Link between obesity and type 2 diabetes.
By Janet B. McGill, MD, FACE Type 2 diabetes mellitus (DM2), the diabetes that is a combination of insulin not working as well as it should in the body, plus a. Obesity and Type 2 Diabetes Mellitus Canada's obesity prevalence rate of % ranks fourth among the OECD countries, behind the United In a research analysis commissioned by the Canadian Diabetes Association (CDA) in , the. People who are obese have a high risk of developing type 2 diabetes, which is also.
Dietary intake of fats and carbohydrates including starchy foods such as bread and pasta should be reduced. It should be made clear that to maintain weight loss, and if further weight loss is desired, additional dietary energy restriction would usually be required. VLCDs are especially useful for selected patients with diabesity under close medical supervision, particularly those who await a bariatric surgical procedure in whom benefits include hepatic shrinkage [ 47 - 50 ].
The long-term effects of VLCDs are however yet to be demonstrated [ 4950 ]. In addition to dietary changes, behaviour modification and motivation form an important component of weight management in diabesity. Approaches include setting realistic targets for weight-loss, improving self-monitoring of weight, stimulus control, environmental changes and problem-solving. Another technique includes cognitive restructuring to identify and modify negative thoughts, and enhance rewarding thoughts [ 51 ].
Enhanced physical activity is also important in the prevention and management of diabesity through improvements to energy balance and metabolic control. Encouragement of physical activity should be tailored and targeted for the individual, and if applied successfully should improve the success of weight management, though long-term maintenance of enhanced physical activity remains an important concern [ 52 - 55 ].
- Your Weight and Diabetes
- Link between obesity and type 2 diabetes.
Medical approaches to management of diabesity It is often a challenge for patients with diabesity to achieve and sustain substantial weight-loss through lifestyle approaches, and often alternative strategies are required [ 56 ].
Unfortunately, as healthcare professionals we are very limited in what we can offer with regards to medical therapies for obesity, and development of safe and effective weight-loss therapies, particularly in those patients with diabesity should be a priority for the future. To make the problem worse, some of the traditional therapies for T2D including sulphonylureas and insulin therapies are associated with weight gain thereby worsening insulin resistance.
One sulphonylurea drug, Glibenclamide was shown to result in weight gain of around kg within the first year of therapy [ 57 ].
Other therapies such as metformin used as a first line therapy in drug-treated patients with T2D following lifestyle implementation [ 57 ] and the Dipeptidyl Peptidase-4 DPP-4 inhibitors are weightneutral. However, recent developments have been exciting with the injectable incretin Glucagon-Like Peptide-1 [GLP-1] based therapies being associated with sustained weight-loss, in addition to being safe and generally well-tolerable [ 58 ].
Likewise, the new Gliflozin class of therapies for T2D based on inhibition of the Sodium-dependent Glucose co-transporter-2 SGLT2-inhibitors also promote weight-loss in an entirely different and complementary way from the injectable incretin-based therapies. Currently, Orlistat is the only weight-loss therapy licensed for management of obesity. Orlistat can be useful as an adjunct to other therapies lifestyle and medical for promotion of weight-loss in diabesity.
Obesity and Type 2 Diabetes Mellitus | OMICS International
Orlistat can result in improvements to glycaemic control and inflammatory and metabolic parameters in diabesity that are likely related to the associated weight-loss with this therapy [ 5960 ]. Whilst Orlistat can be a useful agent, its unpleasant side-effect profile that includes oily faeces and excessive flatulence can pose a problem for compliance with this therapy.
Unfortunately, obesity often begets further weight gain and worsening of obesity and there are a number of complex mechanisms that are likely to be implicated that include effects on appetite, stomach capacity and feelings of fullnessleptin resistance, brown fat activity, changes in energy expenditure related to expansion of fat depots, and changes in physical activity.
Despite the efforts of a multi-disciplinary team, instigation of lifestyle including dietary changes and optimal use of medical therapies in diabesity, lack of weight loss and even further weight gain may continue to be a problem. In such cases, careful consideration should be given to a surgical management approach which forms the topic of the next section. Surgical approaches to management of diabesity Metabolic surgical techniques are broadly divided into restrictive including insertion of a gastric band and sleeve gastrectomy and by-pass procedures including Roux-en-Y Gastric Bypass and Bilio- Pancreatic Diversion.
Metabolic surgery can be an attractive option for patients with diabesity, especially if performed before the stage at which irreversible beta-cell insulin secretory failure ensues. One advantage of metabolic surgery is that maintenance of weight-loss which is particularly difficult to achieve through lifestyle modification in patients with diabesity is often achievable with this treatment modality [ 61 ]. In addition to being an effective means of promoting weight loss, metabolic surgery also often results in improvements to glycaemic control in patients with diabesity.
