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How Can Obesity Care Reverse Type 2 Diabetes?

Many publications lately have documented the possibility for obesity care and resulting weight loss to reverse type 2 diabetes. But it’s hardly a sure thing. So the question remains, how does this happen in some patients and not in others?

A new study in Cell Metabolism offers some clues.

Digging into Diabetes Remissions

Late last year in Lancet, investigators created quite a stir with a study that showed remissions of type 2 diabetes were possible in a bit less than half of patients receiving intensive weight management. Other studies have shown that bariatric surgery can reverse type 2 diabetes.

But the benefit is not 100%. Intensive treatment does not reverse type 2 diabetes in every patient. Even with bariatric surgery, remission rates aren’t much higher than 50%.

So the obvious question is what distinguishes patients who enjoy a reversal of their type 2 diabetes.

Earlier Disease, Beta Cell Function

With a detailed metabolic study of some of the patients in the Lancet study, Roy Taylor and colleagues found two clues for better outcomes. Fat in the liver and the pancreas declined in responders and non-responders alike. But they found two important differences.

First, the responders had been living with type 2 diabetes for a shorter time. Their disease duration averaged 2.7 years, compared to 3.8 years for the non-responders. This confirms the impression of many clinicians that early interventions offer the best outcomes.

The second difference was pancreatic beta cell function. The patients with diabetes remissions were the ones who quickly saw improvements in the insulin response of beta cells in the pancreas. In those responders, that improvement in beta cell function persisted, even after 12 months.

These are important clues that challenge notions about type 2 diabetes. The findings suggest that lost beta cell function can be reversed in some patients. Further research to understand how may well lead to further advances.

With continued growth of obesity and type 2 obesity prevalence, we need those advances.

Click here for the study and here for more from Medscape.

Reverse Lens Macro, photograph © Kevin Fai / flickr

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August 3, 2018