What is diabetes?
Diabetes is a disease characterised by high blood glucose levels resulting from defects in insulin production, insulin action or both. Type 1 diabetes develops when the body's immune system destroys pancreatic beta cells, the only cells in the body that make the hormone insulin, which regulates blood glucose levels. This form of diabetes usually strikes children and young adults, although onset can occur at any age.
Type 1 diabetes accounts for a few percent of all diagnosed cases of diabetes. Risk factors for type 1 diabetes include autoimmune, genetic and environmental factors.
Type 2 diabetes accounts for the vast majority of all diagnosed cases. It usually begins as insulin resistance, a disorder in which cells do not use insulin properly. As the demand for insulin increases, the pancreas gradually loses its ability to produce insulin.
Type 2 diabetes risk
The risk of developing type 2 diabetes depends on modifiable and non-modifiable factors. Some people are more likely to develop type 2 diabetes because of their genes. A first-degree relative of a person with type 2 diabetes has a risk 5-10 times higher than a person with no family history.
At any age, the risk of type 2 diabetes increases as body weight increases. The incidence of type 2 diabetes is three to seven times higher in obese people than in adults of normal weight and is 20 times more likely in people with a body mass index (BMI) greater than 35 kg/m2.
The role of obesity in the development of type 2 diabetes
It is not known for sure why some people develop insulin resistance, but it is known that obesity and physical inactivity make it worse. The development of insulin resistance is an important part of the development of type 2 diabetes, and this relationship is also evident in the fact that weight loss can improve control of type 2 diabetes. In addition to the degree of obesity, where excess body fat is deposited is an important element in determining the risk of type 2 diabetes.
The degree of insulin resistance and incidence of type 2 diabetes is highest in a person with an 'apple' figure. These individuals carry most of their excess body weight around their belly button. This is in contrast to a person whose figure resembles a "pear", where excess body fat is deposited around the hips and on the thighs.
Treating obesity will treat type 2 diabetes
Weight reduction is an important goal for people who are overweight or obese, especially those with type 2 diabetes. Moderate and sustained weight loss (5-10% of body weight) can improve insulin action, reduce fasting glucose levels and reduce the need for some diabetes drugs.
Weight loss occurs when energy expenditure exceeds energy intake. Creating an energy deficit of 500-1000 calories per day will result in weight loss of half to one kilogram per week. Recording meals, portion sizes and calorie counts has been found to increase awareness and provide objective evidence of calorie intake.
For an obese patient with diabetes or insulin resistance, it is beneficial to limit carbohydrate portions. These foods include bread, rice, pasta, potatoes, cereals, groats. Carbohydrates raise blood sugar levels, so it's a good idea to be guided by the glycemic index and glycemic load values of foods or dishes to lower insulin outputs. In the case of insulin resistance, increased insulin levels may promote weight gain.
Increasing dietary fibre can be beneficial for both diabetes and obesity. High dietary fibre intake, especially of the soluble type, may improve glycaemic control, reduce hyperinsulinaemia and lower plasma lipid levels in patients with type 2 diabetes. In addition, high-fibre foods help with weight loss and long-term weight maintenance by: requiring more chewing and longer eating, providing fewer calories per serving, creating a sense of satiety and increasing fullness between meals.
The meals of a patient with type 2 obesity or insulin resistance should be complete. Processed foods, simple sugar and saturated fats should be avoided. The energy and nutrient requirements will be determined by a clinical dietician, in addition to nutritional education that will allow the patient to compose the menu correctly.
Regular physical activity helps maintain weight loss and prevent weight regain. It also improves insulin sensitivity and glycaemic control, can reduce the risk of developing diabetes and make it easier, more supportive of its treatment.
A physical activity goal should be set at about 200 minutes of moderate exercise per week. Exercise does not have to occur in one session. Splitting exercise into several times a week of about 45-60min each has rewarding results for patients. Using a pedometer can help to set objective exercise goals. Gradually increasing the number of steps per day, with a goal of 10000 steps, is ideal. Any increase in physical activity from baseline will help to increase the energy deficit and consequently to successful weight loss.
There are several drugs for the treatment of diabetes, insulin resistance and obesity. A full review of these drugs is beyond the scope of this article. However, metformin is one drug that has been shown to help reduce the risk of type 2 diabetes in patients with insulin resistance. Metformin reduced the rate of progression to diabetes in obese patients with impaired glucose tolerance.
Bariatric surgery should be considered by those who have a BMI greater than 40 or have a BMI of 35-39.9 and medical indications such as diabetes, heart disease or sleep apnoea.
Bariatric surgery alters the process of digestion and nutrient absorption. The types of surgery performed by the Baria team3 are sleeve gastrectomy, gastric bypass and mini gastric bypass. Treating diabetes with a scalpel is possible because of the limited size of the stomach and also because of the hormonal changes that occur in the body after surgery.
Patients and their doctors must consider the risks of bariatric surgery compared to the risks of obesity and related medical problems. When other treatments for obesity disease have failed, bariatric surgery may be the best chance for significant and permanent weight loss. It is worth mentioning that bariatric surgery is currently the most effective treatment for obesity.
Preventing and treating obesity will help prevent and treat diabetes. Promoting healthy lifestyles in children and young people will put them on a path that will reduce the risk of diabetes and its complications. Helping adults at high risk of diabetes to change their diet and lifestyle can prevent the development of diabetes and its consequences.