Influence of obesity on the progression of complications

Abstract

Obesity is a modifiable risk factor that is not only involved in the etiopathogenesis of type 2 diabetes mellitus (T2DM) but also in the development of its macro- and microvascular complications, suggesting the complex interplay of mechanisms related to dysfunctional adipose tissue.

Obesity interferes with normal metabolic and vascular functions through insulin resistance, chronic inflammation, oxidative stress, and adipokine imbalance. These processes damage blood vessels and organs, aggravating microvascular complications such as retinopathy, nephropathy, and neuropathy, as well as macrovascular problems such as cardiovascular disease. Central (visceral) obesity is particularly detrimental, with a strong correlation with these complications.

There is growing evidence about the role of obesity and overweight in T1DM. On the one hand, weight gain can be a complication of insulin treatment, but on the other, it reveals a significant pathophysiological impact at various stages of the disease. Intensive insulin treatment may be a factor linked to the development of obesity after diagnosis and counteract the impact of good metabolic control on the development of complications by generating insulin resistance and compounding the effects of metabolic alterations associated with obesity.

Strategies aimed at reducing visceral adipose tissue and targeting the inflammatory and metabolic pathways that link adipose tissue with target organ damage may contribute to reducing the risk and progression of diabetic complications.