Scientists discover how Type 2 Diabetes is reversed using Lifestyle Changes

A team of scientists have been examining how lifestyle changes can cause people with Type 2 diabetes to go into remission. The study was led by Professor Roy Taylor, who had previously co-led the Diabetes Remission Clinical Trial (DiRECT), who is based at Newcastle University. The study was published in Cell Metabolism, a peer-reviewed journal.

Type 2 dabetes is a disease that has been linked to lifestyle and numbers have been growing. More than 1 in 16 people in the UK are estimated to have the disease, with around 1 in 10 being already diagnosed. Some estimates have suggested that numbers could rise to 5 million by 2025. It has been suggested that perhaps 1 million people in the UK, are living with diabetes, who have not yet been diagnosed.

This study took data from the original DiRECT study, which recruited 300 participants, who had been diagnosed with the disease, between July 2014 and August 2016, and put half of them on an intensive weight management program, with cognitive behaviour therapy related to weight loss, while half of them were a control group, who were managed as normal. The results were astounding: 9 out of 10 people who had lost 15kg in weight went into diabetes remission. Three-quarters of those who had lost around 10kg of weight also went into remission. Measures of their health improved including lowered average levels of blood lipids and blood pressure. Almost half of the weight management group did not resume their blood pressure pills following the trial. The trial continued to follow the participants for 4 years following the end of the study.

The latest trial aimed to find out why weight loss had been so effective for people with Type 2 diabetes and what caused the remission to occur, given that not all of the subjects of the study achieved lasting remission.

The scientists took the data from the original trial and subjected it to imaging and blood monitoring techniques. The scientists examined the results from the tests for evidence that the disease was caused  by fat accumulating in the liver. This causes resistance to insulin and increased blood sugar production. When glucose stays in the blood rather than being converted for energy, then people can feel extra tired. Increasing the blood sugar production then increases plasma insulin levels which promotes the production of more fat. Increased levels of fat in the liver, cause lipids to overspill into other areas of the body, including the pancreas, where there are beta-cells. The beta-cells create insulin but are damaged by long-term exposure to saturated fatty acids. This cycle is known as the twin cycle hypothesis.

From the tests, the scientists discovered that remission of type 2 diabetes was only possible if the triglycerides in the liver and the fat in the pancreas remained low. This was the case for 9 out of 10 participants who managed to lose 15 kg and their remission continued for 2 years after the study had ended. They did not need to take the diabetes medication. For a small group, the liver triglycerides and pancreatic fat levels rose again. This was associated with a relapse into type 2 diabetes and the need to take medication again. The scientists noted that when fat accumulates under the skin, that there comes a point where it needs to be stored elsewhere. The amount of fat that a person was able to store seemed to be unique to each person. When fat loss could be achieved through persistence and diet, then the disease could be reversed. This study showed the underlying physiological changes during the cycle of the disease, including remission following weight loss.

Symptoms of type 2 diabetes include tiredness, feeling thirsty, multiple trips to the toilet, especially at night, weight loss, longer healing cuts and wounds, developing thrush and blurred vision. Not everyone experiences symptoms if they have type 2 diabetes. Complications of untreated diabetes can include causing problems with major organs, including the heart and blood vessels, eyes, kidneys and nerve damage. If you suspect that you have type 2 diabetes, it is best to see your GP.

A program of weight loss therapy is due to be rolled out through the UK NHS which will test the efficacy of the therapy for people with type 2 diabetes.

Taylor, R., et al., Hepatic Lipoprotein Export and Remission of Human Type 2 Diabetes after Weight Loss, Cell Metabolism (December 2019) 

https://www.cell.com/cell-metabolism/fulltext/S1550-4131(19)30662-X#sec4 

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