Diabetes affects 422 million people globally, with the majority living in low- and middle-income countries. It is a carbohydrate metabolism disorder characterized by hyperglycemias, insulin resistance, and altered lipid and amino acid metabolism. Diagnosis tests include fasting sugar >126mg/dL, HbA1c >6.5%, and random blood sugar >200 mg/dL. Long-term consequences include microvascular complications like retinopathy and neuropathies, and macrovascular complications like cardiovascular diseases and stroke. Chronic systemic low-grade inflammation is key to the pathogenesis and progression of type 2 diabetes mellitus. Obesity is the main risk factor for the initiation and progression of T2DM and other metabolic syndrome spectrum disorders. The Activin A-Follistatin system has emerged as a potential predictor of inflammation and homeostasis of glucose and lipids, showing promise as a risk stratification index or prognostic marker of T2DM progression. This study aims to explore circulating levels of activin A, follistatin, and the activin A: follistatin ratio in T2DM patients with normal BMI and compare them with overweight T2DM patients. It also aims to correlate the above inflammatory markers with biochemical and haematological markers, along with determining effect of comorbidities and lifestyle on these inflammatory markers.

Understanding the role of activin A, follistatin, and activin A: follistatin ratio in obesity, inflammation, glycemic status, and lipid homeostasis in T2DM patients can provide insights into inflammatory status, guide early anti-inflammatory therapy introduction, and assess the effects of dietary, lifestyle, and psychosocial interventions.