Management of diabesity: Current concepts

Abstract

The global prevalence of obesity is increasing rapidly with an exponential rise in incidence of type 2 diabetes mellitus in recent years. ‘Diabesity’, the term coined to show the strong interlink between obesity and diabetes, is the direct cons-equence of the obesity pandemic, and poses significant challenges in the management of the disease. Without addressing the clinical and mechanistic complications of obesity such as metabolic-associated fatty liver disease and obstructive sleep apnoea, a rational management algorithm for diabesity cannot be developed. Several classes of anti-diabetic medications including insulins, sulphonylureas, thiazolidinediones and meglitinides are associated with the risk of weight gain and may potentially worsen diabesity. Therefore, appropriate selection of antidiabetic drug regimen is crucial in the medical management of diabesity. The role of non-pharmacological measures such as dietary adjustments, exercise interventions and bariatric procedures should also be emphasised. Unfortunately, the importance of appropriate and optimal management of diabesity is often overlooked by medical professionals when achieving adequate glycemic control which results in inappropriate management of the disease and its complications. This review provides a narrative clinical update on the evidence behind the management of diabesity.

Association of medical comorbidities in obese subjects diagnosed with heparin-induced thrombocytopenia

“… 33 It is theorized that pro-inflammatory proteins released by adipocytes lead to a chronic inflammatory state impacting glucose regulation. 34 These two linked conditions, termed diabesity, are rising in prevalence worldwide, are associated with various comorbidities, and may need to be regarded as a potential risk factor for the development of HIT. There are several reasons to consider this.…”

Associations of diabesity with all‐cause and cardiovascular disease mortality: Findings from the Mexico City Prospective Study

“…4,5 The factor that probably stands out in both conditions is insulin resistance, a consequence of abdominal adiposity. 6 The term 'diabesity' describes a condition in which both diabetes and obesity coexist, referring to the close association in the pathophysiology of both conditions and how they exacerbate each other. 6,7 It represents the continuation of metabolic alterations that begin with resistance to the action of insulin in target cells and culminate in diabetes diagnosis.…”

“…6 The term 'diabesity' describes a condition in which both diabetes and obesity coexist, referring to the close association in the pathophysiology of both conditions and how they exacerbate each other. 6,7 It represents the continuation of metabolic alterations that begin with resistance to the action of insulin in target cells and culminate in diabetes diagnosis. Although the etiology of diabetes may have genetic predispositions, its development is strongly influenced by environmental factors, dietary patterns and lifestyles.…”

Comparative efficacy of sodium glucose cotransporter-2 inhibitors in the management of type 2 diabetes mellitus: A real-world experience

“…Glycosuria also results in a net body energy deficit (the reason why SGLT-2i causes weight loss), and osmotic diuresis as consequence - the additional benefits of these medications. The weight loss benefit makes this class of drugs an attractive treatment option for patients with type 2 diabetes mellitus (T2DM) and diabesity - diabetes because of obesity[ 2 , 3 ]. Moderate improvement in glycemic control with a reduction in glycated hemoglobin (HbA1c) is seen with the use of these drugs[ 1 - 11 ].…”