Discussion on Diabetes Type 2 and Obesity for Community Development Nursing (Theory and Practice)
Type 2 diabetes, associated with obesity, is the widely prevalent form of diabetes. Obesity and increasing adiposity are predictors of the increasing prevalence of type 2 diabetes. There is clear evidence of positive epidemiological link between obesity and the risk of diabetes. Obesity, causing cardiovascular morbidity, is ascribed to comorbidities and risk factors such as type 2 diabetes and insulin resistance. This paper discusses the incidence and trends of type 2 diabetes including obesity, the associated morbidities and mortality rates; identifies the cohort at risk of the disease; and recommends current health promotion strategies to prevent the occurrence of the disease.
Incidence and Prevalence
Type 2 diabetes mellitus is a global epidemic (T2DM) that would possibly affect a global population exceeding 592 million by 2035, registering an increase of 210 million from 2013 (Guariguata et al., 2014). WHO (2016) predicted that diabetes in pregnancy and gestational diabetes mellitus (GDM) can precipitate the prevalence of obesity and T2DM. The American Diabetes Association (2014) reported that T2DM accounts for 90% to 95% of all diabetes mellitus case. The length of experience of obesity modulates the exposure to T2DM. WHO (2018) expressed its concern on the rising trends of diabetes on World Health Day 2016. It attributed the rise in number of adults living with diabetes to the rise in T2DM, and the factors of obesity and overweight behind it. It urged people to make make healthy choices and control excessive weight to prevent T2DM. Webber (2009) noted that the outbreak of childhood obesity coupled with the impact of obesity duration have implications of increasing frequency of diabetes in its earlier stage. Hartstra et al. (2015) in their research have recognized the potential role of the microbiome in the wide prevalence of the metabolic disorders of T2DM and obesity. The majority of people affected by diabetes is diagnosed with T2DM.
Morbidity and Mortality
Obesity is etiologically related to T2DM. Bozorgmanesh et al. (2014) rejected obesity paradox in 1,322 new-onset diabetic patients after adjustment for waist and hip circumference although there is suggestion of mortality risk by BMI in the overweight range. In the study by Eeg-Olofsson et al. (2009), it was found that the relative risk of total mortality for a 5-unit increase in BMI was 27% in a cohort of 13,087 diabetic participants followed for 6 years while in the study by Tobias et al. (2014) a J-shaped association between BMI and mortality among all type 2 diabetes mellitus patients was detected. Tobias et al. (2014), further, found no evidence of lower mortality among diabetes patients with obesity contrasted with normal weight. It follows that the obesity paradox is due to non-causal relationship between higher BMI and mortality in diabetes although weigh reduction as a clinical advice should not be overlooked in patients with T2DM. WHO (2018) in its gloabl report on diabtes indicated that T2DM remains undiagnosed because of lack of evidence on true incidence. It correlated overweigt or obesity to diabetes. It showed that high- and middle-income countries have more than double the overweight and obesity prevalence than low-income countries.
Cohort at Risk of Condition
Researchers in Monash University, Australia, investigated the magnitude of association between overweight and obesity and the risk of T2DM compared to those with normal weight in a meta-analysis of 18 prospective cohort studies (Abdullah et al., 2010). They concluded that obesity was associated 7 times higher risk of T2DM; overweight was 3 three times higher risk of T2DM than normal weight. Among the cohort studies, where BMI was measured, the number of cases of incidence diabetes exceeded 400 the median number of cases. Bell, Kivimaki and Hamer (2014) undertook a meta-analysis of prospective published cohort studies of T2DM incidence among metabolically healthy obese adults, defined by BMI and normal cardiometabolic clustering, insulin profile or risk score) aged ≥18 years at baseline. They concluded that metabolically healthy indicated more than four times greater risk of developing T2DM compared to healthy normal weight adults. Data retrieved from Whitehall II cohort study, engaging over 7000 adults, was examined by Hinnouho et al. (2014) to understand the association of metabolically healthy obese (MHO) with incident cardiovascular disease (CVD) and T2DM. The authors found that MHO phenotype carries less risk for T2DM. This suggests that “for type 2 diabetes, where metabolic health is an important predictor, the risk in the MHO group is lower” than metabolically unhealthy obese (Hinnouho et al., 2014).
Current Health Promotion Strategies
Multifaceted lifestyle interventions in the form of dietary education and exercise programs are recommended health promotion strategies to control obesity for the treatment of T2DM. There is strong evidence that obesity management can delay the progression from prediabetes to T2DM that is also effective for the treatment of the latter (Garvey et al., 2014; Lim et al., 2011). The American Diabetes Association (ADA) proposed evidence-based recommendations for weight-loss therapy by integrating diet, behavioral, pharmacologic, and surgical interventions for obesity control and as treatment for hyperglycemia in T2DM (ADA, 2019). Assessment for BMI calculation and documentation at each routine patient encounter is a part of the therapy. Diet, physical activity and behavioral therapy should be planned for weight-loss to arrest T2DM. Lifestyle interventions aimed at achieving 500–750 kcal/day energy deficits according to the individual’s baseline body weight can produce significant weight loss (ADA, 2019). While choosing glucose-lowering medications for overweight or obese patients with T2DM, its effect on weight should be weighed in (ADA, 2019). Reviewing concomitant medications and minimizing and providing choices for medications that promote weight gain is obligatory (ADA, 2019). Metabolic surgery as an option of treatment for T2DM patients should be carefully assessed considering its adverse effects. WHO (2018) recommended a Model list of essential medicines that should contain effective, established and costeffective treatments as the basis of therapeutic options.
The discussion on the prevalence, trends, morbidity and mortality rates, and cohort studies focused on the risk of the condition of T2DM with obesity gives insights into the scale of association between the two variables of T2DM and obesity and how the latter can potentially risk and aggravate the condition of T2DM. T2DM has assumed a global epidemic proportion with high mortality rates among diabetec obese men. However, health intervention strategies including dietary knowledge, physical exercise targeting weight loss can hold the progression from prediabetes to T2DM. Obesity management is a crucial component of the treatment of T2DM and almost all cohort studies have emphasized on its instrumentality in T2DM treatment.
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