Diabesidad: concepto e implicancias

The purpose of this review is to raise awareness and educate physicians about the concept, pathogenesis, and general aspects of diabesity treatment. The concept of diabesity is based on the twin epidemics of obesity and diabetes. Given a positive caloric balance, the inability of subcutaneous adipose tissue to expand leads to the deposition of visceral and ectopic fat, which favors lipotoxicity and inflammation, causing insulin resistance in the liver and muscle. At early stages, pancreatic beta cells compensate insulin resistance with hyperinsulinemia. However, lipotoxicity and inflammation trigger beta cell apoptosis, rendering them unable to compensate, resulting in hyperglycemia, first in the prediabetic range and later, full-blown diabetes. Furthermore, lipotoxicity and inflammation affect other organs and systems, such as the heart, circulatory system, and kidneys, which in turn are targets for the complications of diabetes, thus constituting a metabolic-cardio-renal syndrome. Weight loss through a healthy lifestyle, the eventual use of antidiabetic drugs that produce weight loss, and endoscopic or surgical interventional procedures, can reduce the morbidity and mortality associated with diabesity.