Obesity with and without type 2 diabetes: are there differences in obesity history, lifestyle factors or concomitant pathology?

Background: Obesity is one of the most significant risk factors for type 2 diabetes (T2D), but a large number of patients with morbid obesity maintain normal glycemia for a long time. There are no definite easy-to-measure clinical features that distinguish severely obese people who will or will not develop T2D. These features may be useful in clinical practice to predict T2D development in obese patients.

Aims: We aimed to identify clinical features (lifestyle factors, obesity history, concomitant diseases) that may be associated with T2D in obese patients.

Materials and methods: The study was conducted at single center during 2002 and 2017 and recruited patients with BMI≥30 kg/m2 who attended bariatric surgeon. Patients weight and height were assessed by the doctor, other features were obtained from the questionnaire: overweight and obesity history (age of onset, duration, family history of obesity), lifestyle factors, T2D and concomitant diseases medical history. Patients were divided into 2 groups with regard to the presence of T2D. Data analysis was performed with Statistica 13.3.

Results: The study included 170 patients with known T2D and 528 patients without history of T2D and prediabetes. Both groups had similar gender structure, as well as current and peak BMI. There were no significant differences in overweight/obesity duration, obesity family history, lifestyle factors and smoking status of patients. Obese patients without T2D were younger than T2D patients at the time of T2D onset (median age 40 and 45 years respectively). Patients without T2D started to gain weight earlier than those with T2D (median age 17 and 25 years respectively) and reached their peak BMI during 1 year before study entry, while patients with T2D went through maximum weight previously. The frequencies of concomitant diseases didn’t differ between the groups with the exception of hypertension that started later in patients with T2D (median age 51 and 47 years in patients with and without T2D respectively); also patients with T2D had gastroesophageal reflux disease (GERD) and chronic back pain less often than patients without T2D with regard to age.

Conclusions: Clinical features that distinguished obese patients with and without T2D were age at the start of overweight/ obesity and concomitant disease profile (hypertension, GERD, chronic back pain) at corresponding age.

1. Bellou V, Belbasis L, Tzoulaki I, Evangelou E. Risk factors for type 2 diabetes mellitus: An exposure-wide umbrella review of meta-analyses. PLoS One. 2018;13(3):e0194127. doi: https://doi.org/10.1371/journal.pone.0194127

2. Bradshaw PT, Reynolds KR, Wagenknecht LE, Ndumele CE, Stevens J. Incidence of components of metabolic syndrome in the metabolically healthy obese over 9 years follow-up: the Atherosclerosis Risk In Communities study. Int J Obes. 2018;42(3):295-301. doi: https://doi.org/10.1038/ijo.2017.249

3. Kim JA, Kim DH, Kim SM, et al. Impact of the Dynamic Change of Metabolic Health Status on the Incident Type 2 Diabetes: A Nationwide Population-Based Cohort Study. Endocrinol Metab. 2019;34(4):406. doi: https://doi.org/10.3803/EnM.2019.34.4.406

4. Rotar O, Boyarinova M, Orlov A, et al. Metabolically healthy obese and metabolically unhealthy non-obese phenotypes in a Russian population. Eur J Epidemiol. 2017;32(3):251-254. doi: https://doi.org/10.1007/s10654-016-0221-z

5. Shestakova EA, Lunina EY, Galstyan GR, Shestakova MV, Dedov II. Type 2 diabetes and prediabetes prevalence in patients with different risk factor combinations in the NATION study. Diabetes Mellitus. 2020;23(1):4-11. (In Russ.) doi: https://doi.org/10.14341/DM12286

6. Hocking S, Samocha-Bonet D, Milner K-L, et al. Adiposity and Insulin Resistance in Humans: The Role of the Different Tissue and Cellular Lipid Depots. Endocr Rev. 2013;34(4):463-500. doi: https://doi.org/10.1210/er.2012-1041

7. Navarro E, Funtikova AN, Fíto M, Schröder H. Can metabolically healthy obesity be explained by diet, genetics, and inflammation? Mol Nutr Food Res. 2015;59(1):75-93. doi: https://doi.org/10.1002/mnfr.201400521

8. Abdullah A, Stoelwinder J, Shortreed S, et al. The duration of obesity and the risk of type 2 diabetes. Public Health Nutr. 2011;14(1):119-126. doi: https://doi.org/10.1017/S1368980010001813