Various mechanisms have been proposed for the improved glycaemic control following metabolic surgery in diabesity, including modification of dietary intake and calorie restriction, changes in gut hormone release that in turn affect appetite and pancreatic function, reversal of abnormal intra-myocellular fat deposition in skeletal muscles and improved effectiveness in hepatic glucose-handling [ 62 - 66 ]. Metabolic surgery can result in euglycaemia in some patients with diabesity, and associated reduction in cardiometabolic risk [ 67 - 70 ].
The actual mechanisms by which metabolic surgery improves weight and glycaemic control in diabesity should be a focus for future research, and should inform future development of novel strategies to manage diabesity perhaps based on therapies that replicate the gut hormone changes that occur following by-pass procedures for example.
Unfortunately, we as a species are maladapted genetically to our modern-day environment, having evolved as with all other species in the context of food scarcity, frequent famine and a biology that is well-adapted to protect us from the potentially life-threatening effects of famine. This same biology which is very useful in the context of famine is unfortunately extremely harmful in the context of chronic over-nutrition.
There is a close epidemiological and pathophysiological association between obesity and T2D. Obesity particularly visceral adiposity is an important risk factor in the development of T2D, and some of the currently understood mechanisms implicated have been outlined here.
In addition to these mechanisms, other factors contributing to diabesity, such as the role of genetic traits, quantitative genetic analysis of obesity, behavioral changes, neonatal factors and childhood obesity have been reviewed recently [ 7172 ]. However, there are likely to be other mechanisms at play in, for example the minority of lean adults who develop T2D. Furthermore, we do not fully understand why some adults with obesity and sometimes morbid obesity appear to be protected in some way from developing T2D and other adverse metabolic features that characterise the metabolic syndrome.
The establishment of a clear understanding of these mechanisms should be a focus for future research in this field. Traditionally, the therapies used to treat patients with T2D have resulted in weight gain that worsens insulin resistance and further contributes to metabolic problems. Metabolic surgery remains the most effective strategy to promote weight loss and improve glycaemic control in many patients with diabesity, although its cost is a little prohibitive, and will currently prevent wide-scale application of this approach.
It is important that further research is focused on exploring the mechanisms implicated in weight-loss following metabolic surgery. Conclusion Obesity and T2D, whether individually or whether co-existing as Diabesity, are of major importance with regards to premature mortality, quality of life, associated chronic microvascular complications in the case of T2Dobesity-associated co-morbidities, and the global healthcare economy. A better understanding of the causative and therapeutic interrelationships between these two conditions is essential.
Tackling the worsening global epidemic of diabesity effectively will require a multifaceted approach focused on both adults and children that includes governments, changes to environments, changes to cultures particularly around food and development of novel, safe and effective therapies that promote weight-loss and improve the dysmetabolic state.
Of these, an estimated 8.Fatty Acids and Disease in Type 2 Diabetes
How does my weight relate to type 2 diabetes? There are many risk factors for type 2 diabetes such as age, race, pregnancy, stress, certain medications, genetics or family history, high cholesterol and obesity. However, the single best predictor of type 2 diabetes is overweight or obesity.
Obesity and Type 2 Diabetes Mellitus
People who are overweight or have obesity have added pressure on their body's ability to use insulin to properly control blood sugar levels, and are therefore more likely to develop diabetes. The number of diabetes cases among American adults increased by a third during the s, and additional increases are expected. This rapid increase in the occurrence of diabetes is mostly attributed to the growing prevalence of obesity in the United States.
What can you do to prevent diabetes? Type 2 diabetes is largely preventable. Association, obesity, type 2 diabetes mellitus How to cite this article: Obesity and type 2 diabetes mellitus: Saudi J Obesity ;1: Of these, over million men and million women were obese, which means that more than one in ten of the world's adult population was obese in This review aims to summarize the evidence of the association between obesity and type 2 diabetes mellitus.
Methodology To achieve the objective of this review, a comprehensive literature review was conducted using Google Scholar and Medline database January The review consisted of two stages. In the first stage, we used several terms of titles and keywords to search for relevant articles of different types e.
Examples of terms used were 'obesity', 'fatness', 'body weight', 'weight', 'body mass index', 'BMI', 'waist circumference', 'diabetes', 'type 2 diabetes', 'association', etc. In the second stage, we used relevant search terms of titles and keywords for each of the five themes we used to explain the complexity of association.
After combination of the search terms for each theme and reviewing titles and then abstracts, we included 10 articles for the first theme, 16 for the second theme, 23 for the third theme, 19 for the fourth theme, and 7 for the fifth theme, respectively.
We did not cite all articles obtained through the search strategy. The mean or median BMI in Asians has been found to be lower than that observed in non-Asian populations; so the BMI distribution is shifted to the left. The simple clinical measure of central obesity is the waist circumference WC. Leptin is a protein produced by adipocytes.
The main role of leptin is to regulate food intake and energy expenditure by reducing food intake and increasing sympathetic nervous system outflow, therefore inducing weight loss. Thus, leptin is a critical factor linking reduced energy stores to eating behavior.
Leptin can impair the production of insulin and reduce the effects of insulin on the liver.