In the era of lifestyle diseases, diabetes is the biggest burden to our society. Not only it slowly damages our internal organs but also decreases our life expectancy significantly. The incidences of diabetes has been on the rising trend since last two decades due to our lifestyle. The relationship between diabetes and obesity is been like milk and water. The two entities can be mixed very well. Obesity leads to metabolic syndrome aggravating diabetes. So we must have a healthy discussion regarding the overwhelming metabolic effects and diseases in association with both diabetes and obesity. Before that we should know about both entities to understand about their metabolic effects.
Obesity prevalence and burden
The burden of overweight and obesity is alarming. According to WHO, more than 1 billion people are obese – 650 million adults, 340 million adolescents and 39 million children. WHO has urged on World Obesity Day, the countries to do more with this potential devastating situation leading to lots of chronic diseases including diabetes.
Basal metabolic index is the single most important factor to know about the overweight and obesity. Basal metabolic index is defined as weight in kilograms divided by height in meter square.
BMI= Weight in kg/Height in meter²
In overweight, BMI is more than 25 and in case of obesity the BMI is more than 30.
Burden of diabetes
Diabetes incidence is on the rising trend since the last two decades. Till 2017, 462 million individuals were affected by type-2 diabetes corresponding to 6.8% of the world’s population. The prevalence was more than 6000 cases per 100,000 population. Over a million deaths per year are attributed to diabetes alone making it the ninth leading cause of mortality overall. The incidence of diabetes is rising very fast specially in developed nations. The gender distribution is almost equal and incidence is peak around at 55 years. Global prevalence is likely to increase to around 7079 per 100,000 population by 2030.
Diabetes may be type 1 and 2. Several pathogenic mechanisms are involved in diabetes. They range from the auto immune destruction of beta cells with resulting insulin deficiency to abnormalities that result in resistance to insulin action. Type 1 diabetes may precipitate in genetically susceptible individuals likely as a result of environmental trigger. It may be HLA gene linked.
Diagnosis of Diabetes
Diabetes is diagnosed when the fasting blood sugar is more than 126mg/dl and post prandial blood sugar is more than 200mg/dl.
Obesity and diabetes association pathogenesis
Obesity is a metabolic state which increases the hormones, cytokines, proinflammatory markers, adiponectin and release of non esterified fatty acids (NEFA) or free fatty acids. The hepatic output or neoglucogenesis increases the blood sugar levels. Insulin is a hormone which helps in lipogenesis. This vicious cycle propagates and leads to aggravation of symptoms.
Complications in relation to diabetes and obesity
There are a series of complications related to the metabolic states like obesity and diabetes.
1. Cardiovascular disease- Risk of cardiovascular diseases increase in an alarming way when both the conditions combined. Obesity leads to increase in cholesterol levels leading to plaques in major arteries including coronary arteries supplying the heart. These plaques gradually increase in size blocking the lumen of arteries leading to thrombosis. By dislodgement of thrombotic plaques, various major organs affected by thromboembolism. Cardiac manifestation occurs in form of myocardial infarction or heart attack.
Studies show overweight and obesity are associated with various risk factors for cardiovascular disease and development of atherosclerotic lesions. They increase the incidence of cardiovascular diseases in adulthood.
2. Stroke- Sometimes, the thromboembolic phenomenon affects major vessels in brain, causing cerebral infarction or stroke. Stroke means weakness or paralysis of one or both sides of body according to the brain involvement. It is called paresis if there is partial weakness and plegia if weakness is full. Hemiplegia is the term used for the paralysis of one side of the body.
3. Involvement of major organs like kidney, eyes
As both are metabolic states, they aggravate the inflammation related injury in these viral organs.
4. Mental illness
Obesity and diabetes both are chronic metabolic states not only affects the physical state but also the mental status. It may lead to depression and anxiety. Again depression may lead to physical inactivity aggravating the ongoing situation. Chronic diseases put pressure not only in physical health but also a financial burden.
Intervention and preventive majors to tackle diabetes and obesity
1. Physical exercise- Daily physical activity of at least thirty minutes may help to reduce the state of inflammation and maintaining lean muscle mass thus putting in shape of our BMI. Exercises like running, bicycling, skipping will do the best results. Even simple morning walk daily will have enormous benefits.
2. Weight reduction- Weight reduction can favourably result in positive outcome of diabetes and obesity. The adipose tissue is the main culprit in the metabolic syndrome and complications.
3. Avoid smoking and alcohol
4. Adequate fruits and vegetables in diet- Fruits and vegetables are rich in antioxidants. They prevent the inflammatory damage induced by the inflammatory markers and cytokines. Also they are rich in complex carbohydrates or fibers. The fibers in diet don’t allow to raise the blood sugar immediately and also help in reducing the total cholesterol level. the long term risks like thromboembolism is also reduced.
5. Reduction of blood pressure- Blood pressure reduction is associated with decrease in incidence of organ damage and reduction of chances of stroke and heart disease.
6. Check in cholesterol level- Cholesterol level is an independent risk factor in development of long term complications like heart attack, diabetes and stroke. It also affects the longevity of the individuals.
7. Promoting the Non communicable disease clinics(NCD)- The non communicable disease like cardiovascular diseases, diabetes, stroke are on rising trend all over the world especially in affluent societies. There should be dedicated NCD clinics as the burden due to lifestyle diseases are far more devastating than infectious diseases due to its chronicity in nature.
Primordial prevention intends to prevent emergence of risk factors in children, youth and young adults to maintain a healthy weight and prevent development of obesity.
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