9. Mongraw-Chaffin M, Foster MC, Kalyani RR, et al. Obesity Severity and Duration Are Associated With Incident Metabolic Syndrome: Evidence Against Metabolically Healthy Obesity From the Multi-Ethnic Study of Atherosclerosis. J Clin Endocrinol Metab. 2016;101(11):4117-4124. doi: https://doi.org/10.1210/jc.2016-2460

10. Dankel SJ, Loenneke JP, Loprinzi PD. Health Outcomes in Relation to Physical Activity Status, Overweight/ Obesity, and History of Overweight/Obesity: A Review of the WATCH Paradigm. Sport Med. 2017;47(6):1029-1034. doi: https://doi.org/10.1007/s40279-016-0641-7

11. The NS, Richardson AS, Gordon-Larsen P. Timing and Duration of Obesity in Relation to Diabetes: Findings from an ethnically diverse, nationally representative sample. Diabetes Care. 2013;36(4):865-872. doi: https://doi.org/10.2337/dc12-0536

12. Tanamas SK, Wong E, Backholer K, et al. Age of onset of obesity and risk of type 2 diabetes. Aust N Z J Public Health. 2016;40(6):579-581. doi: https://doi.org/10.1111/1753-6405.12593

13. Luo J, Hodge A, Hendryx M, Byles JE. Age of obesity onset, cumulative obesity exposure over early adulthood and risk of type 2 diabetes. Diabetologia. 2020;63(3):519-527. doi: https://doi.org/10.1007/s00125-019-05058-7

14. Ozawa H, Fukui K, Komukai S, et al. Clinical Significance of the Maximum Body Mass Index Before Onset of Type 2 Diabetes for Predicting Beta-Cell Function. J Endocr Soc. 2020;4(4):519-527. doi: https://doi.org/10.1210/jendso/bvz023

15. Styne DM, Arslanian SA, Connor EL, et al. Pediatric Obesity— Assessment, Treatment, and Prevention: An Endocrine Society Clinical Practice Guideline. J Clin Endocrinol Metab. 2017;102(3):709-757. doi: https://doi.org/10.1210/jc.2016-2573

16. Lindstrom J, Tuomilehto J. The Diabetes Risk Score: A practical tool to predict type 2 diabetes risk. Diabetes Care. 2003;26(3):725-731. doi: https://doi.org/10.2337/diacare.26.3.725

17. American Diabetes Association. 2. Classification and Diagnosis of Diabetes: Standards of Medical Care in Diabetes—2020. Diabetes Care. 2020;43(Supplement 1):S14-S31. doi: https://doi.org/10.2337/dc20-S002

18. Hekimsoy Z, Oktem IK. Duration of obesity is not a risk factor for type 2 diabetes mellitus, arterial hypertension and hyperlipidemia. Diabetes, Obes Metab. 2003;5(6):432-437. doi: https://doi.org/10.1046/j.1463-1326.2003.00298.x

19. Reis JP, Hankinson AL, Loria CM, et al. Duration of Abdominal Obesity Beginning in Young Adulthood and Incident Diabetes Through Middle Age: The CARDIA Study. Diabetes Care. 2013;36(5):1241-1247. doi: https://doi.org/10.2337/dc12-1714

20. Kodama S, Fujihara K, Ishiguro H, et al. Unstable bodyweight and incident type 2 diabetes mellitus: A meta-analysis. J Diabetes Investig. 2017;8(4):501-509. doi: https://doi.org/10.1111/jdi.12623

21. Ng CD, Elliott MR, Riosmena F, Cunningham SA. Beyond recent BMI: BMI exposure metrics and their relationship to health. SSM - Popul Heal. 2020;11(4):100547. doi: https://doi.org/10.1016/j.ssmph.2020.100547

22. Kolb H, Martin S. Environmental/lifestyle factors in the pathogenesis and prevention of type 2 diabetes. BMC Med. 2017;15(1):131. doi: https://doi.org/10.1186/s12916-017-0901-x

23. Magkos F, Hjorth MF, Astrup A. Diet and exercise in the prevention and treatment of type 2 diabetes mellitus. Nat Rev Endocrinol. 2020;16(10):545-555. doi: https://doi.org/10.1038/s41574-020-0381-5