First Department of Internal Medicine, Division of Endocrinology and Metabolism, Diabetes Center, Medical School, AHEPA University Hospital, Thessaloniki, Greece.
Unit of Reproductive Endocrinology, 1st Department of Obstetrics and Gynecology, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece.
Curr Pharm Des. 2019;25(18):2051-2059. doi: 10.2174/1381612825666190708192134.
Obesity frequently co-exists with type 2 diabetes mellitus (T2DM), leading to the socalled "diabesity epidemic". The metabolic syndrome (MetS), a cluster of central obesity, hypertension, dysglycemia, insulin resistance and/or atherogenic dyslipidemia, as well as non-alcoholic fatty liver disease (NAFLD), a hepatic manifestation of MetS, has been associated with increased cardiovascular disease (CVD), T2DM and chronic kidney disease (CKD) incidence. However, the association between obesity, MetS (including NAFLD) and diabetic microvascular complications is less evident.
The present narrative review discusses the associations of obesity, MetS and NAFLD with diabetic kidney disease (DKD), diabetic retinopathy (DR) and diabetic peripheral neuropathy (DPN) as well as cardiac autonomic neuropathy (CAN). The available data on the effects of lifestyle measures and bariatric surgery on these diabetic complications are also briefly discussed.
Overall, both obesity and MetS have been related to DKD, DR and DPN, although conflicting results exist. Links between NAFLD and diabetic microvascular complications have also been reported but data are still limited. Lifestyle intervention and bariatric surgery may prevent the development and/or progression of these microvascular complications but more evidence is needed.
Clinicians should be aware of the frequent co-existence of MetS and/or NAFLD in T2DM patients to prevent or treat these metabolic disorders, thus potentially minimizing the risk for both CVD and diabetic microvascular complications.
肥胖症常与 2 型糖尿病（T2DM）并存，导致所谓的“糖尿病肥胖症流行”。代谢综合征（MetS）是一种以中心性肥胖、高血压、糖代谢异常、胰岛素抵抗和/或致动脉粥样硬化性血脂异常为特征的疾病，以及非酒精性脂肪性肝病（NAFLD），即 MetS 的肝脏表现，与增加心血管疾病（CVD）、T2DM 和慢性肾脏病（CKD）的发生率有关。然而，肥胖症、MetS（包括 NAFLD）与糖尿病微血管并发症之间的关联并不明显。
本叙述性综述讨论了肥胖症、MetS 和 NAFLD 与糖尿病肾病（DKD）、糖尿病视网膜病变（DR）和糖尿病周围神经病变（DPN）以及心脏自主神经病变（CAN）的关联。还简要讨论了生活方式措施和减肥手术对这些糖尿病并发症影响的现有数据。
总体而言，肥胖症和 MetS 与 DKD、DR 和 DPN 均有关联，尽管存在相互矛盾的结果。NAFLD 与糖尿病微血管并发症之间的联系也有报道，但数据仍然有限。生活方式干预和减肥手术可能预防这些微血管并发症的发生和/或进展，但需要更多的证据。
临床医生应意识到 T2DM 患者中 MetS 和/或 NAFLD 的频繁并存，以预防或治疗这些代谢紊乱，从而最大限度地降低 CVD 和糖尿病微血管并发症的风险。
