Recent research published in Cardiovascular Diabetology has revealed a surprising truth about diabetes, obesity, and heart health: it's not just about weight. The study found that people with diabetes who have a combination of high blood pressure, unhealthy cholesterol, and chronic kidney disease are at the highest risk for heart problems, regardless of their weight. This challenges the traditional understanding that diabetes is primarily linked to obesity. The findings emphasize the importance of a holistic approach to diabetes management, considering multiple factors beyond weight to assess risk and provide effective treatment

Key Points

1. Diabetes is Not Solely Linked to Obesity: The study challenges the traditional notion that diabetes is primarily associated with obesity. It found that a significant number of people with diabetes have a normal weight.

2. CKM Comorbidities Increase Heart Risk: The presence of Chronic Kidney Disease (CKD), Hypertension, and Dyslipidemia (CKM comorbidities) significantly increases the risk of heart problems in people with diabetes, regardless of their weight.

3. "Extremely Unhealthy" Phenotype: People with diabetes who have all three CKM comorbidities are classified as having an "extremely unhealthy" phenotype. This group faces the highest risk of heart problems.

4. Age Matters, But Not in the Expected Way: The study found that being "extremely unhealthy" has a greater impact on younger people with diabetes compared to older adults, possibly because older adults already have a higher baseline risk for heart problems.

5. Newer Medications Offer Promise: Medications like SGLT2 inhibitors and GLP1 receptor agonists have shown heart benefits and are being used more frequently in people with diabetes and CKM comorbidities. However, they are not being used as much in the "extremely unhealthy" group, which might benefit the most from them.

The Changing Face of Diabetes

First things first: did you know that the "typical" diabetes patient isn't so typical anymore? That's right—while we often picture someone with diabetes as being overweight, the reality is changing fast. Recent studies show that about half of people with diabetes aren't obese at all! This shift is happening so quickly that researchers are scrambling to keep up. One study even found that the number of normal-weight people developing diabetes is increasing by a whopping 36% every five years. That's huge!

CKM Comorbidities: The "Troublesome Trio"

These three health conditions—Chronic Kidney Disease (CKD), hypertension (high blood pressure), and dyslipidemia (unhealthy cholesterol levels)—often appear alongside diabetes. They dramatically increase the risk of heart attacks, strokes, and heart failure, even in people who are not overweight. Think of these as the "troublesome trio" that can make diabetes even more complicated. The more of these a person has, the higher their risk for serious health problems down the road.

Key Findings from the Study

A study involving over 2,000 diabetic patients revealed some surprising results. The participants were grouped by two factors:

• Whether they were obese or not

• How many CKM comorbidities they had (0, 1-2, or all 3)

Here’s what the study found:

• Highest risk groups: Both obese and non-obese people with all three CKM comorbidities had about four times the risk of heart problems compared to those with no CKM comorbidities.

• Extremely Unhealthy Phenotype: Researchers identified a group labelled as “extremely unhealthy”—people with diabetes and all three CKM comorbidities. Whether they were obese or not, these individuals were at the greatest risk of heart problems.

• Impact on Younger Adults: Surprisingly, younger adults (under 65) who were in the "extremely unhealthy" group faced a higher risk of heart problems than older adults. This may be because older adults already have a higher baseline risk for cardiovascular issues.

The Role of Medications in Reducing Risk

Newer diabetes medications like SGLT2 inhibitors and GLP1 receptor agonists have shown promise in reducing heart-related complications. However, these medications aren’t being used enough in those at the highest risk—the “extremely unhealthy” group. If you or a loved one has diabetes with CKM comorbidities, it’s worth discussing these treatments with your healthcare provider.

What Can You Do?

1. Monitor More Than Weight: Heart disease risk isn’t just about weight. Even if you’re not overweight, regular check-ups to monitor blood pressure, cholesterol, and kidney health are essential.

2. Be Proactive with Medications: Talk to your doctor about newer medications that can help protect your heart, especially if you have multiple CKM comorbidities.

3. Early detection is key. Preventing complications starts with catching issues early. Regular screenings and managing CKM comorbidities can significantly reduce your risk of heart disease.

