Pancreatic fat loss may reverse type 2 diabetes

Weight loss is key to managing a number of chronic conditions, but a new study has determined that significant weight loss has a specific benefit for individuals with diabetes mellitus not seen in patients without the condition.

“Type 2 diabetes only develops when the body has accumulated more fat than it can cope with,” says Roy Taylor, BSc, MB ChB, MD, FRCP, FRCPE, professor of medicine and metabolism and director at the Newcastle Magnetic Resonance Centre at Newcastle University in the United Kingdom. “Everyone has a personal fat threshold above which they might develop the disease. It follows that everyone developing type 2 diabetes must lose substantial weight-even if BMI is normal. BMI is a population metric and should not be applied to individuals”

Using that theory, Taylor determined in a study published online in Diabetes Care that even one gram of weight loss-although that gram must consist of intrapancreatic triacylglycerol-can reverse diabetes.

“It is helpful to explain to people with type 2 diabetes that it is due to excess fat accumulating in the pancreas. At present, the only way to remove this is by substantial weight loss, after which the subcutaneous fat depot can accommodate the fat stores in a safe manner,” Taylor told Medical Economics. “The proportions of fat, carbohydrate, and protein eaten are relatively unimportant. Weight loss of around 15% must be achieved by whatever method suits the individual. No one size fits all. If a person loses 15% of body weight and blood glucose levels remain normal, then that person will remain free of diabetes for many years provided that they achieve steady weight. That requires continuing support.”

The study involved 18 individuals with type 2 diabetes and nine without who received gastric bypass surgery for obesity surgery. Weight, fat levels in the pancreas, and insulin response were measured before and after the surgery, and those participants with diabetes were found to have increased levels of fat in the pancreas.

Participants with diabetes were taken off their diabetic medications immediately after surgery, and tests were repeated eight weeks after the surgery. All the study participants lost about 13% of their body weight post-operatively, but the diabetics lost fat in the pancreas whereas participants who had not had diabetes did not. Taylor surmised that, as a result of the pancreatic fat loss, insulin secretion returned to normal levels, effectively reversing the development of type 2 diabetes in those patients as long as they maintained their diet.

Taylor cautions, however, that larger scale studies should be performed before universal application of his theory.

“On current information, it is reasonable for people very motivated to regain their lost health to take this approach. However, it should not yet be rolled out to be used for all patients with type 2 diabetes as the overall outcomes in the long term have not yet been defined,” Taylor says.

Taylor adds that the DiRECT study, which aims to identify specific biomarkers to aid in the development of new medications and therapies to treat type 2 diabetes, is currently underway in primary care and "will show whether the approach produces overall benefit or balance."