Type 2 Diabetes in People with Obesity - Research Paper Example

? Health sciences and medicine, Research Paper   Topic:  Final Paper: Role of anti-inflammatory agents in the prevention of type 2 diabetes in people with obesity Background Information Type 2 diabetes mellitus (T2DM) is a chronic metabolic disease characterized by abnormalities in carbohydrates and fat metabolism (Scheen, 2003). Various factors have been documented in literature as the causes of T2DM including genetic and environmental factors and they affect the pancreas’ ?-cell function in addition to reducing the insulin sensitivity of muscles, liver and adipose tissues. Since a majority of T2DM patients are obese individuals, the adipose tissue may serve critical role(s) in the pathophysiology of type 2 diabetes mellitus (Scheen, 2003). This chronic disease is characterized by excess glucose levels in the blood, as a result of abnormalities in its metabolism. This non-insulin-dependent diabetes mellitus may begin at childhood stage and become very severe. Insulin injection is a common mode of management since the pancreatic beta cells are not able to secrete enough insulin. Symptoms of the disease may include signs of polydipsia (taking large volumes of water) as a result of excessive thirst and polyuria (excessive urination). Even though it is ideally expected among adults, prevalence has been reported among younger populations because of the effect of obesity. The disease is majorly associated with age but is also associated with obesity and overweight among the younger population (Medline, 2012). Overweight and obesity according to World Health Organization (WHO) may be defined as excessive fat accumulation which may present health risk (WHO, 2012). The body mass index (BMI = person’s weight in kilograms divided by the square of his height in metres) is used to determine whether a person is obese or not. A BMI equal to 25 is overweight whereas more than 30 is considered obese. According to the World Health Organization (WHO), obesity has been increasing over the years in both developed and developing nations. In obesity, oxidative stress and inflammation are a common phenomenon which catapults insulin resistance and onset of T2DM (Badawi et al., 2010). Acute phase reactants such as TNF-?, IL-6 and C-reactive protein are evident of inflammation and various studies have demonstrated their presence in obese subjects (Dandona et al., 2004; Pradhan et al., 2001). With the ever increasing incidence of T2DM worldwide, it is crucial to develop or design preventative measures or strategies especially to certain population at high risk of acquiring the disease, people living with obesity (Emmanuela et al., 2012). Calculated measures aimed at reducing the oxidative stress and consequently the inflammation will be crucial in preventing the development of type 2 diabetes mellitus in the obese individuals group. Various studies have linked T2DM and obesity via inflammation, it is therefore imperative to cut the link through administration of anti-inflammatory agents to the obese individuals. This forms the basis of the research question in this study. Research Question What is the role of anti-inflammatory agents in prevention of type 2 diabetes (T2DM) in people with obesity?’ The incidence rates of T2DM have been on the increase worldwide as reported by Emmanuela et al (2012). This increase has seen some proportion of the population being at a high risk of developing the disease. This group is comprised of obese individuals who are prone to developing T2DM. Therefore, the research question explores ways that may be used to tame the spread of the condition to this group. Inflammation in the obese subgroup of the population provides the link between the obesity and development of T2DM. This is the route that the research question seeks to address and form the basis of this research undertaking. Hence the research question undertakes to fill the gap of knowledge as to whether anti-inflammatory agents play any role in prevention of T2DM especially in the obese subset of the general population Literature Review The impaired insulin action and/or secretion is the characteristic cause of T2DM, a complex metabolic conditions characterized by high blood glucose. Insulin is the main hormone involved in the control of blood glucose and usually it is synthesized in the pancreas ?-cells. This hormone converts glucose into glycogen for storage in hepatocytes and skeletal muscles and also regulates the uptake of glucose from blood into cells. Therefore, in T2DM, three conditions are evident; increased liver glucose production, impaired insulin action or a diminished insulin secretion. Among these conditions evident in T2DM, insulin resistant, which is a suppressed or delayed response to insulin (Teixira-Lemos et al., 2011), especially in obese individuals is as a result of alteration in the insulin receptor signal transduction which may occur due to genetic factors or environmental factors such as lack of regular exercise and obesity (Eriksson et al., 2001). In insulin resistant, glucose tolerance may remain normal if the ?-cells functions to augment production of more glucose to compensate glucose resistance. However, as time progresses the ?-cells fail and there is onset of overt T2DM. The two main features of T2DM are an increased glucose resistance and ?