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Beta-cell function can be recovered with type 2 diabetes remission
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SAN FRANCISCO — After undergoing a weight-loss regimen to achieve diabetes remission, adults with type 2 diabetes who sustain weight loss can continue to experience this benefit, according to data presented at the American Diabetes Association 79th Scientific Sessions.
“Beta cells, of course, the insulin-secreting cells, are at the very heart of diabetes,” said Roy Taylor, MD, FRCP, professor of medicine and metabolism at Newcastle University in the United Kingdom. Beta-cell function has declined by roughly 50% by the time of diagnosis of type 2 diabetes, he said.
Taylor and colleagues examined beta-cell function and insulin secretion rates in a subgroup of participants from the Diabetes Remission Clinical Trial (DiRECT) who reached remission. In the initial trial, a diet and weight-loss program that consisted of a meal-replacement plan was completed by a randomly assigned group of participants, of whom 40 achieved diabetes remission, defined as an HbA1c level of less than 6.5% or discontinuation of diabetes drugs and a fasting plasma glucose level of less than 126 mg/dL.
Although Taylor noted that those in remission did not reach “normal” values for HbA1c and FPG, the improvements shown were sustained over the 2 years. In addition, the percentage of those who achieved remission was highest for those who had more weight loss, with 64% of those who lost at least 10 kg reaching remission. To test beta-cell function in those who had remission, Taylor and colleagues provided a glucose and protein infusion that is the “scientific equivalent of a Big Mac,” according to Taylor, providing an environment where the pancreas must produce maximum exertion.
The researchers found that remission was sustained by the majority of the participants who maintained more than 10 kg weight loss after 2 years. Those who maintained remission had a higher median maximum rate of insulin secretion at 24 months which was twofold higher than at baseline. The improved rate was comparable to that of a second cohort of age- and sex-matched participants without diabetes, according to the researchers. In addition, the median first phase insulin response was higher at 24 months compared with baseline for those who achieved diabetes remission. However, those who lost remission status after 2 years had gained more weight than those who continued to be without diabetes (11.3 kg vs. 6.6 kg; P = .036).
“Basically, this is enormously good news for people with type 2 diabetes. There is a possible way back, even after type 2 diabetes has been diagnosed,” Taylor said. “These beta cells are not dead. Rumors of their death have been much exaggerated you might say.” – Phil Neuffer
Reference:
Zhyzhneuskaya SV, et al. Remission of type 2 diabetes for two years is associated with full recovery of beta-cell functional mass in the Diabetes Remission Clinical Trial (DiRECT). Presented at: American Diabetes Association 79th Scientific Sessions; June 7-11, 2019; San Francisco.
Disclosure: Taylor reports he has received lecture fees from Novartis, Lilly and Janssen and is on the advisory board of Wilmington Healthcare.