Obesity and Type 2 Diabetes: What Can Be Unified and What Needs to Be Individualized?

Abstract

OBJECTIVEThis report examines what is known about the relationship between obesity and type 2 diabetes and how future research in these areas might be directed to benefit prevention, interventions, and overall patient care.RESEARCH DESIGN AND METHODSAn international working group of 32 experts in the pathophysiology, genetics, clinical trials, and clinical care of obesity and/or type 2 diabetes participated in a conference held on 6–7 January 2011 and cosponsored by The Endocrine Society, the American Diabetes Association, and the European Association for the Study of Diabetes. A writing group comprising eight participants subsequently prepared this summary and recommendations. Participants reviewed and discussed published literature and their own unpublished data.RESULTSThe writing group unanimously supported the summary and recommendations as representing the working group's majority or unanimous opinions.CONCLUSIONSThe major questions linking obesity to type 2 diabetes that need to be addressed by combined basic, clinical, and population-based scientific approaches include the following: 1) Why do not all patients with obesity develop type 2 diabetes? 2) Through what mechanisms do obesity and insulin resistance contribute to β-cell decompensation, and if/when obesity prevention ensues, how much reduction in type 2 diabetes incidence will follow? 3) How does the duration of type 2 diabetes relate to the benefits of weight reduction by lifestyle, weight-loss drugs, and/or bariatric surgery on β-cell function and glycemia? 4) What is necessary for regulatory approval of medications and possibly surgical approaches for preventing type 2 diabetes in patients with obesity? Improved understanding of how obesity relates to type 2 diabetes may help advance effective and cost-effective interventions for both conditions, including more tailored therapy. To expedite this process, we recommend further investigation into the pathogenesis of these coexistent conditions and innovative approaches to their pharmacological and surgical management.

HbA1c as an index of glycemic status in obese type 2 diabetics

“…The prevalence of T2DM parallels the increasing preva- lence of obesity. The increase in the incidence and prevalence of type 2 diabetes over the past few decades is due to obesity reaching to epidemic proportions [1]. Over the years an increase prevalence of obesity in both urban and rural India has been observed [10].…”

“…There is a close association between obesity and type 2 diabetes. The global epidemic of obesity to a large extent explains the dramatic increase in the incidence and prevalence of type 2 diabetes over the past two decades [1]. Overweight and obese individuals are at a much higher risk of developing type 2 diabetes.…”

Coronary Risk Estimation according to the Framingham-Wilson Score and Impaired Fasting Glucose in Adult Subjects from Maracaibo city, Venezuela

“…Exploration of IFG subjects revealed these show significantly higher hypertriacylglyceridemia, insulin levels, HOMA2-IR, BMI and waist circumference values compared to NG individuals. This behavior reflects the close link between visceral adiposity, insulin resistance and progression to DM2 [45], which only highlights that weight loss, physical activity and hypocaloric diets are key players in the management of IFG subjects, aiding in decrease of cardiovascular risk and progression to T2DM [46]. Future prospective studies are needed to evaluate which metabolic control surrogate (and corresponding cut-off point) should be used according to pharmacological treatment, evolution of prediabetes/ diabetes, weight control, physical activity, nutritional variables and comorbidities observed in the patients.…”

Chronic stress aggravates glucose intolerance in leptin receptor-deficient (db/db) mice

“…The pervasiveness of obesity largely explains the dramatic increase of type 2 diabetes (T2D) and associated life-threatening complications (WHO 2006;Eckel et al 2011). However, the mechanisms of obesity-related comorbidities remain unclear, as does our understanding of individual susceptibility.…”