Diabetes remission restores normal pancreas

The shrunken, mis-shapen pancreas seen in people with type 2 diabetes is restored to normal shape following weight-loss induced remission of the condition, UK research has shown.

Using MRI scans to follow up participants in the DIabetes REmission Clinical Trial (DIRECT), investigators observed that pancreas volume increased in people with type 2 following a two-year weight loss program that resulted in restoration of normal insulin secretion.

The findings, published in Lancet Diabetes and Endocrinology, support the hypothesis that abnormal pancreas morphology is secondary to the disease process in type 2 rather than a risk factor for developing the condition, the study authors say.

Low-calorie diet

In their paper they note that pancreas volume is typically about 30% lower than normal in people with type 2 diabetes, with irregularity of shape.

Their study followed up 64 obese adults (BMI of 27–45 kg/m2) with type 2 who underwent a 3 to 5 month low-calorie diet followed by a supervised weight loss program and a matched group of 25 people who did not have diabetes who also took part in a similar program.

At baseline, mean pancreas volume was 61·7cm3 in all participants with type 2 diabetes and 79·8 cm3 in the non-diabetes control group. After 24 months, pancreas volume had increased by 9.4cm3 in responders compared with 6·4cm3 (in non-responders).

This represented an increase in volume of the irregular diabetic pancreas to 89% of that of the non-diabetic control group, the authors said.

Pancreas borders at baseline were more irregular in participants with T2D than in the non-diabetes control group, but normalised by 24 months in responders to the weight loss program.

“To our knowledge, this study is the first to show normalisation of the gross morphology of the pancreas in people with type 2 diabetes and underpins a frame-shift of understanding of the nature of type 2 diabetes,” the researchers wrote.

Australian type 2 remission research

“In people with established type 2 diabetes, long-term return to non-diabetic blood glucose control after weight loss is well documented but is not yet universally accepted. Concurrence of morphological and functional restoration of the pancreas provides a solid basis for the concept.

“These data show that type 2 diabetes is a potentially reversible disease affecting the whole pancreas with gradual morphological and functional recovery during remission,” they concluded.

Diabetes NSW & ACT is currently fundraising for the Australian T2 Remission Project. The purpose of the project is to show that an intensive, supported, weight-loss program can lead to remission of type 2, based on research in the UK called The DiRECT study.

Diabetes Queensland believes that if the same results are achieved in Australia, the treatment of type 2 diabetes and the long-term health of the country will be transformed.

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