Early Recognition of Overweight Hyperglycaemia May Improve Clinical Outcomes in Type 2 Diabetes

Abstract

Diabetes is the ninth leading cause of death, directly accounting for 1.5 million deaths annually worldwide. Despite several breakthrough discoveries, little progress has been made in type 2 diabetes outcomes over the past 100 years. Younger age (below 60 years), a diet high in calories and processed food, and severe obesity (body mass index >35 kg/m2) may identify reversible beta cell dysfunction. Much of the clinical presentation pertains to flooding the body’s adaptive limits with overnutrition. Recognizing this as a global societal trend brought about by lifestyle changes, sedentary work, mental stress and unlimited access to calorie-dense foods is crucial. Insulin resistance and genetic abnormalities cannot account for the dramatic increase in diabetes, from only 1% five decades ago to nearly 10% today. Obesity – and not insulin resistance – is at the core of the problem. As well as hyperglycaemia, end-organ damage can also be reversed with diet and weight loss in many affected individuals. We present the evolution of our understanding and compelling reasons to reframe diabetes in the severely obese to what it really is – overweight hyperglycaemia. This may shift societal perception, governmental funding, workplace reformations and individual engagement with healthy lifestyles. The objective of this review is to better understand global trends and the potential to improve outcomes by reframing the diabetes narrative towards remission. This may shift societal perception, governmental funding, workplace reformations and individual engagement with healthy lifestyles.

Obesity-Induced Hyperglycemia and Heart Failure Preserved Ejection Fraction: Uncharted Territories to Remission

“…On the other hand, type 2 diabetes results from insulin resistance caused by genetic and environmental factors [ 12 ]. OH shares similar etiologies with type 2 diabetes, except that it occurs before the development of type 2 diabetes and involves experiencing a state of chronic hyperinsulinemia for decades [ 3 , 12 ]. Further differences and comparisons between type 1, type 2, and OH can be seen in Table 1 .…”

“…Obesity-induced hyperglycemia OH is an emerging clinical phenotype characterized by elevated blood glucose levels resulting from excess body fat accumulation [3]. It is a consequence of the intricate relationship between adipose tissue, hormones, and insulin resistance [9].…”

“…Further differences and comparisons between type 1, type 2, and OH can be seen in Table 1. Author's own work [3].…”

“…Obesity is associated with numerous cardiovascular risk factors, including hypertension, type 2 diabetes, and dyslipidemia [ 2 ]. However, recent insights have enhanced our understanding of the mechanisms underlying the development of obesity-related complications, suggesting significant interindividual heterogeneity, particularly including obesity-induced hyperglycemia (OH) and obesity-induced heart failure (HF) with preserved ejection fraction [ 3 , 4 ].…”

Glucose Fluctuation Inhibits Nrf2 Signaling Pathway in Hippocampal Tissues and Exacerbates Cognitive Impairment in Streptozotocin-Induced Diabetic Rats

“…Globally, the DM-related health expenditures were estimated at 966 billion USD in 2021, which are projected to reach 1,054 billion USD by 2045. DM can result in over 1 million deaths every year, becoming the ninth leading cause of death [4,5].…”