Currently, obesity and diabetes are prevalent worldwide, and some epidemiological studies have found a parallel relationship between the increasing incidence of the two. The close relationship between the two can be seen in the term “diabesity” (sugar fat disease, fatty sugar disease).
From obesity to diabetes
Regardless of whether it is obesity or diabetes, these metabolic disorders are characterized by defective insulin action. It is estimated that about 90% of type 2 diabetes is caused by excessive obesity. The pathophysiological link between obesity and diabetes is two-fold: insulin resistance and insulin deficiency.
Common metabolic abnormalities that link the two closely
Over the years, many studies have been conducted to investigate the metabolic abnormalities common to obesity and diabetes: the
1. impaired tissue perfusion
Progressive microvascular dysfunction can lead to insulin resistance, and increased insulin resistance in turn can worsen microvascular dysfunction. Impaired capillary health recovery and reduction can reduce glucose uptake and lead to insulin resistance. Microvascular function is negatively associated with obesity. Proposed mechanisms include.
(1) Obesity-related oxidative stress and reduced availability of nitric oxide are both mechanisms of reduced microvasculature.
(2) Excessive obesity is associated with a severe chronic state of microvasculature and elevated levels of pro-inflammatory cytokines, particularly tumor necrosis factor (TNF) production. These are negatively correlated with recovery of skin capillary health and insulin sensitivity.
(3) The increase in the amount of fat can lead to a long-term increase in the level of free fatty acids in the blood, which affects the recovery of microvasculature.
2.Sleep disorders
Epidemiological studies have found that sleep deprivation is associated with increased prevalence of obesity and type 2 diabetes. Cross-sectional observational studies have shown that reduced sleep time is seen in reduced leptin levels and increased gastric hunger concentrations, thereby increasing the risk of obesity.
Some studies have shown that partial sleep deprivation is associated with reduced glucose tolerance. In addition, reduced sleep also leads to impaired insulin signaling in abdominal adipose tissue, while reducing systemic insulin sensitivity.
3. Androgen dysfunction
Blood glucose homeostasis is bidirectionally regulated by estrogen in both men and women. Both androgen deficiency in men and androgen excess in women can lead to metabolic disorders in multiple tissues, including the central nervous system, liver, skeletal muscle, adipocytes and beta cells.
4.Alteration of vitamin D level
It has been shown that vitamin D can play a role in inhibiting fat accumulation, increasing insulin sensitivity, reducing insulin resistance, reducing hunger and other loci, which is beneficial to the control of obesity and type 2 diabetes.
5.Gastrointestinal stress
Enterostatin can play a role in reducing blood glucose concentration by increasing insulin release from pancreatic beta cells, inhibiting postprandial glucagon secretion and gastric emptying. Gastric hunger stimulates appetite and causes an increase in blood glucose, while obesity suppressants have the opposite effect.
Because of these mechanisms, diabetes surgery allows patients with obesity-induced type 2 diabetes to escape drug therapy.