Pancreatic size and shape can be restored in individuals with type 2 diabetes who have achieved remission as a result of an intensive weight loss and weight loss maintenance program. A new analysis from the landmark is shown Directly trial.
The study was presented at the EASD Virtual Meeting 2020 on September 22, held online for the COVID-19 pandemic.
So report Along Medscape Medical NewsDiRECT, which includes a calorie-restricted liquid diet followed by a gradual dietary reintroduction and weight loss maintenance program, resulted in 36% of patients achieving diabetic reintroduction, which could be sustained for 24 months.
Retrospective analysis
Reuterer, a professor of medicine and professor of metabolism at Newcastle University, Newcastle upon Tyne, used new imaging techniques to perform a retrospective analysis of 64 patients and 64 non-diabetic controls from the trial. ..
Researchers have found that among those who were DiRECT responders, pancreatic volume increased 24 months after the first weight loss.
In addition, the irregular borders seen at baseline were normalized, pancreatic fat content was significantly reduced, and insulin secretion was elevated to the levels seen in control.
“Our previous study demonstrated a return to normal glucose control over the long term, but despite our demonstration of a return to normal insulin production by the pancreas, this is simply” well-controlled diabetes. “Some experts claim that it is,” Professor Taylor said in the news release.
“But the significant changes in pancreas size and shape are solid evidence of a return to normal.”
“Type 2 diabetes is a simple disease that occurs when there is too much fat in the body for an individual to cope with.
“The solution to the huge and growing problem of type 2 diabetes in the population is in the hands of politicians. The law on the supply of high-calorie foods is essential to change our environment.”
Ask more questions
Dr. Elizabeth Robertson is the lead investigator in the UK for diabetes who funded this study. “Our groundbreaking DiRECT trial has revolutionized the way we think about type 2 diabetes. We don’t consider it a lifelong condition for everyone. Relief is one. I know it’s possible for the people in the club. “
“These new discoveries help build a clearer picture of the biology behind remission and how weight loss restores pancreatic health.
“But we still have questions to answer, such as why no one can reconcile.”
Dr. Robertson said: “When NHS England begins testing a DiRECT-inspired weight management remission program, it is important to continue exploring these questions to enable remission to as many people as possible.”
Survey details
Researchers have pointed out that people with type 2 diabetes have a reduced pancreas volume and an abnormal shape.
However, it is not clear whether these changes are the result or cause of the medical condition. In the former case, when beta-cell function recovers during the remission phase of type 2 diabetes, “it is expected to correct the abnormality.”
To further investigate, the team surveyed 64 participants in the DiRECT trial for two years and compared them to 64 non-diabetic controls of age, weight, and gender matching.
People with type 2 diabetes achieved HbA1c <6.5% (48 mmol / mol) and fasting blood glucose <7.0 mmol / l, and were classified as responders if they were not taking all antidiabetic drugs.
New magnetic resonance imaging technology is used to obtain anatomical and fat fraction images of the pancreas, from which the pancreatic volume, intrapancreatic fat content, and pancreatic border irregularities are quantified. Did.
In addition, a step-by-step insulin secretion test with arginine was used to measure insulin secretion, and thus beta cell function.
Baseline pancreatic volume was significantly smaller, averaging 63.8 cm in all type 2 diabetic patients3 Vs. 79.8 cm3 Non-diabetic control group (p <0.0001).
Pancreatic volume did not change at baseline and 5 months after weight loss, regardless of remission.
However, in 24 months, pancreatic volume increased by an average of 12.6 cm.3 In the responder, it was well over 4.5 cm.3 It was seen in non-responders (p <0.0001).
Pancreatic borders were significantly more irregular in patients with type 2 diabetes compared to non-diabetic controls (p <0.0001). However, by 24 months, it was normalized by the responder and the difference from the non-diabetic control was no longer significant (p = 0.92).
Importantly, responders lost significantly more pancreatic fat during the course of their studies than non-responders, with a 1.56% vs. 0.51% reduction (p <0.05).
Finally, 5 months after initial weight loss, Phase 1 insulin increased significantly from baseline, but only in responders reached 0.11 mmol / ml / min (p <0.0001) and was maintained at 24 months. It was an increase.
Downhill, uphill
Professor Taylor said in a statement that a 50% loss of beta cell function in people with type 2 diabetes “has been reproduced by many studies using different methodologies and is often a dark message: always downhill.” Said.
“Now, here you can see not only the uphill, but also the uphill that is completely back to normal. The weight is maintained, so it remained normal until the 24-month DiRECT.”
In a post-presentation discussion, Dr. Harald Sourij of the Medical University of Graz in Austria asked Professor Taylor about the mechanism by which the pancreatic morphology and volume of these patients recover.
“It must be remembered that insulin is a very powerful stimulant of growth,” Taylor replied.
He pointed out that insulin and insulin-like growth factor 1 “have the same effect on each receptor by about 10 times the concentration.”
“Think about insulin now,” he said. “After a meal, plasma insulin rises up to 10-fold above baseline. Imagine a local concentration around the island. It should be fairly significant.”
Professor Taylor goes on to say, “The nutritional benefits of insulin are probably the most likely reason for this. [normalisation of pancreatic morphology]..
“We can see that the parenchymal cells of the pancreas have returned to normal. We pay attention to the fact that when insulin secretion is lost in that very different state, the pancreas also contracts in type 1 diabetes.
“At the onset of type 1 diabetes, it’s about 30% of normal size. You probably shouldn’t be surprised to know that the acute response to a diet for type 2 diabetes is very low and the pancreas can shrink. Because there is no continuous nutritional effect of insulin. “
The study was funded by Diabetes UK.
Professor Taylor declares: Wilmington Healthcare; Grants; Diabetes UK. Lectures / Other Fees; Lily and Novartis. No other relevant financial relationships have been declared.
EASD Virtual Meeting 2020: Abstract 18. Announced on September 22nd.
