Zezheng Kang,1,* Zishan Jin,2,3,* Lei Wu,1 Aru Sun,1 Lishuo Dong,1 Jiarui Li,1 Qingwei Li,2 Xiaolin Tong2 

1Changchun University of Chinese Medicine, Changchun, 130117, People’s Republic of China; 2Institute of Metabolic Diseases, Guang’anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, 100053, People’s Republic of China; 3Beijing University of Chinese Medicine, Beijing, 100105, People’s Republic of China

*These authors contributed equally to this work

Correspondence: Qingwei Li, Institute of Metabolic Diseases, Guang’anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, 100053, People’s Republic of China, Email dsliqingwei@163.com Xiaolin Tong, Institute of Metabolic Diseases, Guang’anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, 100053, People’s Republic of China, Email tongxiaolin@vip.163.com

Abstract: Type 2 diabetes mellitus (T2DM) has a high prevalence worldwide; its cardiac, renal, and visual complications greatly affect patients’ quality of life. This, together with the large patient base, makes clinical health management of T2DM a problem. Existing studies have shown that obesity and the onset of T2DM are highly correlated, which can start from the earliest lipid metabolism problems and ultimately develop into T2DM. Moreover, adipose tissue can also seriously affect patient treatment by affecting insulin secretion, promoting pancreatic β-cell proliferation, and increasing insulin resistance. Our study describes the association between obesity and T2DM, summarizes the role played by the adipose tissue in T2DM, and focuses on fatty acid esters of hydroxy fatty acids (FAHFA), whose role in improving insulin secretion and increasing insulin sensitivity shows greater potential in T2DM. In addition, we summarize the existing more mature clinical treatment strategies, such as life interventions, drugs, and surgery, which can help control blood glucose levels and reduce adipose-related insulin resistance by reducing the adipose tissue. Among these treatments, Chinese medicine is another factor worth exploring. However, due to the influence of geography, culture, and other factors, this method has only achieved some success in China and part of the East Asia region and has been applied clinically. Although there is no evidence of clinical benefit for obesity or adipose tissue, its clinical benefit for T2DM has been demonstrated; therefore, there is still a need to develop it, as well as considerable potential for development.

Keywords: T2DM, obesity, adipose tissue, FAHFA, treatment, Chinese medicine