Abstract
Metabolic disorders have emerged as a global health challenge. Conditions like type 2 diabetes mellitus (T2DM), dyslipidemia, obesity, and metabolic-dysfunction-associated steatotic liver disease are on the rise, affecting individuals, families, healthcare systems, and societies.[1] Given the scale of the problem, a comprehensive approach that brings together all stakeholders is essential to tackle it. This includes public awareness campaigns, personalised diagnostic and therapeutic strategies, and research to ensure enhanced and equitable care delivery. The current issue of Apollo Medicine presents a diverse compilation of articles exploring the evolving and overlooked aspects of metabolic disorders.
Obesity is a major driver of the increased burden of metabolic disease. Obesity in South Asia presents unique challenges modulated by genetic, cultural, and dietary factors. Despite lower average body mass index (BMI) than Western populations, South Asians have a higher percentage of body fat, increased visceral adiposity, and greater metabolic risk at lower BMI thresholds.[2] This predisposes them to obesity-related complications, including T2DM and cardiovascular disease, at lower BMI levels. The intricacies of the management of obesity in South Asia have been highlighted in the article by Das et al. in the current issue.[3]
Additionally, in resource-limited regions of Asia and Africa, widely available parameters like platelet indices could aid in monitoring glycaemic status and complications. Diabetes mellitus induces a prothrombotic state characterised by altered platelet morphology and function. Platelet indices such as mean platelet volume, platelet distribution width, and platelet-large-cell ratio reflect these alterations.[4] The article by Jena et al. investigates the potential of platelet indices as a diagnostic tool in diabetes.[5]
Diabetes and metabolic disorders impact multiple organ systems, with both microvascular and macrovascular complications being well-recognised. Macrovascular complications, including stroke, can be associated with metabolic syndrome, even in the absence of overt diabetes. The link between metabolic syndrome and stroke pathogenesis has been enumerated in the article by Renjen et al.[6]
Further, the unusual complications of metabolic disorders, such as impaired skeletal health,[7] sarcopenia,[8] obstructive sleep apnoea (OSA),[9] and male hypogonadism,[10] are discussed in separate articles. Metabolic disorders and musculoskeletal health are closely interconnected, with osteoporosis and sarcopenia both strongly linked to diabetes. Diabetes heightens the risk of fractures and osteoarthritis, but these complications remain underdiagnosed, often leading to disability.[11] Even after diagnosis, the treatment offered is frequently suboptimal. We hope the articles focusing on musculoskeletal health will increase awareness about the association.[7,12] In men with diabetes, testosterone deficiency adds another layer of complexity, as the relationship is often bidirectional, with each contributing to the pathogenesis of the other. While testosterone therapy shows promise in improving insulin resistance, the risks and benefits must be carefully weighed.[10]
OSA, frequently seen in individuals with diabetes, further complicates metabolic health. Its shared mechanisms with diabetes, such as obesity, insulin resistance and inflammation, emphasise the need for an integrated approach. The first prescription drug approved for treating moderate to severe OSA is tirzepatide, a dual glucagon-like peptide-1 receptor and glucose-dependent insulinotropic polypeptide receptor agonist.[12] The drug, though primarily developed for treating diabetes and obesity, reduced apnoea-hypopnea index, hypoxic burden, high-sensitivity C-reactive protein concentration and systolic blood pressure in persons with OSA. The benefits were observed in participants who received treatment with positive airway pressure and those who did not.[13] The bidirectional and evolving connection between OSA and diabetes is presented in the article by Kantroo et al.[9] By examining these non-classic complications, this issue takes a broader look at the systemic impact of diabetes.
Subbaiyan I et al. have investigated the correlation between admission hyperglycaemia and outcomes in critical care settings, an area with significant implications for short and long-term consequences.[14] This issue also explores two widely debated aspects of metabolic health. The article by Velayutham et al. provides an overview of T2DM remission, a subject gaining increasing attention. It examines the various strategies to achieve remission, including lifestyle interventions, pharmacotherapy and bariatric surgery.[15] Ray et al., in their article, narrate the benefits, risks and ongoing controversies surrounding artificial sweeteners. The article evaluates their metabolic effects, role in weight management, and potential impact on insulin sensitivity and gut microbiota.[16]
Communication between healthcare providers and care-seekers is paramount for managing any disease, especially chronic conditions such as diabetes. Clear, empathetic, patient-centred communication generates trust, enhances understanding and encourages treatment adherence.[17] The article on communication in diabetes emphasises the role of dialogue and shared decision-making in improving outcomes. [18] This is increasingly becoming relevant given the enormous burden of care-seekers with metabolic disorders and limited access to specialists in terms of number and time.
The articles in this issue offer a diverse perspective on the complexities of metabolic disorders. We hope our shared knowledge will promote awareness, stimulate research, and ensure better care for metabolic disorders.