-cells dysfunction. Inflammation is a key feature of obese condition (Teixira-Lemos et al., 2011). The adipose tissues of obese individuals contain mononuclear cells and are usually in an inflammation state (Wellen and Hotamisligil, 2003). Consequently these mononuclear cells produce adipocytokines such as pro-inflammatory cytokines (TNF-?, IL-6, resistin) which causes insulin resistance (Teixira-Lemos et al., 2011). Therefore, it is evident that obesity may be linked to causation of T2DM through the production of pro-inflammatory factors that mediates insulin resistance in body tissues and lead to a systemic inflammation. Type 2 diabetes mellitus may be as a result of obesity related pathologies which some studies hypothesize may be as a result of low-grade inflammation. This inflammation is the one that is associated with development of insulin resistance and the eventual dysfunction of ?-cells of the pancreases (Emmanuela et al., 2011). Obesity has been ranked as monogenic, syndromic or polygenic/common obesity (Herrera and Lindgren, 2010). As observed here, inflammation is a leading cause of ?-cells death and in this respect obesity has also been linked with inflammation (Hotamisligil et al, 1993). This inflammation is as a result of proinflammatory cytokines that are overexpressed in obese condition. Hypoxia is a condition that arises in obese condition where adipose enlargement hinders blood supply to the adipocytes thereby leading to necrosis and infiltration of macrophages to the affected tissues. The macrophages releases proinflammatory cytokines that mediates the insulin signals in these tissues. Therefore, inflammation is a reliable link between the obese individuals and the onset of type 2 diabetes, it is therefore logical to presume that anti-inflammatory agents may prevent type 2 diabetes mellitus in obese individuals as they will counter inflammation from proinflammatory cytokines as discussed earlier. The anti-inflammatory agents will scavenge reactive oxygen species (ROS) released and therefore curtail the progression to a metabolic imbalance leading to T2DM. The inflammation evident in obese condition is a result of activation the immune system. The inflammation results from oxidative stress due to an elevation in the production of free radicals. The sampling plan will provide a detailed layout on the target population for this study on anti-inflammatory agents and their effect in preventing type II diabetes. The sampling plan will include identifying the target population, sampling frame, sample size and other parameters. Sampling frame is a list of the elements or variables that the study will seek to measure in the sample which will be obtained from the target population. The target population is the population of interest. In this case, the effect of anti-inflammatory agents on prevention of progression of type II diabetes mellitus, the population of interest will be the obese individuals. In drawing the sample from the target population, various parameters need to be observed namely; the sampling method, sample size and reliability degree which is an estimation of errors the study may likely encounter. The errors may be in the form of selection error or non-answer error. Since not all persons present in the general population are obese and thus are not subjects to developing the obese related type II diabetes mellitus the study is concentrating on, the study therefore will be limited to a proportion of the population that will be referred as the population of study. Conclusion from the sample obtained will be pegged on this group. In view of the fact that this target population is not uniformly distributed across the population, the choice of the sampling method therefore is of great importance in ensuring the study gets reliable conclusion that are representative of the target population. Various anti-inflammatory agents identified in the literature will be tested in this study on their overall effect of preventing or managing T2DM in obese individuals. The anti-inflammatory agents include dietary supplementation with antioxidants, vitamins and other micronutrients, in addition to pharmacological anti-inflammatory agents. These have been shown to decrease the oxidative stress injuries, which are witnessed in obese people (Emmanuela et al., 2012). This oxidative stress injury may cause metabolic imbalances within the body. Type 2 DM is an example of this category of metabolic imbalances. In this study, there are different sampling strategies that can be applied; however the appropriate one is non-probability sampling method. Albeit probability sampling may provide the best results in terms of scoring for selection error and other errors occurring in sampling, it may not yield the best sample since the population intended to be subject in this study is not concentrated in the same location. The target population is people having obesity. This is the population at risk of developing T2DM and the research question seeks to unravel whether anti-inflammatory agents are capable of preventing secondary pathological effect, T2DM, in these individuals. This study seeks to explore the impact of anti-inflammatory agents towards preventing T2DM. It is impracticable to study each and every individual in the population since they are too many. However, of importance is that the target (research) populations possess similar characteristics of being obese. Therefore the