Normalization of Functional β-Cell Capacity After Weight Loss in Type 2 Diabetes
abstract
This abstract is available on the publisher's site.
Access this abstract nowOBJECTIVE
To assess functional β-cell capacity in type 2 diabetes during 2 years of remission induced by dietary weight loss.
RESEARCH DESIGN AND METHODS
A Stepped Insulin Secretion Test with Arginine was used to quantify functional β-cell capacity by hyperglycemia and arginine stimulation. Thirty-nine of 57 participants initially achieved remission (HbA1c <6.5% [<48 mmol/mol] and fasting plasma glucose <7 mmol/L on no antidiabetic drug therapy) with a 16.4 ± 7.7 kg weight loss and were followed up with supportive advice on avoidance of weight regain. At 2 years, 20 participants remained in remission in the study. A nondiabetic control (NDC) group, matched for age, sex, and weight after weight loss with the intervention group, was studied once.
RESULTS
During remission, median (interquartile range) maximal rate of insulin secretion increased from 581 (480-811) pmol/min/m2 at baseline to 736 (542-998) pmol/min/m2 at 5 months, 942 (565-1,240) pmol/min/m2 at 12 months (P = 0.028 from baseline), and 936 (635-1,435) pmol/min/m2 at 24 months (P = 0.023 from baseline; n = 20 of 39 of those initially in remission). This was comparable to the NDC group (1,016 [857-1,507] pmol/min/m2) by 12 (P = 0.064) and 24 (P = 0.244) months. Median first-phase insulin response increased from baseline to 5 months (42 [4-67] to 107 [59-163] pmol/min/m2; P < 0.0001) and then remained stable at 12 and 24 months (110 [59-201] and 125 [65-166] pmol/min/m2, respectively; P < 0.0001 vs. baseline) but lower than that of the NDC group (250 [226-429] pmol/min/m2; P < 0.0001).
CONCLUSIONS
A gradual increase in assessed functional β-cell capacity occurred after weight loss, becoming similar to NDC participants by 12 months. This was unchanged at 2 years with continuing remission of type 2 diabetes.
Click on any of these tags to subscribe to Topic Alerts. Once subscribed, you can get a single, daily email any time PracticeUpdate publishes content on the topics that interest you.
Visit your Preferences and Settings section to Manage All Topic Alerts
Additional Info
Time Course of Normalization of Functional β-Cell Capacity in the Diabetes Remission Clinical Trial After Weight Loss in Type 2 Diabetes
Diabetes Care 2020 Feb 14;[EPub Ahead of Print], SV Zhyzhneuskaya, A Al-Mrabeh, C Peters, A Barnes, B Aribisala, KG Hollingsworth, A McConnachie, N Sattar, MEJ Lean, R TaylorFrom MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.
The Diabetes Remission Clinical Trial (DiRECT) highlighted the ability of a very low-calorie diet intervention to achieve significant weight loss and sustained diabetes remission off medication in over a third of participants at 24 months.1 In those with sustained remission (responders), first-phase and maximal insulin secretion increased and were maintained at 24 months. Although maximal insulin secretion reached values similar to those in nondiabetic controls, the first-phase insulin response remained impaired. Responders lost, on average, 16% of their weight at 5 months, with some weight regain over time. In contrast, insulin secretion did not change in nonresponders despite weight loss of 13.2%. Although measures of insulin secretion were not adjusted for the known modulating effect of insulin sensitivity,2 which likely changed during the study due to weight loss and regain, these results demonstrate that beta-cell dysfunction can be partially reversed in a subset of patients in response to an intensive dietary weight-loss program. Responders were characterized by lower HbA1c and a shorter duration of diabetes, features that may identify those more likely to go into remission. These results emphasize the potential benefits of this degree of weight loss on beta-cell function and provide a nonsurgical alternative to attain diabetes remission.
References