Weight adds weight to declining quality of life in diabetes

Accepted: 22 February 2014; published online: 26 March 2014 Citation: Curr Med Res Opin 2014; 30:1275–8 It is a cliché in today’s times to state that type 2 diabetes has assumed epidemic proportions. It is also well known that type 2 diabetes is largely a lifestyle disease resulting from undesirable dietary habits and sedentary behaviors. The parallel epidemic of obesity is the trigger that has set off the cascade of events culminating in the dysglycemic states. Current lifestyles that include consumption of calorie dense foods, sedentary habits and leisure time inactivity have all contributed to the obesity epidemic. Obese individuals who are insulin resistant and hyperinsulinemic may go on to develop Type 2 diabetes. The combination of obesity and type 2 diabetes, often referred to as ‘diabesity’, increases the risk of cardiovascular mortality and morbidity. The association of hypertension, dyslipidemia, gallbladder disease, sleep apnea, respiratory problems, and chances of endometrial, breast and prostrate cancer are high in these individuals. Overweight people may also suffer from social stigmatization and discrimination. A combination of all the above often results in psychological problems leading to depression. This can seriously get in the way of treatment modalities that are currently available. While weight loss is the primary outcome of interest for most obesity treatments, measuring quality of life is a vital component as individuals evaluate their treatment outcome. Thomas A. Wadden and Suzanne Phelan describe QOL as a ‘buzz’ word in medicine, psychology & society at large. The term is used to describe events that range from satisfaction with one’s work or leisure activities to the physical and economic burden imposed by specific illnesses. QOL questionnaire is developed to specifically assess the effects of obesity on healthrelated quality of life. Five important aspects that need assessment are physical function, self-esteem, sexual life, public distress, and work. This in general covers all aspects of physical, social and emotional functions. Importantly, a QOL questionnaire must be relevant to obesity, reliable, validated and accepted by researchers for widespread use and should be easy to administer. Unfortunately, obesity begets obesity in type 2 diabetes. Key therapeutic agents such as insulin and insulin secretagogues cause weight gain in these patients. Agents that do not cause weight gain like GLP1 analogs and DPP4 inhibitors are within the reach of every patient with diabetes. Bariatric surgery, though an option, is not without problems and also expensive. Added to this, as age advances, sarcopenia and fat accumulation is enhanced, worsening an already undesirable situation. So does this ‘excess weight’ add to the woes of a chronic disease from the patient’s perspective? Does an already compromised quality of life get worse because of excess weight? Diabetes being a chronic disease and longevity being the rule rather than the exception with improved therapies, quality of life issues often take center stage. It is known that diabetes particularly affects the quality of life. The SHIELD, a longitudinal prospective study, is indicative of this as it not only measures