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 they have a lower body weight, the European Association’s annual meeting for the Study of Diabetes (EASD) in Stockholm, Sweden (September 19-23), will hear.

The most common form of diabetes, T2D, occurs when the pancreas cannot make enough insulin (a hormone that helps move sugar from food into cells for energy) or the insulin that it manufactures does not work correctly.

Have a BMI over 301 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 all people with T2D are overweight. About 15% of T2D diagnoses are in people of normal weight and the condition is generally assumed to have a different cause in such cases.

The ReTUNE (Reversal of Type 2 Diabetes upon Normalization of Energy Intake in the Non-obese) study examined whether weight loss could also reverse the condition in people with a BMI at or just above the “normal” range. » (BMI less than 27 kg/m2).

This would support the idea that we each have a ‘personal fat threshold’ – a level of body fat that we can cope with – and if we exceed it we will develop T2DM, even if our weight seems trivial.

Twenty men and women with T2DM (mean BMI 24.8 kg/m2, mean age 59.0 years) took part in the study funded by Diabetes UK.

They followed a weight loss program in which they consumed 800 calories a day (from low-calorie soups and shakes and non-starchy vegetables) for two weeks, followed by four to six weeks during which they maintained their new stable weight. They did up to three cycles of this diet/weight maintenance cycle until they lost 10-15% of their body weight.

Their results at the end of the study were compared with those of a control group – 20 people without diabetes matched for age, sex and BMI.

Fourteen of 20 participants (70%) with type 2 diabetes went into remission, a similar proportion to previous studies of participants with type 2 diabetes who were overweight and obese. Remission is an HbA1c (average blood sugar level) below 48 mmol/mol for at least 6 months and off any medication. Participants had lost an average of 7.7 kg in remission (10.7% of initial weight).

The weight remained stable between 6 and 12 months.

Average BMI went from 24.8 to 22.4 and total body fat went from 32.1% to 27.7%. (Matched to the control group of people without diabetes who had an average BMI of 21.5 and 24.6 percent total body fat.)

Special MRI scans showed that fat levels in the liver and pancreas had dropped significantly.

Although the average amount of fat in the liver of study participants would be considered unremarkable at 4.1%, it was about three times higher than in healthy controls of the same weight and fell to 1.4% , close to the healthy control level. .

Fat in the pancreas dropped from an average of 5.8% to 4.3% and the activity of insulin-producing cells returned to normal.

The researchers say their findings clearly demonstrate that T2D is caused by the same factors in normal-weight people as in overweight or obese people.

This is important because doctors tend to assume that T2DM has a different cause in people with lower body weight and therefore they are generally not advised to lose weight before starting diabetes medication. and, optionally, insulin.

“But if they lost around 10% of their weight, they would have a very good chance of putting their type 2 diabetes into remission,” says researcher Professor Roy Taylor, from Newcastle University, Newcastle, UK main of the test.

The results should also help dispel the stigma that can be attached to a diagnosis of T2D, says Professor Taylor.

He explains: “The results also support the concept of a personal fat threshold that everyone with type 2 diabetes has a little more fat on board than they can handle individually. This is determined by your genes. Each of us has a threshold below which we can safely store fat and it has little to do with BMI.

“If you develop type 2 diabetes, you simply have more fat in your body than you can handle, even though you are apparently thin.

“This excess fat spreads through your liver and pancreas, stopping normal functioning and causing type 2 diabetes. You only need an extra half gram of fat in the pancreas to prevent normal production of ‘insulin.

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“This should help remove some of the stigma that attaches to type 2 diabetes. It is clearly a condition that is not ’caused’ by a higher BMI at any level but by the storage of too much fat in the liver and pancreas, regardless of your weight.

The researchers recommend that anyone with a family member with T2DM should have their blood sugar checked annually, regardless of weight. Regular check-ups are also advised for anyone who had diabetes during pregnancy or who is not of white European descent.

Professor Roy Taylor, University of Newcastle, Newcastle, UK. T) 07946 429123 E) [email protected]

Alternate contact: Tony Kirby at the EASD Media Center. T) +44 7834 385827 E) [email protected]

Notes to Editors:

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

The authors declare no conflict of interest.

This press release is based on the oral presentation 255 at the annual meeting of the European Association for the Study of Diabetes (EASD). The material was reviewed by the congress selection committee. There is no complete document at this stage.

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