ABSTRACT
While the majority of obese and insulin-resistant individuals do not develop type 2 diabetes mellitus (T2DM), it is estimated that 20% or more of obese individuals will develop type 2 diabetes (T2DM) in their lifetime. This chapter provides the background science on how those who develop T2DM or “diabesity” differ from the majority of obese individuals. Diabetes and prediabetes affect half of the population of the state of California (Babey et al. 2016) and about half the population in China (Xu et al. 2013). These statistics are likely to be repeated elsewhere in the world and represent both an economic and a global health disaster in the making. The ability of diet and lifestyle, in combination with the long-established, off-patent, and safe drug metformin, to reduce the rate of progression of T2DM with benefits on cardiovascular mortality will be the emphasis of the intervention approach recommended here. The issues previously reviewed in Chapter 2 on dietary recommendations and in Chapter 5 on obesity treatment will not be repeated here, but those considerations fully apply to the individuals with obesity who are at risk of T2DM.
