The pathophysiological nexus and management of diabesity: a narrative review with a focus on the Nigerian perspective

The co-occurrence of obesity and type 2 diabetes mellitus (T2DM), commonly termed diabesity, has been increasingly reported as a major global health challenge. The prevalence of both conditions has risen rapidly in recent decades, largely driven by lifestyle transitions, including unhealthy dietary patterns, physical inactivity, and underlying genetic susceptibility. Diabesity describes the occurrence of T2DM in the context of obesity and reflects the strong pathophysiological and epidemiological link between the two conditions. This narrative review highlights the mechanisms underlying diabesity, with emphasis on insulin resistance, chronic low-grade inflammation, and mitochondrial dysfunction. Central to its pathogenesis is lipotoxicity, characterized by persistently elevated levels of non-esterified fatty acids (NEFAs) released from adipose tissue. These fatty acids impair glucose uptake and utilization in peripheral tissues, thereby exacerbating insulin resistance. Over time, this metabolic imbalance contributes to the dysfunction of pancreatic β-cells, resulting in impaired insulin secretion and poor glycemic control. The review further explains that the interaction between excess adiposity, increased circulating NEFAs, and progressive insulin resistance plays a critical role in the development of diabesity. In addition to pathophysiological insights, the rising prevalence and burden of diabesity are discussed, particularly in low- and middle-income countries like Nigeria, where health systems face increasing strain. Management approaches, including lifestyle modification, pharmacological therapies, and bariatric surgery, are also examined, with evidence suggesting variable outcomes across populations. The review highlights the urgent need for targeted public health interventions, policy reforms, and region-specific strategies to address the growing burden of diabesity effectively.Top of Form