Category: General

Many people with diabetes have excess body fat. Losing excess body fat can help reduce the risk of various problems like cardiovascular disease, stroke, diabetic kidney disease and fatty liver. Many medicines used in the management of diabetes help weight loss.

The most common medicine that helps weight loss is Metformin. Metformin has minimum effects on weight loss and helps you lose 1-2 kg weight loss, although some people may lose much more weight.

Dapagliflozin, Empagliflozin and Canagliflozin belonging to the SGLT2 inhibitor class will reduce weight by 2-4 kg or even more. In addition, they reduce the risk of progression of kidney disease, heart disease and heart failure. Some new scientific studies show that they may help reduce retinopathy and fatty liver disease.

Certain drugs like Liraglutide, Semaglutide and Dulaglutide have been found to reduce weight and reduce the risk of cardiovascular disease including heart attacks and stroke. It has also been found to have benefits for fatty liver disease. These drugs may reduce weight by 4-5 kg or even more. Semaglutide in doses of 2.4 mg resulted in weight loss of 12-15 kg.

Tirzepatide is a new medicine for diabetes which will result in a weight loss of more than 15 kg. These medicines have positive effects on the heart, kidneys, and fatty liver. There are many new drugs like Retratutide and Cagrisema which may produce further weight loss.

Diabetes mellitus can cause various complications of which the most important is the disease of the kidneys. The presence of small amounts of albumin in urine (microalbumin) is one of the earliest abnormalities seen in people with diabetes. This is an indication of diabetes affecting the kidneys. There are various methods to protect the kidneys in people with diabetes. This includes the following.

1. Improving the blood glucose control to achieve HbA1c of less than 7 %
2. Controlling the blood pressure to less than 130/80 mm Hg
3. Reducing weight
4. Stopping smoking
5. Avoid medicines that may harm the kidney like painkillers.
6. Medicines like Telmisartan, Losartan and Ramipril
7. Diabetes medicines like Dapagliflozin, Empagliflozin and Canagliflozin
8. New medicines like Finerenone can also reduce the risk of kidney disease progression.

 All these measures must be implemented in people with early signs of kidney disease like albumin in urine to prevent it from progressing to more severe disease. 

Author: Dr Deepa G MHSc (Diab), Dip (Diab)

Diabetes is a disease which affects multiple organs in the body. It can affect the eyes, kidneys, nerves, heart, brain, and arteries of the legs. In people with diabetes, damage to various organs is caused by high blood glucose, high blood pressure, high cholesterol, sedentary lifestyle, obesity, and smoking. No medicines used for glucose control have been linked to any diabetes complications.

In fact, some of the medicines which are used to manage diabetes have been found to reduce the risk of developing various diabetes complications. Certain drugs like Liraglutide, Semaglutide and Dulaglutide have been found to reduce weight and reduce the risk of cardiovascular disease including heart attacks and stroke. It has also been found to have benefits for fatty liver disease.

Commonly used drugs like Dapagliflozin, Empagliflozin and Canagliflozin have been associated with reduced risk of progression of kidney disease, heart disease and heart failure. Pioglitazone, another commonly used medicine, has been found to have benefits in fatty liver disease. 

The disturbances in thyroid function can cause various changes in the brain of people suffering from this disease.

Hyperthyroidism may be associated with anxiety, irritability, emotional liability, and impaired concentration. However, older people with hyperthyroidism can present with a clinical state that resembles depression with less interest in their surroundings and an inability to function normally.

Severe hypothyroidism has been associated with depression. However, most people with depression do not have hypothyroidism and most people with hypothyroidism do not have any significant depression. Scientific studies have shown that there is an association between depression and hypothyroidism, but it is seldom cause and effect. Furthermore, some people with depression may have mild abnormalities in TSH or thyroid antibodies. People who suffer from signs of depression and have hypothyroidism should consider meeting a mental health professional.

Some people with hypothyroidism may have symptoms that resemble depression even after the thyroid functions are normal. Some of the symptoms may affect the quality of life. Some scientific studies have shown that these people may benefit from a combination of T3 (triiodothyronine) and T4 (Thyroxine)  therapy.

It is common to find a thyroid disease when a lady gets investigated for menstrual abnormalities. It is prudent for doctors to check thyroid function while investigating anyone with menstrual problems. Menstrual problems can occur in both hypothyroidism and hyperthyroidism.

