UK trial shows remission of type 2 diabetes

Everyone has a ‘personal ‘fat threshold’ which, if exceeded, will allow type 2 diabetes (T2D) to develop, even if the body weight is lower, European Association for the Study of Diabetes (EASD) annual meeting in Stockholm, Sweden ( September 19-23), you’ll listen.

The most common type of diabetes, T2D occurs when the pancreas can’t produce enough insulin (a hormone that helps move sugar in food into cells for energy) or when the insulin it makes doesn’t work properly.

If your BMI is over 301 It is a risk factor for T2D and landmark research from Newcastle University has previously shown how and why an intensive weight loss program can put T2D into remission in people who are obese or overweight.

But not everyone with T2D is overweight. About 15% of T2D diagnoses occur in people of normal weight and it is generally assumed that the condition has a different cause in such cases.

The ReTUNE study (reversing type 2 diabetes when energy intake is normalized in non-obese people) looked at whether weight loss could also reverse the condition in people with a BMI at or just above the “normal” range (a lower BMI). from 27 kg/m2).

This would support the idea that we each have a “personal fat threshold” – a level of body fat we can handle – and if we exceed that, we will develop T2D, even if our weight seems unnoticeable.

Twenty men and women with T2D (mean BMI 24.8 kg/m2, mean age 59.0 years) participated in the study, which was funded by Diabetes UK.

They followed a weight loss program in which they consumed 800 calories per day (from reduced-calorie soups, shakes, and non-starchy vegetables) for two weeks, followed by four to six weeks in which they kept their new weight steady. They completed up to three rounds of the maintenance/weight maintenance cycle until they lost 10-15% of their weight.

Their results were compared at the end of the study with those of a group of controls – 20 non-diabetics who were matched for age, gender and BMI.

Fourteen of the 20 participants (70%) with type 2 diabetes went into remission, a similar proportion to previous studies involving participants with type 2 diabetes, overweight and obesity. Calm is HbA1c (average blood glucose level) below 48 mmol/mol for at least 6 months and off all medications. Participants lost an average of 7.7 kg in the remission period (10.7% of their initial weight).

Weight remained stable between 6 and 12 months.

The average BMI decreased from 24.8 to 22.4 and the total body fat decreased from 32.1% to 27.7%. (Identical to the control group of non-diabetic subjects who had an average BMI of 21.5 and 24.6% of total body fat.)

MRI scans showed that the levels of fat inside the liver and pancreas were significantly reduced.

Although the average amount of liver fat in study participants is considered unremarkable at 4.1%, this was nearly three times higher than in healthy controls of the same weight and decreased to 1.4%, near the healthy control level. .

The pancreatic fat rate decreased from 5.8% to 4.3% and the activity of the insulin-producing cells returned to normal.

The researchers say their results clearly show that T2D is caused by the same factors in people of normal weight as in those who are overweight or obese.

This is important because clinicians tend to assume that T2D has a different cause in those who have a lower body weight, and so they are not usually advised to lose weight before starting diabetes medications, and eventually insulin.

“But if they lose about 10% of their weight, they have a very good chance of putting their type 2 diabetes into remission,” says Professor Roy Taylor of Newcastle University, Newcastle, UK, the lead researcher on the trial.

The findings should also help dispel the stigma that can be linked to a T2D diagnosis, says Professor Taylor.

He explains: “The results also support the personal fat threshold concept that a person with type 2 diabetes has slightly more fat than they can tolerate individually. This is determined by your genes. Each of us has a threshold level at which we can safely store fat and this has nothing to do with BMI.

If you have type 2 diabetes, you simply have more fat inside your body than you can handle, even if it looks skinny.

This extra fat seeps into the liver and pancreas which stops normal function and causes type 2 diabetes. You only need an extra half gram of fat in your pancreas to prevent natural insulin production.

He often asks me, “Why did I get type 2 diabetes when all my friends are older than me and don’t have diabetes?” The present work answers this puzzle.

This should help remove some of the stigma associated with type 2 diabetes. It is clearly a condition not “caused” by exceeding any level of BMI but by storing a lot of fat within your liver and pancreas, whatever your weight.

Researchers recommend that everyone with someone with T2D in their family have their blood sugar checked every year, no matter their weight. Regular checkups are also recommended for anyone who has diabetes during pregnancy or who is not of white European descent.

Professor Roy Taylor, University of Newcastle, Newcastle, UK. T) 07946 429123 H)

Alternate contact: Tony Kirby at EASD Media Center. Tel) +44 7834 385827 H)

Notes to editors:

  1. A “healthy” BMI range is defined as 18-24.9; ‘Overweight’ is defined as 25-29.9; The term “obesity” is defined as being over 30 years old.

The authors declared that there was no difference in interests.

This press release is based on an oral basis 255 presented at the annual meeting of the European Association for the Study of Diabetes (EASD). The materials were reviewed by the conference’s peer selection committee. There is no complete paper at this point.

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