Obesity and Diabetic Complications: A Study from the Nationwide Diabetes Report of the National Program for Prevention and Control of Diabetes (NPPCD-2021) Implications for Action on Multiple Scales

Impaired Sensitivity to Thyroid Hormones Is Associated With the Change of Abdominal Fat in Euthyroid Type 2 Diabetes Patients: A Retrospective Cohort Study

Background and Aims: This study is aimed at investigating the potential correlation of thyroid hormone sensitivity with visceral fat area (VFA), subcutaneous fat area (SFA), and body mass index (BMI) among euthyroid type 2 diabetes mellitus (T2DM) subjects. Methods: Thyroid hormone sensitivity indices were calculated by thyroid feedback quantile-based index (TFQI), TSH index (TSHI), thyrotropin thyroxine resistance index (TT4RI), and free thyroxine (fT4)/free triiodothyronine (fT3) ratio. These indices were then categorized into quartiles for analysis. The outcomes were the change rates in VFA, SFA, and BMI among the participants. Result: The present study included 921 patients, with a median follow-up of 2.2 years. In multivariate linear regression, when compared to the first quartile, SFA demonstrated a notable decline in the fourth quartile of TFQI, TSHI, and TT4RI (β coefficient = -5.78, -7.83, and - 6.84 cm2 per year), while it significantly increased in the fourth quartile of fT4/fT3 ratio (β coefficient = 6.13 cm2 per year). Similarly, in the fourth quartile of TFQI, TSHI, and TT4RI, VFA decreased significantly, evidenced by β coefficients of -5.14, -4.80, and -4.08 cm2 per year. Yet, among the quartiles of the fT4/fT3 ratio, no discernible trend in VFA was observed. There was no significant association between indices of thyroid hormone sensitivity and change in BMI. Conclusion: Impaired central sensitivity to thyroid hormones was significantly associated with the reduction of VFA and SFA, while impaired peripheral sensitivity was associated with an increase of SFA in euthyroid individuals with T2DM.

Treat Obesity to Treat Type 2 Diabetes Mellitus

Obesity, a multifactorial, relapsing chronic disease, serves as a gateway to a spectrum of metabolic, cardiovascular, mechanical and mental health problems. Over the last few decades, the global prevalence of obesity has surged nearly threefold, mirroring the escalating rates of type 2 diabetes mellitus (T2DM). This parallel trajectory strongly suggests a cause-and-effect relationship between obesity and T2DM. Extensive research indicates that even modest weight gain elevates the risk of T2DM, favoring the notion of obesity being a root cause. This perspective finds robust support in numerous studies demonstrating the preventive effects of obesity management on the onset of T2DM. Beyond prevention, obesity management has been shown to enhance remission in individuals with T2DM and to decrease microvascular complications, cardiovascular risk factors, renal failure and heart failure. This evidence underpins the urgent need for global initiatives aimed at addressing obesity management as a key strategy in the prevention and management of T2DM and its complications.

Cognitive and Emotional Perceptions of Illness in Patients Diagnosed with Type 2 Diabetes Mellitus

Type 2 diabetes mellitus (T2DM) affects a patient's physical, social, and mental well-being. Perceptions of the illness are linked to quality of life. The aim of this study was to assess illness perception in patients diagnosed with T2DM and to validate the Brief Illness Perception Questionnaire in the Slovenian language. A cross-sectional study involved 141 patients diagnosed with T2DM. We performed a content analysis of the questionnaire and estimated the S-CVI, I-CVI, kappa coefficient. We also used Cronbach's alpha to assess the reliability. Participants did not have a very threatening perception of T2DM, but being overweight and having cardiovascular disease were significant contributors to a more threatening perception. The most frequently indicated factors influencing the onset and development of T2DM were heredity and genetics, stress and other psychological distress, and poor and inadequate nutrition. I-CVI ranged from 0.833 to 1.00, while the kappa is greater than 0.74, confirming the excellent validity of the questions. The content validity assessment of the questionnaire further confirms that the questionnaire is suitable for use with the target population in Slovenia. The questionnaire proved to be a valid and reliable tool that can be used to assess the relationship between illness perception and self-management of T2DM.

