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Description of Conditions
Metabolic Complications of Obesity
Insulin Resistance, Glucose Intolerance, and Type 2
Diabetes Mellitus (T2DM)
Risk Factors
• Notable risk factors include family history of diabetes, ethnicity
(higher risk in Hispanic, Black, Native American, and Asian
populations), age older than 45 years, gestational diabetes history,
polycystic ovary syndrome, hypertension, dyslipidemia, and
sedentary lifestyle. The duration and severity of obesity signif icantly
influence diabetes risk, particularly in individuals with abdominal
(central) adiposity.
➤ Clinical Manifestations
• Clinical signs and symptoms include acanthosis nigricans
(hyperpigmented, velvety skin changes typically in neck folds,
axillae, and groin), skin tags, hirsutism in women, and central
obesity with increased waist circumference. Patients may present
with polyuria, polydipsia, unexplained weight loss, blurred
vision, or recurrent infections, though many individuals remain
asymptomatic until advanced glucose intolerance develops.
Hallmarks of the hypertriglyceridemic obesity phenotype include
a waist circumference >94 cm in men or >80 cm in women and
triglycerides ≥150 milligrams (mg)/dL.
➤ Screening
• Identifying insulin resistance and glucose intolerance requires
systematic screening of appropriate patient populations. The
American Diabetes Association recommends screening for T2DM
in adults with body mass index (BMI) ≥25 kg/m² (≥23 kg/m² in those
of Asian descent) who have additional risk factors, and in all adults
aged 35 years and older. The United States Preventive Services Task
Force (USPSTF) recommends screening adults 35 years or older
who have overweight or obesity. Screening should be repeated
every three years if results are normal, or annually in patients with
prediabetes. Age-appropriate screening approaches vary between
pediatric and adult populations. In children and adolescents,
screening should begin at age 10 years or at the onset of puberty
(whichever occurs first) in those with a BMI of 85th percentile or
higher and additional risk factors, including a family history of
diabetes, high-risk ethnicity, signs of insulin resistance, or a maternal
history of diabetes.
