Remission of type 2 diabetes is achievable in non-obese people

A small amount of weight loss in non-obese people with type 2 diabetes can put diabetes into remission. At the recent annual Diabetes UK conference, researchers presented the most recent findings from the reTUNE study, a part of the Diabetes Remission Clinical Trial (DiRECT), which investigated the effects of weight loss in people with type 2 diabetes who aren’t obese. Results were presented by Dr. Roy Taylor at the recent Diabetes UK conference. He is a professor of medicine and metabolism at the Magnetic Resonance Centre Campus for Ageing and Vitality Translational and Clinical Research Institute at Newcastle upon Tyne. The findings are “good news for people with type 2 diabetes and normal weight, who previously have been told that they should not lose weight to try to achieve remission as it might be ‘unhealthy’. And now know that their type 2 diabetes (T2DM) is not necessarily a life sentence,” he told the Medical Post in an email. Read: Prediabetes diagnosed in older (70+) adults rarely leads to diabetes In brief, while fat plays a role, the findings suggest that T2DM is not caused by obesity. Previously it was assumed the aetiology of T2DM in people with healthy weight and BMI must differ from that of obese individuals. Yet about 10% of people with T2DM are not obese and have healthy BMIs. This raised the question of how fat contributed to risk and how it might vary between individuals. In 2015, Dr. Taylor published the Personal Fat Threshold (PFT) hypothesis. In brief, each individual has a PFT in terms of fat deposits in the liver and pancreas. If exceeded this makes the development of T2DM likely. Crucially, this is regardless of BMI, he said. “Just look at people in the street—we all differ in build.” Excess fat within liver cells causes insulin resistance, but this resolves if liver fat drops to low-normal levels. Once liver fat levels drop, it triggers a reduction of fat in the pancreas and normal insulin responses return. Previous studies from DiRECT showed that obese individuals with T2DM who lost weight could achieve remission. But there was a need for a study to investigate the effects of weight loss in non-obese individuals, Dr. Taylor said. The ReTUNE study included a total of 20 adults with T2DM. They had an average of 59.3 years, average BMI of 24.7kg/m3, and had diabetes for an average of 2.5 years. Just over half, 13, were women. The goal was to determine whether weight loss in people who had BMI less than 27kg/m2 would lead to T2DM remission, and to test the PFT hypothesis by inducing step-wise weight loss. All the participants underwent two eight-week long cycles of 5% weight loss, with a third cycle if the goal of remission was not reached. Each cycle consisted of two to four weeks of a low energy diet (800kcal/day). The weight loss cycles were then followed by four to six weeks of a diet that maintained weight. Follow-up was conducted at one year. Liver and pancreas fat content was measured at study entry and follow-up. In the whole study population, HbA1c and fasting plasma glucose declined respectively from an average of 54mmol/mol and 7.4mmol/l at baseline, to 46mmol/mol and 6.0mmol/l at the one-year mark. A total of 14 (70%) subjects achieved remission, with HbA1c decreasing below 48mmol/mol HbA1c. The fat levels in the liver and pancreas “started almost three times higher than normal and fell to normal,” Dr. Taylor said. As long as subjects maintain the lower weight the diabetes will stay in remission, he said. Overall, subjects had about a 10% weight loss. The six people who did not achieve remission had longer duration of diabetes but still were able to come off their diabetes tablets and improve their control. Dr. David Jenkins, who was not involved in the study concurs with the general findings. He is a professor in the departments of Nutritional Science and of medicine at the University of Toronto and conducts research in diabetes and nutrition. “Obesity may not be the cause of diabetes, but where you store your fat may be,” he said. “If you are the type of person who stores fat in the omentum, in the liver or in muscle, then you’re at risk of diabetes. But if you can get rid of the fat in liver, and muscle then you reduce the insulin resistance and the diabetes may go away—at least for the time,” he said. That doesn’t mean weight isn’t worth managing. “I think body weight and BMI are still important clinical measures but it may be important to include also waist circumference as an indicator of the intra-abdominal fat that appears to relate more directly to diabetes and CVD risk,” Dr. Jenkins said.

Remission of type 2 diabetes is achievable in non-obese people

Register for free access or login.

Related Topics