target population in this study is well defined, it is the people who obese and have not developed type II diabetes. All other members of the general population who are obese are excluded from this study irrespective of being diabetic as long as they have developed T2DM. Since this group of individuals is the one the study is interested in, all conclusions derived from the study will be generalized to it. This group is also referred to as the theoretical population. However, practically, it is impossible to include all its members in the study and from it the study will extract a study population, which is the accessible population. This is the population from which samples will be drawn from and the conclusions so derived will be applied to this population. The study population is a subset of the target population. Of the millions of people worldwide who are reported to be obese and have not developed T2DM. The study population will form the basis for generalizing the outcome of the study. The non-probability sampling (purposive or judgemental sampling) will be the appropriate technique in this particular study. Study population will seek individuals who are obese and therefore are at high risk of having metabolic imbalances predisposing them to T2DM. The sampling frame will define the cost of the study and the quality of the sample in this study. According to Turner (2003), it may be defined as set of source materials from which the sample is drawn from. For instance, the target population for this study may be involving subjects who are distributed all over the country, for example in the United States. If the frame seeks all the obese individuals who have not developed T2DM, then their number may be too large. The frame then will narrow to an area frame, which may be the state or county. However this frame may not be exhaustive enough in finding obese victims since not every household has an obese person. Therefore, the frame will be focus on a location or environment where there is a high concentration of meeting obese individuals. The unit of selection, therefore, will be a crucial factor in the sampling frame. This will entail figuring where the target population may be found. As pertains to this study, anti-inflammatory agents especially anti-oxidants may be prescribed to obese individuals in a medical facility which may be a hospital, pharmacy or clinic. The hospital records indicating the population (patients) who are obese and measure they are taking towards preventing T2DM will be investigated. In the hospital records, a suitable sampling frame that will include all members of the target population, males and females of different age, gender will be found. In the virtue of the sampling frame being set for the study, there were be minimal cost in terms of finding the target population members and there will be reliability since errors evident in sampling such as selection error will be avoided. In addition, answer-errors also found in sampling will be by-passed when this sampling frame is adopted. Another area of selection that may be incorporated in this sampling frame may be a gym. Usually obese individuals are advised to take regular exercise besides observing appropriate diets. In this light, a gym may also offer the best chance of finding the people to recruit in the study as sample subjects. Physician may prescribe regular exercise to their obese patients and it is in these settings that they are more likely to be found. In order for a researcher to draw valid conclusion from a study, it is imperative then to draw a sample from the study population that is representative of the whole population of interest (target population). This sample may not be readily available in a general population and thus a convenience sampling is appropriate to get our sample. The elements required by the study will be defined by the sampling frame (target population). This sample is a subset of the target population and is composed of individuals who we will be subjected to test in this study that will then be applied to target population. The sample then will have to be of an appropriate size to guarantee statistical analyses and also it should be representative of the target population. All the characteristics defining the target population should be present in the sample. This sample is usually defined well in terms of characteristics so that interested persons may draw conclusions, apply the results from the study and also compare the study with other similar investigations (Kazerooni, 2001). In defining the sample, there are inclusion and exclusion criteria. The sample is part of the population of study and together with this population they share same features. For instance, both the sample and the population of study share the geographical location and existed in this locality at the same period of time. In this study, it may be possible that all the obese people from a certain location will not be selected in the study, but a subset of them will be taken as candidates for the study. Exclusion criteria will define the criterion of not including each and every member of the study population in the sample. It is normal for some of the study population members out of their own wish to choose not to participate in the study. In another case, the members that are recruited may drop out. These are just but a few of scenario where the inclusion and