In last month’s edition, we explored diabesity—obesity-dependent diabetes. The relationship between diabetes and obesity is deeply intertwined. Type 2 diabetes is caused by insulin resistance and a decline in β-cell insulin secretory function.
The global increase in the prevalence of obesity is likely responsible for the recent rise in type 2 diabetes, as obesity influences both insulin action and β-cell function. Understanding this relationship is essential for effective patient care and for implementing strategies to mitigate the risks associated with diabesity.
Healthcare providers play a crucial role; they are at the forefront of diagnosing, managing, and preventing this dual burden.
Role of healthcare providers
Prevention and management strategies
The lifetime risk of diabetes in men over 18 years of age increases from 7 per cent to 70 per cent when BMI rises from less than 18.5 kg/m² to more than 35 kg/m². The risk for women shows a similar increase, from 12 per cent to 74 per cent, with the same BMI values. Therefore, diabetic screening is essential for all patients with obesity. Interventions that lead to weight loss are also recommended.
Early screening and diagnosis: Early screening for diabetes in obese patients is critical. Healthcare providers should perform regular blood glucose tests and monitor other risk factors, such as blood pressure and cholesterol levels. Early diagnosis enables timely intervention, which can prevent or delay the onset of diabetes.
Comprehensive lifestyle modification: The goal of comprehensive lifestyle modification is to lose at least 5 per cent of body weight. Encouraging patients to adopt a healthy lifestyle is crucial for managing diabesity. Key areas include:
Diet: Emphasise a balanced diet rich in whole grains, lean proteins, fruits, and vegetables. Lowering the intake of processed foods, sugary drinks, and high-fat foods can significantly improve blood sugar levels and promote weight loss.
Physical activity: Regular physical activity improves insulin sensitivity and promotes weight loss. Patients should aim for at least 150 minutes of moderate-intensity exercise weekly, such as brisk walking, swimming, or cycling.
Behavioural therapy: Addressing psychological factors that contribute to overeating and sedentary behaviour is crucial. Cognitive-behavioural therapy (CBT) and other behavioural interventions can help patients develop healthier habits and coping mechanisms. Regular screening for mood disorders and other psychosocial factors related to diabetes and obesity is recommended. Young and older adults with obesity and diabetes should also be screened for smoking and other tobacco use, as smoking is associated with increased diabetes risk, possibly by raising insulin resistance. Counselling and appropriate pharmacological interventions for smoking cessation should be offered to smokers.
Pharmacotherapy: Lifestyle modifications alone may not be sufficient. Medications can help improve insulin sensitivity and control blood sugar levels. Newer antidiabetic drugs, such as GLP-1 receptor agonists, have been shown to promote weight loss and improve glycaemic control. After initiating pharmacotherapy, patients should be closely monitored for medication efficacy and adverse effects.
Bariatric surgery: For severely obese patients with type 2 diabetes, bariatric surgery may be an option. Surgical procedures such as gastric bypass and sleeve gastrectomy can result in significant weight loss and even remission of diabetes in some cases. Healthcare providers should carefully evaluate candidates for bariatric surgery and provide comprehensive pre- and post-operative care.
Patient self-management education and support: Patient self-management education ensures a better understanding of these coexisting conditions and promotes awareness of the importance of self-testing and adherence to medical therapy. Healthcare providers should educate patients about the risks associated with obesity and diabetes, and the importance of sticking to treatment plans. Support groups and counselling can provide the encouragement and resources patients need to make lasting lifestyle changes.
Conclusion
Focusing on prevention, early intervention, and comprehensive management strategies allows patients to lead healthier and more fulfilling lives. Addressing diabesity requires a collective effort, but with dedication and the right approach, it is possible to turn the tide on this growing health crisis.
References
Yashi K, Daley SF. Obesity and Type 2 Diabetes. [Updated 2023 Jun 19]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK592412/
Samuel Klein, Amalia Gastaldelli, Hannele Yki-Järvinen, Philipp E. Scherer, Why does obesity cause diabetes?, Cell Metabolism, Volume 34, Issue 1, 2022, Pages 11-20, ISSN 1550-4131, https://doi.org/10.1016/j.cmet.2021.12.012.
Pharm. (Dr) Onyinye Chiekwe Bridget, PharmD, MPH, ABMP
pharmbree25@gmail.com
