Type 2 diabetes remission is possible even in people with lower body weight

Credit: Nataliya Vaitkevich/ Pexels.

In a study from Newcastle University, scientists found everyone has a “personal fat threshold,” which if exceeded, will allow type 2 diabetes (T2D) to develop, even if they are of lower body weight.

The most common form of diabetes, T2D occurs when the pancreas can’t make enough insulin (a hormone that helps move the sugar in food into cells for energy) or the insulin it makes doesn’t work properly.

Research has previously shown how and why an intensive weight loss program can put T2D into remission in people who are living with obesity or overweight.

But not everyone with T2D is overweight. Around 15% of T2D diagnoses are in people with normal weight and it is generally assumed the condition has a different cause in such cases.

In the current study, researchers looked at whether weight loss can also reverse the condition in people with a BMI at or only just above the “normal” range (BMI below 27kg/m2).

This would support the idea that we each have a “personal fat threshold”—a level of body fat we can cope with—and if we go above it, we will develop T2D, even if our weight seems unremarkable.

They tested 20 men and women with T2D (average BMI 24.8kg/m2, average age 59.0 years).

They followed a weight loss program in which they consumed 800 calories a day (from low-calorie soups and shakes and non-starchy vegetables) for two weeks, followed by four to six weeks in which they kept their new weight steady.

They completed up to three rounds of this diet/weight maintenance cycle until they had lost 10–15% of their body weight.

Fourteen of the 20 participants (70%) with type 2 diabetes went into remission, a similar proportion to previous studies involving participants living with type 2 diabetes and overweight and obesity.

Remission is an HbA1c (average blood sugar level) of less than 48mmol/mol for at least 6 months and off all medication. Participants had lost an average of 7.7kg at remission (10.7% of initial weight).

Weight remained stable between 6 and 12 months. Average BMI fell from 24.8 to 22.4 and total body fat fell from 32.1% to 27.7%, matched to the control group of people without diabetes who had an average BMI of 21.5 and 24.6% total body fat.

Special MRI scans showed that levels of fat inside the liver and pancreas fell substantially.

Even though the average amount of fat in the liver of the study participants would be regarded as unremarkable at 4.1%, this was around three times higher than in healthy controls of the same weight and it fell to 1.4%, close to the healthy control level.

Fat in the pancreas fell from an average of 5.8% to 4.3% and the activity of the insulin-producing cells returned to normal.

The researchers say that their results clearly demonstrate that T2D is caused by the same factors in normal-weight people as it is in those living with overweight or obesity.

This is important because doctors tend to assume that T2D has a different cause in those with lower body weights and so they aren’t usually advised to lose weight before starting on diabetes drugs, and eventually insulin.

If you care about diabetes, please read studies about how to cure type 2 diabetes successfully, and this hormone may be a critical driver of diabetes.

For more information about COVID, please see recent studies about people who are more likely to get severe COVID-19 after vaccination, and results showing this existing drug can prevent COVID death.

The study was conducted by Professor Roy Taylor et al and presented at the annual meeting of the European Association for the Study of Diabetes.

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