Dysglycaemia and the DBCD model are part of a larger framework of comprehensive cardiometabolic risk, proposed by the AACE, drawing together ideas around body mass, diabetes, and metabolic syndrome.2

The framework includes another recent diagnostic term: adiposity-based chronic disease (ABCD). This is described as “abnormalities in the amount, distribution, and/or function of adipose tissue” and was proposed in December 2016 to recognise the chronic disease and the pathophysiological process underlying it, that simply using the term ‘obesity’ may not convey.1,2,4

The ABCD concept highlights the role of adipocytes (fat cells) in adipose tissue which secrete a wide number of compounds including regulatory peptides known as adipokines. These affect various body pathways including the immune, endocrine-metabolic, and cardiovascular systems. They are also involved in the complex pathways around obesity and insulin resistance.4,5

With more than 600 known adipokines, a couple are of particular interest in obesity and T2D – adiponectin and leptin – but their effects are complex. Adiponectin levels are inversely related to cardiometabolic risk, but there is a direct relationship with coronary heart disease (CHD) and heart failure mortality.5

Leptin is sometimes known as the ‘hunger control hormone’ and genetic mutations which reduce leptin levels are linked with obesity and T2D. It is also associated with atheroma build up in the arteries and heart, and improved left ventricle function.

Obesity can also be regarded as an inflammatory process with macrophages linked to obesity-associated adipose tissue (M1) and lean-associated adipose tissue (M2). The M1 phenotype is associated with tissue destruction and insulin resistance, while the M2 phenotype is linked with improved insulin sensitivity.

Another adipokine, secreted frizzled-related protein 5 or SFRP5, acts in a similar way to adiponectin with insulin-sensitising and anti-inflammatory roles. It can decrease macrophage-dependent adipose tissue inflammation and may also offer some reduction in CHD risk.