A Holistic Approach to Diabetes Management

This research highlights the need for a comprehensive approach to diabetes care. It’s not just about managing blood sugar or weight—it's about the entire picture of your health. Cardiologists, endocrinologists, and nephrologists should work together to provide the best care for diabetic patients, focusing on all risk factors, not just glucose control.

Some Food for Thought

Before we wrap up, let's chew on a few more interesting tidbits from this study:

• The obesity paradox: Some previous studies have found that obese people with certain health conditions sometimes do better than normal-weight people. This study didn't really support that idea, at least not when it comes to diabetes and heart health.

• Body composition matters: The researchers point out that BMI (the standard measure of obesity) doesn't tell the whole story. It doesn't account for things like where fat is distributed in the body or how much muscle someone has. These factors can make a big difference in health risks.

• The changing landscape: The fact that we're seeing more non-obese people with diabetes is a big deal. It means we might need to rethink how we screen for and prevent diabetes in the future.

Wrapping It Up

Whew! We've covered a lot of ground here, haven't we? Let's sum up the big points:

• Diabetes isn't just an "obese person's disease" anymore.

• When it comes to heart health in diabetes, those extra health problems (high blood pressure, cholesterol issues, kidney problems) matter a lot—maybe even more than weight.

• Being "extremely unhealthy" (having all those extra issues) puts you at high risk for heart problems, whether you're obese or not.

• This risk seems to be even more important for younger people with diabetes.

• We need to think about diabetes care in a more holistic, team-based way.

Remember, knowledge is power! By understanding these new insights, we can all make better decisions about our health or help support our loved ones who are living with diabetes.

FAQs

Can I develop diabetes and heart problems if I’m not overweight? Yes. Many people with diabetes are not overweight, yet CKM comorbidities significantly increase their risk of heart issues.

What are the signs of CKM comorbidities?

• Hypertension: Often no symptoms, but it can lead to headaches or dizziness.

• Dyslipidemia: Usually asymptomatic but contributes to heart disease.

• CKD: Can cause fatigue, swelling, and changes in urination patterns.

How can I prevent heart problems with diabetes? Focus on controlling your blood sugar, blood pressure, and cholesterol levels, and keep up with regular medical check-ups.

Takeaway

Diabetes management is about much more than just your weight. If you or a loved one has diabetes, pay attention to the bigger picture—high blood pressure, cholesterol, and kidney health are crucial in preventing heart disease. Staying proactive with your health and medications can make all the difference in reducing the risk of serious cardiovascular events.

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Journal References

Janota, O., Mantovani, M., Kwiendacz, H. et al. Metabolically “extremely unhealthy” obese and non-obese people with diabetes and the risk of cardiovascular adverse events: the Silesia Diabetes - Heart Project. Cardiovasc Diabetol 23, 326 (2024). https://doi.org/10.1186/s12933-024-02420-x

Your Heart and Diabetes. (2024, May 15). Diabetes. https://www.cdc.gov/diabetes/diabetes-complications/diabetes-and-your-heart.html

Image credit:https://www.frontiersin.org/files/Articles/661297/fphys-12-661297-HTML-r1/image_m/fphys-12-661297-g001.jpg

Disclaimer

The information on this website is for informational purposes only and is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health care provider with any questions you may have regarding a medical condition or treatment. Never disregard professional medical advice or delay in seeking it because of something you have read on this website.

About the Author:

Dr.T.S. Didwal, MD, is an experienced Internal Medicine Physician with over 30 years of practice. Specializing in internal medicine, he is dedicated to promoting wellness, preventive health, and fitness as core components of patient care. Dr. Didwal’s approach emphasizes the importance of proactive health management, encouraging patients to adopt healthy lifestyles, focus on fitness, and prioritize preventive measures. His expertise includes early detection and treatment of diseases, with a particular focus on preventing chronic conditions before they develop. Through personalized care, he helps patients understand the importance of regular health screenings, proper nutrition, exercise, and stress management in maintaining overall well-being.

With a commitment to improving patient outcomes, Dr. Didwal integrates the latest medical advancements with a compassionate approach. He believes in empowering patients to take control of their health and make informed decisions that support long-term wellness.