the same developmental age. Macrosomia is a similar term that describes excessive birth weight, but refers to an absolute measurement, regardless of gestational age. Typically the threshold for diagnosing macrosomia is a body weight between 4,000 and 4,500 grams, or more, measured at birth, but there are difficulties reaching a universal agreement of this definition.

<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.

The main goal of diabetes management is to keep blood glucose (BG) levels as normal as possible. If diabetes is not well controlled, further challenges to health may occur. People with diabetes can measure blood sugar by various methods, such as with a BG meter or a continuous glucose monitor, which monitors over several days. Glucose can also be measured by analysis of a routine blood sample. Usually, people are recommended to control diet, exercise, and maintain a healthy weight, although some people may need medications to control their blood sugar levels. Other goals of diabetes management are to prevent or treat complications that can result from the disease itself and from its treatment.

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.

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.

<span class="mw-page-title-main">Sarcopenic obesity</span> Medical condition: obesity and loss of muscle

Sarcopenic obesity is a combination of two disease states, sarcopenia and obesity. Sarcopenia is the muscle mass/strength/physical function loss associated with increased age, and obesity is based off a weight to height ratio or body mass index (BMI) that is characterized by high body fat or being overweight.

Glucagon-like peptide-1 (GLP-1) receptor agonists, also known as GLP-1 analogs, GLP-1DAs, or incretin mimetics, are a class of anorectic 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, which is released by the gut after eating.

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

Diabetes, also known as diabetes mellitus, 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 polydipsia, 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. Diabetes accounts for approximately 4.2 million deaths every year, with an estimated 1.5 million caused by either untreated or poorly treated diabetes.

Obstetric medicine, similar to maternal medicine, is a sub-specialty of general internal medicine and obstetrics that specializes in process of prevention, diagnosing, and treating medical disorders in with pregnant humans. It is closely related to the specialty of maternal-fetal medicine, although obstetric medicine does not directly care for the fetus. The practice of obstetric medicine, or previously known as "obstetric intervention," primarily consisted of the extraction of the baby during instances of duress, such as obstructed labor or if the baby was positioned in breech.

Semaglutide is an anti-diabetic medication used for the treatment of type 2 diabetes and an anti-obesity medication used for long-term weight management. It is a peptide similar to the hormone glucagon-like peptide-1 (GLP-1), modified with a side chain. It can be administered by subcutaneous injection or taken orally. It is sold by Novo Nordisk under the brand names Ozempic and Rybelsus for diabetes, and under the brand name Wegovy for weight loss.

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.

GLP1 poly-agonist peptides are a class of drugs that activate multiple peptide hormone receptors including the glucagon-like peptide-1 (GLP-1) receptor. These drugs are developed for the same indications as GLP-1 receptor agonists—especially obesity, type 2 diabetes, and non-alcoholic fatty liver disease. They are expected to provide superior efficacy with fewer adverse effects compared to GLP-1 mono-agonists, which are dose-limited by gastrointestinal disturbances. The effectiveness of multi-receptor agonists could possibly equal or exceed that of bariatric surgery. The first such drug to receive approval is tirzepatide, a dual agonist of GLP-1 and GIP receptors.

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. PMID   33188304.
  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. PMC   10130896 . PMID   37122433.
  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" (PDF). Acta Physiologica. 232 (4): e13671. doi:10.1111/apha.13671. PMID   33942517.
  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. PMID   36948384.
  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. PMID   33781949.
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