Obesity And Type 2 Diabetes

2017-11-11 11:49:33

Credit: twenty20.com

Credit: twenty20.com

Obesity and type 2 diabetes are public health problems, with health consequences and economic costs that have raised concern worldwide. Most patients with type 2 diabetes are obese, and the global epidemic of obesity largely explains the dramatic increase in the incidence and prevalence of type 2 diabetes over the past 20 years. Type 2 diabetes is more prevalent than type 1 diabetes and is therefore seen in roughly 90% of all diabetes cases. Type 2 diabetes is predominantly diagnosed after the age of forty, however, it is now being found in all age ranges, including children and adolescents. There is a close association between BMI and risk of developing T2D, the relative risk of T2D increasing with BMI. For each kilogram of weight gained annually over a period of 10 years, there is an associated 49% increase in the risk of developing T2D in the subsequent 10 years. While the exact causes of diabetes are still not fully understood, it is known that factors up the risk of developing different types of diabetes mellitus. For type 2 diabetes, this includes being overweight or obese (having a body mass index - BMI - of 30 or greater).

How does obesity cause type 2 diabetes?

According to study LTB4 is the inflammatory factor causing insulin resistance, we can inhibit it to break the link between obesity and diabetes. Extra fat, particularly in the liver, activates resident macrophages, the immune cells living there. These macrophages then do what they’re supposed to do when activated — release LTB4 and other immune signaling molecules to call up an influx of new macrophages. Then, in a positive feedback loop, the newly arriving macrophages also get activated and release even more LTB4 in the liver.

This inflammatory response would be a good thing if the body was fighting off an infection. But when inflammation is chronic, as is the case in obesity, all of this extra LTB4 starts activating other cells, too. Like macrophages, nearby liver, fat and muscle cells also have LTB4 receptors on their cell surfaces and are activated when LTB4 binds them. Now, in obesity, those cells become inflamed as well, rendering them resistant to insulin.

Does all patients with obesity develop type 2 diabetes

Not all but almost 90% of people living with type 2 diabetes are overweight or have obesity. In healthy people, a "fasting switch" only flips on glucose production when blood glucose levels run low during fasting. "The existence of a second cellular signaling cascade—like an alternate route from A to B—that can modulate glucose production, presents the potential to identify new classes of drugs that might help to lower blood sugar by disrupting this alternative pathway.

It had been well established that obesity promotes insulin resistance through the inappropriate inactivation of a process called gluconeogenesis, where the liver creates glucose for fuel and which ordinarily occurs only in times of fasting. Yet, not all obese people become insulin resistant, and insulin resistance occurs in non-obese individuals

Management of diabesity

Lifestyle modification: changes in diet, physical activity and behaviour, is generally the first-line strategy.

Medical approaches: 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. 

Surgical approaches: 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).

Source:  Salk Institute, obesity.org, Saboor et al., 2014, doi:10.4172/2165-8048.S6-002, UC San Diego