Women with significant hypothyroidism can have increased menstrual bleeds (menorrhagia) and irregular dates. If the thyroid disease is severe, some women may cease to have periods for a while. Some women with hypothyroidism may have a polycystic appearance of the ovaries. This should not be confused with polycystic ovary disease. Most of these changes can be reversed with proper dose titration of thyroxine.

Women with hyperthyroidism can have irregular periods and hypomenorrhea (less bleeding during periods). Some women with severe hyperthyroidism can have significant weight loss and this can lead to irregular periods. Rarely women with thyroid diseases may have premature ovarian failure. Both these diseases are autoimmune and hence can occur together. Physicians treating people with thyroid disease and menstrual problems should consider this possibility.

Obesity is a complex medical condition influenced by various factors, including genetics, environment, and lifestyle. Various aspects of food consumption, appetite and satiety are linked to abnormalities in brain circuits and hormones. These include hormones like Ghrelin which stimulate hunger, and others like GLP-1, Cholecystokinin, Leptin and Amylin, which leads to satiety. So despite our efforts to control the intake of high-calorie food and exercise, it is essential to address the various abnormal physiological changes that drive obesity. While making healthy choices is vital, it is not as simple as “trying harder” or having more willpower.

• It is essential to understand that just like diabetes and hypertension, obesity is also a disease that requires proper treatment. While overeating and lack of physical activity can contribute to obesity, many other factors can also play a role. These include genetics, certain medical conditions, and medication side effects.

• People with obesity have abnormalities in the circuitry related to various areas of the brain like hypothalamus and amydala. There are changes in the neurons like POMC/CART and AgRP/NPY that regulate the weight. In addition, there are hormones like Ghrelin which stimulate hunger and others like GLP-1, Cholecystokinin, Leptin and Amylin which leads to satiety. These hormones are produced by the gut, adipose tissue, or pancreas.

• External factors like diet and physical activity are part of the obesogenic environment that facilitate obesity. And these are potentially modifiable too. But these alone do not lead to obesity.

Reality: Obesity is a serious medical condition that can lead to a variety of health problems. It can include metabolic problems like diabetes, hypertension, high cholesterol levels and high uric acid. Obesity is a risk factor for various cancers like breast cancer, endometrial cancer, prostate, and colonic cancer. It can lead to fatty liver disease which could progress to cirrhosis. Sleep apnoea and gastroesophageal reflux is also related to obesity. Certain mechanical problems like osteoarthritis of knee and ankle and plantar fasciitis. People with obesity have higher risk of coronary artery disease, stroke, and heart failure. In addition, obesity can be associated with depression, mood disorders and eating disorders.

So, obesity is much more beyond a mere cosmetic issue.

Just like diabetes and hypertension, obesity is also a disease. Obesity results in various other diseases that may eventually become fatal. Just like not all diabetes can be controlled with diet, not all people with obesity can get their weight down with diet and exercise.

People with obesity and multiple other diseases like sleep apnea, uncontrolled diabetes, fatty liver and hypertension have a poor quality of life and reduced lifespan due to these diseases. So, anyone with obesity and other associated disorders would benefit from using anti-obesity drugs like Semaglutide, Liraglutide or Tirzepatide. People with higher degrees of weight gain and related diseases also will benefit from bariatric surgery. Bariatric surgery has been shown to prolong the lifespan and reduce the risk of diseases like diabetes, hypertension, sleep apnea, fatty liver and heart disease.

Body mass index ( weight ( in kg)/height(meters) 2) is a straightforward measure of obesity. It is easily measured without any complicated instruments and tests. In the western world, a normal BMI is defined as below 25 and above 30 is classified as obese.

We are using a measure like BMI to understand if the person is at risk of developing complications associated with high-fat mass. However, BMI may not be an accurate measure of body fat for many people. For example, the BMI may be high for someone with a high muscle mass, but the fat mass may be low. Similarly, the relation between BMI and disease risk is different in ethnic populations like Asian Indians. Here we define obesity as BMI > 25 and normal as less than 23. Such assessments like body composition analysis( hyperlink to Inbody page) may be helpful in deciding the degree of body fat. So, although useful, BMI cannot be considered the best measure of obesity.