Page 473 - fbkCardioDiabetes_2017

vv

Cardio Diabetes Medicine 2017 449

Bariatric Surgery In Diabesity :

What Is Endocrinologist’s Perspective?

Dr. S. Murthy, MD, DM, Director
Endocrine Diagnostic and Research Centre,
Diabetes Care Centre, Chennai.

Introduction as liver andβ-cells thereby impairing function, survival
The intrinsic association between obesity and Type and regeneration.
2 diabetes (T2DM) is well recognized, to the extent (3) The “adipokine hypothesis” refers to the
that the term Diabesity was coined by Dr Ethan principal feature of white adipose cells to function
Sims [1]. The word ‘diabesity’ highlights the etiologic as an endocrine organ, and to secrete a variety of
effect of obesity on type 2 diabetes, with or without hormones with auto- and paracrine function. It has
associated risk factors such as dyslipidaemia and been proposed that expanding fat stores in obesity
hypertension. Thus diabesity forms a subset of cause dysfunctional secretion of such endocrine
metabolic syndrome. factors, thereby resulting in metabolic impairment of
In India, standard international criteria are followed insulin target tissues and eventually failure of insulin
for the diagnosis of diabetes. For obesity, however, producing β-cells.
ethnic-specific diagnostic criteria should be used. As
Asians have a higher risk of cardiovascular disease, Drug class & potential Reduction
low cut offs are taken for obesity. Medication Effect on in A1c Side Effects
weight
While the World Health Organization suggests an
upper limit of 25.0km/m2 for normal body mass
index (BMI), South Asians should ideally have a BMI Biguanides 2-3kg 1.5-2% Lactic acidosis,
less than 23kg/m2. Similarly, overweight is defined (Metformin) weight loss Gastrointestinal
as a BMI of 23.0kg/m2 to 24.9kg/m2 in Indians.
Obesity is diagnosed above BMI 25.0kg/m2 in South Sodium- Urinary tract
Asians. glucose co infection, Genital
transporter Mycotic infection,
2 inhibitors 2-3kg increase in
Pathophysiology (SGLT2) weight loss 0.6-0.9% potassium,
Three main hypotheses have been developed [2]: (Empaglifozin, Creatinine and Low
canagliflozin, density lipoproteins
(1) The “inflammation hypothesis” asserts that obesity Dapagliflozin) cholesterol
represents a state of chronic inflammation in which Glucagon-
inflammatory molecules produced by infiltrating like peptide Medullary Thyroid
macrophages in adipose tissue exert pathological 1 agonists 2.87-3.84kg 0.9-1% cancer, acute
(Exenatide,
pancreatitis,
weight loss
changes in insulin-sensitive tissues and β-cells. Liraglutide, Gastrointestinal
Dulaglutide)
(2) The “lipid overflow hypothesis”, also known as
“Adipose Tissue Expandability Hypothesis (ATEH)” Amylin
predicts that obesity may result in increased ectopic analogues 2.57kg 0.3-0.4% Gastrointestinal
weight loss
lipid stores due to the limited capacity of adipose (Pramlinitide)
tissue to properly store fat in obese subjects.
Potentially harmful lipid components and metabolites
may exert cytotoxic effects on peripheral cells, such

Cardio Diabetes Medicine