Flavonols as a Potential Pharmacological Intervention for Alleviating Cognitive Decline in Diabetes: Evidence from Preclinical Studies

Diabetes mellitus is a complex metabolic disease associated with reduced synaptic plasticity, atrophy of the hippocampus, and cognitive decline. Cognitive impairment results from several pathological mechanisms, including increased levels of advanced glycation end products (AGEs) and their receptors, prolonged oxidative stress and impaired activity of endogenous mechanisms of antioxidant defense, neuroinflammation driven by the nuclear factor kappa-light-chain enhancer of activated B cells (NF-κB), decreased expression of brain-derived neurotrophic factor (BDNF), and disturbance of signaling pathways involved in neuronal survival and cognitive functioning. There is increasing evidence that dietary interventions can reduce the risk of various diabetic complications. In this context, flavonols, a highly abundant class of flavonoids in the human diet, are appreciated as a potential pharmacological intervention against cognitive decline in diabetes. In preclinical studies, flavonols have shown neuroprotective, antioxidative, anti-inflammatory, and memory-enhancing properties based on their ability to regulate glucose levels, attenuate oxidative stress and inflammation, promote the expression of neurotrophic factors, and regulate signaling pathways. The present review gives an overview of the molecular mechanisms involved in diabetes-induced cognitive dysfunctions and the results of preclinical studies showing that flavonols have the ability to alleviate cognitive impairment. Although the results from animal studies are promising, clinical and epidemiological studies are still needed to advance our knowledge on the potential of flavonols to improve cognitive decline in diabetic patients.

Association of BMI and waist circumference with diabetic microvascular complications: A prospective cohort study from the UK Biobank and Mendelian randomization analysis

AIMS

To investigate the precise association between BMI and waist circumference (WC) and diabetic complications, including retinopathy (DR), nephropathy (DN) and peripheral neuropathy (DPN).

METHODS

A multivariable-adjusted Cox proportional hazard model was used to evaluate the observed association from 30,541 UK Biobank participants with diabetes. A two-sample Mendelian randomization (MR) framework was applied to summary-level GWASs of BMI and WC comprising a total of 461,460 and 462,166 participants from UK Biobank to explore the potential causal association.

RESULTS

Higher BMI and WC were associated with increased risks of DR, DN, and DPN (HR (95% CI), per-SD increase: BMI: DR 1.09 (1.04-1.13), DN 1.37 (1.33-1.41), DPN 1.27 (1.20-1.34); WC: DR 1.11 (1.07-1.16), DN 1.41 (1.36-1.46), DPN 1.38 (1.30-1.45)) in the UK Biobank cohort. Univariate MR indicated that increased BMI and WC were causal risk factors for these complications (OR (95% CI), per-SD increase: BMI: DR 1.33 (1.22-1.45), DN 1.74 (1.47-2.07), DPN 2.20 (1.67-2.90); WC: DR 1.43 (1.27-1.61), DN 2.03 (1.62-2.55), DPN 2.80 (1.99-3.92)), and the effect sizes remained significant after adjustment for glycated hemoglobin.

CONCLUSIONS

Prospective observational and MR analyses provided evidence that high BMI and WC may represent potential causal risk factors for diabetic microvascular complications. Weight control might modify the risks of these complications independently of glycemic control and should be considered as a therapeutic recommendation.

Management of hyperglycaemia in people with obesity

Diabetes and obesity are closely interlinked. Obesity is a major risk factor for the development of type 2 diabetes mellitus and appears to be an important risk factor for diabetic micro- and macrovascular complications. Management of hyperglycaemia in people with diabetes is important to reduce diabetes-related complications. Previously, there was a significant tension between management of hyperglycaemia and mitigating weight gain. Older drugs, such as sulfonylureas, glitazones, and insulin, although effective antihyperglycaemic agents, tend to induce weight gain. There is now an increasing recognition in people with obesity and diabetes that the focus should be on aiding weight loss, initially with improvements in diet and physical activity, possibly with the use of low-calorie diet programmes. Subsequent addition of metformin and newer agents, such as sodium-glucose transporter-2 inhibitors and glucagon-like peptide-1 analogues, will aid glucose control and weight reduction, and offer cardiovascular and renal protection. These drugs are now much higher in the therapeutic pathway in many national and international guidelines. Bariatric surgery may also be an effective way to manage hyperglycaemia or induce remission in individuals with both obesity and diabetes.

