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• Response to Comments:
  Abhinav Sinha, Parul Puri and Sanghamitra Pati
  Published on: 9 December 2022
• Letter to The Editor: Social determinants of diabesity and its association with multimorbidity among older adults in India: a population-based-cross sectional study
  Chante' B Deal
  Published on: 24 November 2022

• Published on: 9 December 2022

  Response to Comments:

  • Abhinav Sinha, Public Heath Researcher ICMR-Regional Medical Research Centre, Bhubnaeswar, Odisha
  • Other Contributors:
    • Parul Puri, Statistician
    • Sanghamitra Pati, Public Health Scientist

  We appreciate Chante' B Deal reading and commenting on our on our article titled "Social determinants of diabesity and its association with multimorbidity among older adults in India: a population-based cross-sectional study". We were intrigued to know about the linkages between diabetes and mortality among the population in The Bahamas. Deal has highlighted a few observations in our paper, which we would like to address on a point-by-point basis.
  Firstly, Deal suggested that NCDs are an essential component of diabesity as their presence plays a vital role in the development and prognosis of diabetes and obesity; however, this was not emphasized in our work. The primary aim of our research was to identify the social determinants of diabesity; it is worth mentioning that all the regression models presented in our study were adjusted for the prominently occurring co-morbidities of diabetes and obesity. These included cancer, chronic heart disease, chronic obstructive pulmonary disorder, chronic renal failure, gastrointestinal disorders, high cholesterol, hypertension, stroke, and thyroid disorders. Also, for the secondary objective, the disease-specific relative risk estimates are presented after adjusting for other co-morbidities. Thus, we ensured that the co-morbidities were foregrounded in our work.
  The second issue highlighted was the timing of the comorbid diseases that might have affected the prevalence of diabetes and obesity. We refrained f...

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  We appreciate Chante' B Deal reading and commenting on our on our article titled "Social determinants of diabesity and its association with multimorbidity among older adults in India: a population-based cross-sectional study". We were intrigued to know about the linkages between diabetes and mortality among the population in The Bahamas. Deal has highlighted a few observations in our paper, which we would like to address on a point-by-point basis.
  Firstly, Deal suggested that NCDs are an essential component of diabesity as their presence plays a vital role in the development and prognosis of diabetes and obesity; however, this was not emphasized in our work. The primary aim of our research was to identify the social determinants of diabesity; it is worth mentioning that all the regression models presented in our study were adjusted for the prominently occurring co-morbidities of diabetes and obesity. These included cancer, chronic heart disease, chronic obstructive pulmonary disorder, chronic renal failure, gastrointestinal disorders, high cholesterol, hypertension, stroke, and thyroid disorders. Also, for the secondary objective, the disease-specific relative risk estimates are presented after adjusting for other co-morbidities. Thus, we ensured that the co-morbidities were foregrounded in our work.
  The second issue highlighted was the timing of the comorbid diseases that might have affected the prevalence of diabetes and obesity. We refrained from adding temporality to our study, primarily because LASI is a cross-sectional dataset and provides a current body mass index status. As a result, more information on the onset of diabetes was required. Furthermore, the timings for all co-morbidities were not included in the dataset. We would love to explore temporal and directional networks for diabesity and its co-morbidities when data from the second wave of LASI is released.
  Finally, we agree that the genetic predisposition is a primary determinant of diabesity, and it is essential to include it in any analysis related to NCDs. However, gathering this information is extremely difficult for any nationally representative survey. When dealing with a populous country like India, the problem becomes unfeasible and logistically impossible to address. We want to reaffirm that the data used in our work has been taken from a secondary cross-sectional dataset, the Longitudinal Ageing Study in India (LASI), 2017–18, which does not provide any information on genetic predisposition or other biological factors.
  We are grateful that you brought up the points and gave us a chance to respond. It will also make our readers more aware of the reasons some crucial components were left out of our research. We value Chante's contributions and eagerly anticipate her further studies.

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  Conflict of Interest:
  None declared.

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• Published on: 24 November 2022

  Letter to The Editor: Social determinants of diabesity and its association with multimorbidity among older adults in India: a population-based-cross sectional study

  • Chante' B Deal, Nursing Student The University of The Bahamas

  This reply is in response to the above-published article on September 18, 2022. This article has been very enlightening in more ways than one, highlighting the connection between obesity and diabetes. It is a known fact that one of the leading causes of diabetes is obesity as mentioned in the article. The attempt to further determine factors among both conditions and how they enhance the risk of developing them is crucial in diabetes prevention. Within the Bahamas, there is a great prevalence of persons living with comorbidities. In 2019, there was a 29% increase in the deaths of persons with diabetes (Vos et al., 2020). This comes behind ischemic heart disease, stroke, and hypertensive heart disease, conditions that can occur as a result of diabetes and can even be factors leading to diabetes. In this, the correlation between obesity and diabetes is also consistent within The Bahamas, however, one of the key causes of diabesity was not foregrounded in this article.
  Though included in the framework of this study, the necessary consideration of other non-communicable diseases was not outlined. While age, residence, sex, education, and wealth are significant causative factors for diabesity, the presence of underlying non-communicable conditions plays a pivotal role in the development of both diabetes and obesity. The time in which these comorbid diseases were diagnosed should have some effect on the prevalence of diabetes and obesity being observed and recorded in the...

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  This reply is in response to the above-published article on September 18, 2022. This article has been very enlightening in more ways than one, highlighting the connection between obesity and diabetes. It is a known fact that one of the leading causes of diabetes is obesity as mentioned in the article. The attempt to further determine factors among both conditions and how they enhance the risk of developing them is crucial in diabetes prevention. Within the Bahamas, there is a great prevalence of persons living with comorbidities. In 2019, there was a 29% increase in the deaths of persons with diabetes (Vos et al., 2020). This comes behind ischemic heart disease, stroke, and hypertensive heart disease, conditions that can occur as a result of diabetes and can even be factors leading to diabetes. In this, the correlation between obesity and diabetes is also consistent within The Bahamas, however, one of the key causes of diabesity was not foregrounded in this article.
  Though included in the framework of this study, the necessary consideration of other non-communicable diseases was not outlined. While age, residence, sex, education, and wealth are significant causative factors for diabesity, the presence of underlying non-communicable conditions plays a pivotal role in the development of both diabetes and obesity. The time in which these comorbid diseases were diagnosed should have some effect on the prevalence of diabetes and obesity being observed and recorded in the persons being studied. Additionally, consideration of other conditions persons may be genetically predisposed should be considered.
  Overall, I do believe that the study done was very informative and much needed in detecting factors that lead to the prevalence of both diabetes and obesity and their simultaneous occurrences. This indeed is a study I would replicate within The Bahamas, as it is a growing health issue that needs to be addressed. However, the above-mentioned considerations would be included in my study to attain a more transparent outlook of the factors influencing the incidences of diabesity within The Bahamas.

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  Conflict of Interest:
  None declared.

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