Type 2 Diabetes Mellitus (T2DM) is a common metabolic disorder associated with aberrations such as hyperglycaemia, hyperlipidaemia and obesity. While the underlying causes of T2DM are multifactorial, the cardinal features are a decline in insulin production by pancreatic beta cells and peripheral insulin resistance.¹ The prevalence of overweight among people diagnosed with T2DM has persistently remained high over time.^2,3 This is partly attributed to adipocytes releasing excess fatty acids that are resistant to insulin action,⁴ low levels of physical activity,⁵ poor dietary practices, ⁶ and the lipogenic effects of anti-diabetic medicines,⁷ among others.

Obesity, overweight and abnormal fat accumulation are critical precursors for T2DM. Following diagnosis and initiation of antidiabetic medications such as sulfonylureas, biguanides, and insulin therapy, patients still show a higher preponderance of weight gain,⁷ further exacerbating the already poor glycaemic control. This, in turn, can undermine the goal of medical therapy to achieve tight glycaemic control without adverse weight changes among diabetic patients.

Evidence in Uganda shows a high rate of overweight among T2DM patients.⁸ Unfortunately, the specific composition of this bodyweight remains largely unknown. We are unsure whether it is fat mass or fat-free mass compartments. Since the quality of weight depends hugely on its composition, increases in fat mass have a negative side effect for many patients with diabetes who aim to achieve glycaemic control. Fat mass is strongly associated with increased cardiovascular risk,⁹ while fat-free mass is associated with better glycaemic control, muscular strength, immunity and survival.¹⁰

This study therefore aimed to understand the body composition of T2DM patients attending the diabetic clinic of Mbarara Regional Referral Hospital and compare it to sex and age-matched healthy controls. Understanding the body composition is essential in harnessing glycaemic control while avoiding the deliberating effects of weight gain and guiding targeted health and dietary advice.

A total of 278 participants were recruited and analyzed with a 1:1 ratio of the case to controls. Cases and controls did not significantly differ in mean age and sex distribution as these were matched at recruitment. The median (IQR) fasting blood glucose of the cases was 7.5 (3.9) mmol/L, while the median (IQR) random blood glucose of the controls was 6.2 (1.8) mmol/L. Cases had a median duration of diabetes of 4 years (IQR: 8). Cases were more likely to have a smaller household size and be physically inactive than controls (all p<0.05). The rest of the demographic and lifestyle characteristics are presented in Table 1.

The study aimed to understand the body composition of Type 2 Diabetes patients compared to the healthy, closely matched controls. The findings of the study indicate that cases had a higher BMI and weight. Waist Hip Ratios, Fat Mass Index, visceral fat and higher metabolic age values than their healthy counterparts. These findings are similar to those from previous studies^2,13 where T2DM patients were overweight and had a higher BMI than their healthy counterparts. A recent study¹⁴ observed a similar occurrence with higher fat mass among diabetic patients. Similarly, other authors¹⁵ reported more visceral fat and total body fat in T2DM patients than in healthy controls.

The study also revealed that diabetic patients had significantly higher systolic median blood pressure and pulse rate than their healthy counterparts. This observation has been witnessed among people with diabetes since diabetes damages blood vessels causing the walls to stiffen, leading to elevated blood pressure. Studies show that there is twice the risk of developing blood pressure among people with diabetes than the healthy non-diabetic populations. Controlling blood pressure is of paramount importance among people with diabetes to prevent adverse outcomes such as metabolic syndrome, congestive heart failure, and stroke.^2,16

Despite the elevated levels of fat mass and high blood pressure, we observed that diabetic patients were less likely to be physically active, which does not support weight loss. Since physical inactivity is a primary risk factor for metabolic disorders, T2DM patients must be supported to engage in an active lifestyle that improves peripheral insulin sensitivity, decreases visceral fat, and improves glycaemic control.⁵

Results from the study illustrate the need to manage weight gain among T2DM patients. Clinicians need to engage patients in health education sessions, equipping them with information on the risks and patterns of weight gain. Insulin-related weight gain has been attributed to the anabolic effects of high-dose insulin, low physical activity and appetite increases. Understanding the cause and pattern of weight gain at an early stage can revert these life-threatening complications among diabetic patients later in life. The assessment of body composition and pattern of body fat distribution is critical in understanding the body fat distribution to reduce complications associated with high adiposity among T2DM patients.

Among key strengths of this study include the use of robust methods of body composition analysis and statistical tests. To our knowledge, this is the first study to carry out a comprehensive assessment of body composition among T2DM patients and compare the results with sex and age-matched controls in Uganda.

Our results indicate that patients with T2DM, compared to healthy age and sex-matched controls, show a considerably higher fat mass level. Clinicians and other public health practitioners need to pay particular attention to these individual parameters when treating and managing T2DM patients. We hope that body composition assessment can be included as a primary anthropometric measure while managing metabolic derangements of Type 2 Diabetes in Uganda.