Diabesity is a global epidemic characterized by the co-occurrence of obesity and type 2 diabetes; excess body fat is the most significant risk factor for type 2 diabetes.[1]
The global disease burden of obesity and type 2 diabetes has greatly increased since the twentieth century and is projected to continue to increase in the twenty-first century.[1] Although it is not fully understood how insulin resistance develops, lifestyle factors are crucial to the development of both illnesses[2] and excess body fat is the most significant risk factor for type 2 diabetes.[1] Common comorbidities include non-alcoholic fatty liver disease, dyslipidemia, high blood pressure, cardiovascular disease, obstructive sleep apnea, and chronic kidney disease.[2]
Gestational diabetes in women whose pre-pregnancy weight was normal is metabolically distinct from the case where obesity existed prior to pregnancy (termed "gestational diabesity" in one review article).[3]
While altered gut microbiota can lead to the development of diabesity, the reverse is also the case. Therapies aimed at altering gut microbiota are a target of drug discovery[4] and lifestyle interventions.[2]
It is recommended to manage diabesity by a low calorie diet, increased exercise, and where indicated, bariatric surgery. Weight loss of 15 kilograms (33 lb) can reverse type 2 diabetes in around 70 percent of patients. This is difficult for most patients to achieve in practice, but even smaller losses of 5 kilograms (11 lb) can improve diabetes. While some antidiabetic drugs such as insulin can cause weight gain and worsen diabesity, others such as metformin, SGLT-2 inhibitors, and GLP-1 receptor agonists reduce body weight and hyperglycemia. Therefore, the latter are recommended for patients with diabesity.[2]
Cannabinoid receptor antagonists have been developed for diabesity but none are currently approved because of safety concerns.[5]