exclusion criteria need to be defined for a given sample. For instance in this study, exercise is listed as one of the anti-inflammatory agent. However, after enlisting the participants in this study, some members may choose to abstain from exercising and thus they are excluded. This forms the exclusion criteria. Ultimately as the conclusion are drawn from the sample, only members of the population of study who meet the same inclusion and exclusion criteria as the sample are the results inferred to. Recruitment of the study subjects will commence with the identification, targeting and finally enlisting of the participants. In this setting, the hospital records will be providing the sampling population of study. Patients will be enlisted in the list after seeking their consent and the full authorization from concerned authorities. Since the study is voluntary, patients that will form part of the population of study will be provided with ample information so that they may generate interest and therefore participate. All this will be geared towards achieving the goals of recruitment as outlined by Keith et al (2001) and Patel et al (2003). Firstly, the recruitment aims at having enough subjects from the population of interest and these members should meet the sample size and power requirement of the study. Sampling errors such as the selection bias may occur at this step of recruitment. How the subjects of the study will be retained in the study until the study objective are reached is also a factor to consider while recruiting. Hospital records will provide the sampling frame and the platform to recruit the subjects of this study. Upon carrying out a convenience sampling of the best hospital (s) to collect the data, a systematic sampling can be adopted to pick the sample subjects. Recruitment strategy will also involve classifying the samples in accordance to the anti-inflammatory agent they are taking, age, sex, race among other parameters. This strategy will afford the study capable of extracting more information on the best anti-inflammatory agents for obese people that will provide maximum protection against developing T2DM. Additional, the recruitment may also avail information as to which anti-inflammatory is best suited for which study group and this information will then be inferred to the study population. Control subjects will also be recruited; these are the participants who are not taking any anti-inflammatory agent aimed at preventing T2DM. Conclusion In conclusion, this study is fuelled by the increase in the population of people with diabetes and the urgent need of deciphering a method to curb its spread among the risk populations. Of interest in this study is the proportion of the population who are obese developing type 2 diabetes mellitus. This study seeks to complement efforts geared towards preventing this disease. The research question aims to establish whether anti-inflammatory agents contribute in preventing of progression of diabetes mellitus type 2 in obese individuals. Most literature sources covered in this study have suggested that anti-inflammatory agents reduce the inflammation which is suggested to be the main cause of ?-cells death/failure which ultimately leads to T2DM. Inflammation is derived from the adipose cells. Consequently, anti-oxidants derived from exercise, or even recommended pharmacological anti inflammatory agents may scavenge the radicals such as reactive oxygen species thereby delaying the onset of T2DM or preventing it all together in the obese individuals. In seeking to answer the research question, a study design is formulated aimed at giving possible solution to the question. The target population is identified, an appropriate sampling frame and sampling method is obtained which will be used to draw the sample subjects. Answering this research question is of importance to the health sector in many dimensions. It is worth noting that there has been much concern on the increasing incidences of obesity in the worldwide population. This is a problem in the developed countries, though it is also catching up on the developing countries. Hence, the question seeks to address a global health issue. Obesity has been termed as a worldwide epidemic by the WHO (Emmanuela et al., 2012). A fraction of these obese people eventually develop Type 2 DM. Therefore, it is imperative to explore options that would prevent the development of Type 2 DM in these patients. Various options exist for this purpose. However, most are considerably expensive and laborious. However, anti-inflammatory agents, especially those derived from regular physical exercise may provide an inexpensive yet an effective method of curbing and managing type 2 diabetes mellitus especially in the developing world where current treatment regiments may be beyond reach to many. Reference Badawi, A., Klip, A. and Haddad, P., (2010). Type 2 diabetes mellitus and inflammation: prospects for biomarkers of risk and nutritional intervention. Diabetes Metab Syndr Obes., 3:173-186. Dandona, P., Aljada, A. and Bandyopadhyay, A. (2004). Inflammation: the link between insulin resistance, obesity and diabetes. Trends Immunol, 25: 4-7. Emmanuela, F., Grazia, M., Marco, D., Paola, L.M., Giorgio, F. and Marco, B. (2011). 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Available at http://www.who.int/topics/obesity/en/. Accessed October 31, 2012 Read More