Archive for the ‘DIABETES AND OBESITY’ Category
Impaired glucose tolerance and type 2 diabetes are often caused directly by the physiological effects of overweight and obesity. Of course, there are many obese non-diabetic individuals, but in those who are genetically susceptible to type 2 diabetes, development of obesity markedly increases the risk of frank diabetes. This should come as no surprise given that 85% of type 2 diabetics are overweight or obese.
The connection between obesity and type 2 diabetes is so strong, that attempting to treat diabetes properly without managing any coexisting obesity is almost futile. The association between the conditions is so close that many experts consider obesity and type 2 diabetes to be different ends of the same spectrum, and that obesity should be treated as a pre-diabetic condition. The term ‘diabesity’ is increasingly being used.
The reason for the link is explored under metabolic syndrome, in particular the fact that insulin resistance, which is the primary defect in type 2 diabetes, is also the fundamental problem in the metabolic syndrome.
A famous study by Sims et al took normal young men with no family history of type 2 diabetes and overfed them for 6 months, increasing their average body weight by 21% to a BMI of 28. This resulted in increased fasting insulin, glucose, triglycerides and an impaired glucose tolerance, which returned to baseline levels when feeding returned to normal.
Statistics emphasize the point; 85-90% of ‘diabetics’ have type 2 diabetes and approximately 80-85% of type 2 diabetics are obese; a staggering 12% of people with a BMI >27 have type 2 diabetes. In men, a waist circumference of over l00 cm increases the risk of diabetes 3.5-fold.
In other words, during a normal Monday morning surgery, a patient with BMI of 35 is 93 times more likely to develop type 2 diabetes than the lean person who has the next appointment. There are estimated to be over one million undiagnosed diabetics in the UK, giving a high probability that this particular obese patient is either one of the missing million or soon will be, and an absolute certainty that sooner rather than later some of the obese patients on a particular doctor’s books will become diabetic.
The National Health and Nutrition Examination Study (NHANES) demonstrates that for each kilogram of weight gain in the population the risk of diabetes rises by an impressive 4.5%.
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