Diabesity or Dibesity is a newer term derived from two words, Dia for Diabetes and Besity for Obesity. It is the occurrence of Diabetes in Obese individuals. It is the combination of two global pandemics, diabetes, and obesity. Commonly used terms, phrases, or definitions used to elaborate diabesity are:
- Diabetes in the context of obesity
- Obesity-related diabetes or diabetes-related to obesity
- Obesity-dependent diabetes
- Diabetes linked to obesity
- The coexistence of diabetes and obesity
Why Understanding Diabesity is Important?
Understanding diabesity is very important for the following reasons:
- The combination of diabetes and obesity multiplies the complications that arise from each of the diseases (the complications do not add up, they multiply). Treating one aspect has a significant effect on the other disease.
- The pathophysiologic processes that cause diabetes and obesity are the same and one treatment could have a significant effect on the other.
- Diabetes in individuals with diabesity could be cured if obesity is treated. Thus, unlike the lean diabetic patients, these patients need a little hard work to get rid of the deadly disease.
Are diabesity and metabolic syndrome two different entities?
Metabolic syndrome, also called syndrome X or Insulin resistance syndrome is defined as the occurrence of three or more of the following criteria in an individual (Ref: NCEP ATP3 2005 Criteria):
- Fasting blood glucose of 100 mg/dl (or 5.6 mmol/liter) or a person on medications to reduce blood sugars.
- A person on drug treatment to increase HDL (high-density lipoproteins) or men with plasma HDL levels of less than 40 mg/dl (or less than 1 mmol/liter) and women with plasma HDL levels of less than 50 mg/dl (or less than 1.3 mmol/liter)
- Plasma triglyceride levels of 150 mg/dl or more (or 1.7 mmol/liter or more) or a person on treatment to reduce plasma triglyceride levels
- Women with a waist circumference of 88 cm or more and men with a waist circumference of 102 cm or more. In Asians, a waist circumference of 90 cm or more in men and 80 cm or more in women is taken as the cut-off.
- Blood pressure equal to or exceeding 130/85 mmHg or a person on blood-pressure-lowering medications.
It is important to note here that metabolic syndrome has five important parameters and obesity is not a prerequisite for the diagnosis of the syndrome. Any three of the criteria constitute the metabolic syndrome.
Diabesity is diabetes in the context of obesity. Diabesity with one other cardiovascular risk factor constitutes metabolic syndrome.
Patients with metabolic syndrome may neither be obese nor have diabetes. Hence, diabesity is a subset of metabolic syndrome. Both the conditions are not synonymous.
How prevalent is diabesity?
Diabetes and obesity are very prevalent. Worldwide, 9.3% of adults have diabetes accounting for 463 million people worldwide.
The prevalence of obesity in diabetic patients is estimated to be around. In 2016, 1.9 billion people were above the normal weight.
Out of these 1.9 billion people, 650 million people were obese. 39 million children under the age of five years were estimated to be obese in 2020.
Among children in the age groups of 5 – 19 years, over 340 million children were obese in 2016. Among overweight individuals, the prevalence of diabetes is estimated to be around 30% and the prevalence of obesity in diabetic individuals is estimated to be around 85% [Ref].
What are the symptoms of diabesity?
As the name suggests, diabesity is the occurrence of diabetes and obesity. The two most common symptoms of diabesity are obesity and high blood sugars.
All the symptoms of diabesity revolve around these two conditions and the complications arising from these two conditions.
What cut-offs are used to define diabesity?
Diabetes is defined as :
- a fasting plasma glucose of 126 mg/dl or more on two separate occasions,
- random blood glucose of 200 mg/dl or more on two separate occasions,
- glycated hemoglobin of 6.4% or more on two separate occasions, or
- single readings of fasting blood glucose of 126 mg/dl, random blood glucose of 200 mg/dl, or glycated hemoglobin of 6.4 % or more in patients who are symptomatic.
Obesity has been defined in various ways. One way is the waist circumference as per the NCEP ATP3 2005 Criteria.
- According to this criteria, women with a waist circumference of 88 cm or more and men with a waist circumference of 102 cm or more are considered obese.
- In Asians, a waist circumference of 90 cm or more in men and 80 cm or more in women is taken as the cut-off to define obesity.
However, the most commonly used classification and criteria for defining obesity are based on the BMI (body mass index). BMI is calculated as (weight in Kgs/ height in m2). The following classification is used according to the BMI:
- Normal weight:
- BMI of 18.5 to less than 25 kg/m2
- BMI of 25 or more to less than 30 kg/m2
- BMI exceeding 30 kg/m2.
This is further divided into three different classes based on the severity of the condition:
- Class I obesity:
- BMI of 30 to 34.9 kg/m2
- Class II obesity:
- BMI of 35 to 39 kg/m2
- Class III obesity:
- BMI of 40 kg/m2 or more. This is also called morbid obesity, severe obesity, or extreme obesity.
It is important to note that the cut-offs for Asians are different. A BMI of 23 or more to less than 25 kg/m2 is labeled as overweight and BMI exceeding 25 kg/m2 is labeled as obesity.
Ho to treat Diabesity?
Treatment of most metabolic conditions starts with lifestyle and dietary interventions. A brisk walk, running, swimming, or cycling are among the best exercises to burn fats and calories.
This should be combined with a low-calorie diet. Diet high in fiber, low in carbohydrates, and calories when combined with regular aerobic exercise for 30 minutes or more constitutes the best practice for weight loss programs.
A long list of medications is available to treat diabetes. However, few medicines effectively treat obesity.
Since diabesity is diabetes occurring in the context of obesity, treating obesity effectively might cure diabetes in these patients.
Until now, most medications used to treat diabetes caused weight gain. This would initiate the vicious cycle of weight gain, immobility, hyperglycemia.
The paradigm has shifted recently to the novel class of medications like GLP-1 analogs and SGLT-2 inhibitors.
These medications effectively lower blood glucose while simultaneously resulting in weight loss. FDA has recently approved Wegovy (a high-dose once-weekly injectable Semaglutide) for the treatment of obesity.
It could prove an important milestone in the treatment of diabesity.
Medications are commonly used for weight loss however, the best results are achieved with metabolic surgeries (previously called bariatric surgery).
The gut is considered one of the major endocrine organs. The field of bariatric and metabolic surgery is evolving.
Surgeons have achieved dramatic results with bariatric surgeries.
Bariatric surgeries do not only result in weight loss but also improve most of the metabolic abnormalities including diabetes, hypertension, and dyslipidemias.
What are the complications of diabesity?
Diabesity is associated with serious complications. It is a two-pronged sword. The complications of diabetes are well-known. It is the most common cause of end-stage renal disease, blindness, cardiovascular disease, and amputations.
Diabesity is a combination of two co-morbid conditions itself. Furthermore, it adds up the complications associated with each condition. Thus patients are at very high risk of developing the following complications:
- Cardiovascular diseases including angina, myocardial infarction, and heart failure
- Cerebrovascular diseases and strokes
- Gastroesophageal reflux disease
- Obstructive sleep apnea
- Fatty liver and non-alcoholic steatohepatitis