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Diabesity

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Global epidemic

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.

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. Although it is not fully understood how insulin resistance develops, lifestyle factors are crucial to the development of both illnesses and excess body fat is the most significant risk factor for type 2 diabetes. Common comorbidities include non-alcoholic fatty liver disease, dyslipidemia, high blood pressure, cardiovascular disease, obstructive sleep apnea, and chronic kidney disease.

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).

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 and lifestyle interventions.

Management

See also: management of obesity

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.

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

References

  1. ^ 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. ^ 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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