Researchers See Type 2 Diabetes Develop for the First Time
Researchers have seen type 2 diabetes (T2D) develop for the first time. A study published this month in Cell Metabolism shows excess fat that spills over from the liver into the pancreas may cause T2D. Type 2 diabetes has long known to be a progressive disease caused by a number of factors, and is characterized as insulin resistance. In other words, the pancreas can’t produce enough insulin or one’s body can’t use insulin properly.
Led by Professor Roy Taylor of Newcastle University in the UK, the study involved individuals who had type 2 diabetes, and reversed the condition due to weight loss in the Diabetes UK-funded DiRECT Trial. Throughout the two-year study, the majority of them were able to remain at normal, non-diabetic blood glucose levels, while others who regained the weight re-developed type 2 diabetes.
Taylor explains the pathway to return of type 2 diabetes after weight gain:
“We saw that when a person accumulates too much fat, which should be stored under the skin, then it has to go elsewhere in the body,” said Taylor. “The amount that can be stored under the skin varies from person to person, indicating a ‘personal fat threshold’ above which fat can cause mischief.”
“When fat cannot be safely stored under the skin, it is then stored inside the liver and over-spills to the rest of the body including the pancreas,” he added. “This ‘clogs up’ the pancreas, switching off the genes which direct how insulin should effectively be produced, and this causes type 2 diabetes.”
In the DiRECT trial, participants lost weight by eating a low-calorie diet and had the support to maintain the weight loss. A quarter of the participants had lost 15 kg (33 pounds) or more. Nearly 9 out of 10 people were able to put their type 2 diabetes in remission. After two years, more than one-third of the group had been diabetes-free and were off all medications.
This research supports Professor Taylor’s Twin Cycle Hypothesis: Type 2 diabetes is caused by excess fat in the liver and pancreas, and that this process is reversible. At the 2017 EASD Conference in Lisbon, the professor presented his Twin Cycle research that highlighted this pathway, as well as that losing less than 1 gram of fat from the pancreas can re-start normal insulin production and reversal remains possible for at least 10 years after the onset of the condition.
In regards to this recent study, Taylor says the sooner one begins the process of losing fat, the more likely remission is possible. “This means we can now see type 2 diabetes as a simple condition where the individual has accumulated more fat than they can cope with,” said Taylor. “Importantly this means that through diet and persistence, patients are able to lose the fat and potentially reverse their diabetes. The sooner this is done after diagnosis, the more likely it is that remission can be achieved.”
In 2020, the NHS plans to pilot the same weight loss plan for up to 5,000 people in England, with a similar program to debut in Scotland. Taylor and his team are continuing to study what may affect an individual’s personal threshold for fat and are supportive of the NHS initiatives in England and Scotland.
Beyond Type 2 will update this story as developments are made.