The 21st century: a diabetogenic era

The link between type 2 diabetes and obesity is so strong that the condition, also known as obesity-dependent diabetes, is now referred to as “diabesity”.

Diabesity has reached epidemic proportions globally, prompting researchers to name this century “the unprecedented diabetogenic era in human history”.

Over time, diabetes causes serious health complications, including heart disease, kidney disease and stroke. It impacts peripheral blood vessels, eyes, gums, and even the brain, with Alzheimer’s disease now dubbed “type 3 diabetes”.

Obesity is also linked to heart disease and stroke, and other conditions including colon cancer, depression, liver diseases and gastroesophageal reflux disease. Both conditions result in poorer quality of life and premature death.

In older adults, muscle wasting can increase risk of diabetes as well, and obesity is a growing problem in this cohort.

The chicken or the egg?

Various lines of evidence have revealed how obesity escalates diabetes risk.

When fat cells grow, particularly by 30 percent or more, they get “angry” and release inflammatory markers, causing chronic inflammation. These cytokines impact insulin receptors that prompt cells to let glucose in. The pancreas tries to release more insulin and eventually becomes exhausted.

Abdominal fat cells also produce hormones that further decrease the effectiveness of insulin receptors.

In the pancreas, fat cells directly reduce its ability to release insulin. All these factors lead to insulin resistance and high blood sugar levels – resulting in diabetes.

In turn, diabetes can reinforce weight gain. For instance, when it’s not controlled and glucose can’t enter cells for energy and important metabolic processes, the cells send out hunger signals.

Anti-diabetic medications including insulin can also increase weight gain.

Essentially, once set in, the condition can spiral out of control and has therefore been described as a slow poison.


Apart from a genetic vulnerability, most factors contributing to diabesity can be addressed before it becomes unmanageable.

The primary candidates are diet and physical activity, so warding off diabesity means taking charge of lifestyle habits.

A varied diet that decreases meat, processed foods and refined carbohydrates while increasing fresh plant foods such as fruit, vegetables, legumes, nuts, seeds and wholegrains is a primary defence.

Apart from reducing caloric intake and weight gain, this dietary approach avoids blood sugar spikes by reducing refined sugars and increasing fibre, putting less strain on the pancreas to release insulin.

Research suggests the antioxidant compounds and magnesium in plant foods help cells become more sensitive to insulin. Antioxidant polyphenols may also prevent diabetes in other ways, including their ability to stimulate insulin secretion and improve glucose uptake.

Plant fibre not only slows the release of glucose into the blood stream, it promotes intestinal bacteria that can improve the body’s glucose response, insulin signalling and insulin sensitivity.

Plant-based diets are also low in saturated fat, advanced glycation end-products (AGEs – oxidant compounds that are particularly high in cooked meat) and other dietary elements associated with insulin resistance.


Exercise can not only help deter weight gain; its numerous health benefits include improved insulin sensitivity. Experts recommend a combination of regular aerobic and resistance or strength training for optimal results.

Other lifestyle factors that can help maintain healthy weight and blood glucose levels include lowering stress and sleeping well.



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