Investigating the prevalence of diabetic complications in overweight/obese patients: a study in a tertiary hospital in Malaysia

Background

In Malaysia, although diabetes accounts for more than 70% of all deaths, it is unclear how it relates to BMI and diabetic complications. This study aimed to investigate the prevalence of obesity and diabetic complications among diabetic patients in Malaysia.

Materials and methods

A cross-sectional study using an existing clinical registry was performed from 1 January 2020 to 31 December 2020 at Hospital Serdang, Malaysia. Adult patients with type 2 diabetes mellitus had their medical records examined for disease complications, as reported by the patient at first contact with the DMTAC pharmacist.

Results

The study comprised a total of 495 participants with an average HbA1c of 10.5%. About 91% (n = 451) of the 495 patients were obese/overweight. Around 37.8% (n = 187) of diabetic patients are between the ages of 50 and 59, and 59% (n = 292) have had diabetes for less than 10 years. A total of 8.5% (n = 42) and 9.7% (n = 48) consume alcohol and smoke, respectively. Around 29.9% (n = 148) had one other comorbidity (hypertension or dyslipidemia), and 63.4% (n = 314) had two comorbidities. Regarding the prevalence of complications, there were 18.9% (n = 94) who had myocardial infarction, 11.1% (n = 55) who had stroke, and 9% (n = 45) who had CKD. Age (adjusted OR = 1.03; 95% CI 1.00 to 1.07; p = 0.041) and hypertension (adjusted OR = 4.06; 95% CI 1.21 to 13.60; p = 0.023) were significantly related with the prevalence of complications in patients with diabetes.

Conclusion

In our study, a BMI of more than 23 kg/m2 (obese/overweight) does not seem to be associated with the prevalence of complications. Age and hypertension, on the other hand, appear to be strong risk predictors of the incidence of complications. With the understanding of the recent outlook on diabetes, it is recommended that public education on the targeted population should be encouraged to negate these complications.

Supplementary Information

The online version contains supplementary material available at 10.1007/s13410-022-01131-x.

Lower Visceral Fat Area in Patients with Type 2 Diabetic Peripheral Neuropathy

OBJECTIVE

There is preliminary evidence that visceral fat area (VFA) was associated with the presence of type 2 diabetic peripheral neuropathy (DPN) in the Korean population; however, no studies have reported the association in Chinese population. The purpose of this study was to explore the possible correlation of VFA with DPN in such a population.

METHODS

A total of 2498 hospitalized patients with type 2 diabetes mellitus (T2DM) undergone VFA measurement, and were divided into DPN group (n=900) and non-DPN group (n=1594). The association of VFA with the presence of DPN was evaluated by correlation and multiple logistic regression analyses, generalized additive model with a smooth curve fitting, and receiver operating characteristic (ROC) curve analysis.

RESULTS

The VFA was significantly lower in the DPN group than in the non-DPN group (P < 0.001). VFA was significantly and positively associated with sural nerve conduction velocity (SNCV) and amplitude potential (SNAP) and negatively associated with the presence of DPN (all P< 0.001); there was no significant difference in the curve fitting (P = 0.344). Multivariate logistic regression analysis showed that the risk of presence of DPN decreased progressively across the VFA quartiles (P for trend < 0.001) and was significantly lower in patients in the highest VFA quartile than in those in the lowest quartile (OR: 0.382, 95% CI 0.151-0.968, P< 0.001) after multivariate adjustment. The ROC analysis revealed that the best cut-off value of VFA for predicting the presence of DPN was 50.5cm² (sensitivity 84.40%; specificity 34.00%).

CONCLUSION

These results suggest that lower VFA level may be associated with increased risk of the presence of DPN in T2DM patients.