Review
Copyright ©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Diabetes. Apr 15, 2023; 14(4): 396-411
Published online Apr 15, 2023. doi: 10.4239/wjd.v14.i4.396
Management of diabesity: Current concepts
Maria Michaelidou, Joseph M Pappachan, Mohammad Sadiq Jeeyavudeen
Maria Michaelidou, Joseph M Pappachan, Department of Endocrinology and Metabolism, Lancashire Teaching Hospitals NHS Trust, Preston PR2 9HT, United Kingdom
Joseph M Pappachan, Faculty of Science, Manchester Metropolitan University, Manchester M15 6BH, United Kingdom
Joseph M Pappachan, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester M13 9PL, United Kingdom
Mohammad Sadiq Jeeyavudeen, Department of Endocrinology & Metabolism, University Hospitals of Edinburgh, Edinburgh EH16 4SA, United Kingdom
Author contributions: Michaelidou M substantially contributed to literature search, interpretation of relevant literature, article drafting, and revision; Pappachan JM conceived the idea, contributed to the interpretation of relevant literature, and revision of the paper; Jeeyavudeen MS contributed to the conception and design of the article, literature search and revision of the article created the figures; and all authors have read and approved the final version of the manuscript.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Joseph M Pappachan, FRCP, MD, Academic Editor, Consultant in Endocrinology, Professor, Senior Researcher, Department of Endocrinology and Metabolism, Lancashire Teaching Hospitals NHS Trust, Sharoe Green Lane, Preston PR2 9HT, United Kingdom. drpappachan@yahoo.co.in
Received: December 25, 2022
Peer-review started: December 25, 2022
First decision: January 9, 2023
Revised: January 15, 2023
Accepted: March 20, 2023
Article in press: March 20, 2023
Published online: April 15, 2023
Processing time: 108 Days and 0.5 Hours
Abstract

The global prevalence of obesity is increasing rapidly with an exponential rise in incidence of type 2 diabetes mellitus in recent years. ‘Diabesity’, the term coined to show the strong interlink between obesity and diabetes, is the direct cons-equence of the obesity pandemic, and poses significant challenges in the management of the disease. Without addressing the clinical and mechanistic complications of obesity such as metabolic-associated fatty liver disease and obstructive sleep apnoea, a rational management algorithm for diabesity cannot be developed. Several classes of anti-diabetic medications including insulins, sulphonylureas, thiazolidinediones and meglitinides are associated with the risk of weight gain and may potentially worsen diabesity. Therefore, appropriate selection of antidiabetic drug regimen is crucial in the medical management of diabesity. The role of non-pharmacological measures such as dietary adjustments, exercise interventions and bariatric procedures should also be emphasised. Unfortunately, the importance of appropriate and optimal management of diabesity is often overlooked by medical professionals when achieving adequate glycemic control which results in inappropriate management of the disease and its complications. This review provides a narrative clinical update on the evidence behind the management of diabesity.

Keywords: Obesity; Diabesity; Metabolic-associated fatty liver disease; Antidiabetic medications; Glycemic control; Metabolic surgery

Core Tip: The worldwide prevalence of diabesity is increasing exponentially because of the global obesity pandemic in the past few decades. This is also expected to increase the prevalence of other associated chronic disorders such as hypertension, dyslipidemia, metabolic-associated fatty liver disease (MAFLD), obstructive sleep apnoea (OSA), and cardiovascular disease. Rational management of diabesity involves prompt control of diabetes while also optimally addressing other comorbidities such as obesity, hypertension, dyslipidemia, MAFLD, OSA and cardiovascular risk. Appropriate selection of the antidiabetic therapeutic agents and early planning of metabolic surgery when indicated are crucial to scientifically approach patients with diabesity. This evidence-based review addresses the key issues regarding management of diabesity.