Weight loss may restore pancreas function in type 2 diabetes
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Weight loss can help the pancreas return to its normal size and shape for people experiencing type 2 diabetes remission, according to a presenter at the European Association for the Study of Diabetes virtual meeting.
“Most people with type 2 diabetes will not know that their pancreas organ is small and shrunken,” Roy Taylor, MD, professor of medicine and metabolism at Newcastle University, United Kingdom, told Healio. “The good news is that this is potentially able to be put right.”
Taylor and colleagues analyzed data from 64 participants with type 2 diabetes in the Diabetes Remission Clinical Trial. Participants were split into two groups. The responder group included people with an HbA1c below 6.5% and fasting blood glucose below 7 mmol/L without diabetes medications. Other people with type 2 diabetes were placed into a nonresponder group. Researchers compared all participant data with a control group of people without diabetes.
Researchers used MRI to assess pancreas size and volume, intrapancreatic fat content and irregularities of the border. The Stepped Insulin Secretion Test with Arginine was used to measure insulin secretion.
The diabetes group had a smaller mean pancreas volume at baseline (63.8 cm3 vs. 79.8 cm3; P < .0001) compared with the control group. At 5 months after weight loss, the volume remained unchanged for both responders and nonresponders. At 24 months, however, responders experienced a mean pancreas volume increase of 12.6 cm3 vs. an increase of 4.5 cm3 for nonresponders (P < .0001). Even at 24 months, Taylor noted responders still had a smaller pancreas volume than the control group.
“Perhaps (the responders’ pancreas volume) increase continues beyond the 24 months,” Taylor said during the presentation. “Further studies will be required to see if this, in fact, correct.”
Participants with diabetes also had a more irregular pancreas border at baseline compared with people without diabetes (fractal dimension, 1.116 vs. 1.097; P < .0001). After 24 months, the diabetes group had a normalized pancreas border.
Five months after weight loss, responders had a mean 0.11 nmol/mL per minute increase in first phase insulin secretion (P < .0001). The increase was maintained at 24 months after weight loss.
Responders lost more intrapancreatic fat during the study period than nonresponders (1.56% vs. 0.51%; P < .05). Both responders and nonresponders had increased insulin-like growth factor I levels and decreased fibroblast growth factor-21 levels after weight loss, but only the responder group had a decrease in plasma growth differentiation factor-15 levels.
“This study provides dramatic evidence that remission of type 2 diabetes is not just ‘diabetes well controlled by diet,’” Taylor said. “The main clinical implication is that people with type 2 diabetes should be told that they have a potentially reversible condition — and the choice is theirs. We have devised a simple way of losing the required weight, but this still requires considerable motivation.”
Future research could examine whether pancreas scans could help predict a future type 2 diabetes diagnosis and what causes the pancreas to shrink, Taylor said, adding that a longer-term study could look at what happens with the pancreas among people with type 2 diabetes who maintain weight loss.
“All our present information suggests these people have long-term remission of type 2 diabetes and scanning studies of these people will be of great interest,” Taylor said.
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Taylor R, et al. Remission of type 2 diabetes with return of insulin secretory function restores normal pancreas morphology. Presented at: European Association for the Study of Diabetes Annual Meeting; Sept. 21-25, 2020 (virtual meeting).
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