Reversing diabetes: Visceral fat more important than overall weight

• Researchers have shown that for people with overweight or obesity, losing weight can reverse type 2 diabetes.

• In a small study, the team found that weight loss reversed type 2 diabetes in participants, even though their body mass index (BMI) was in a moderate range.

• The study authors believe that lowering levels of fat around the organs may be more important than lowering BMI.

In a small, preliminary study, researchers have found that people with type 2 diabetes who also have a BMI that falls within a moderate range can reverse their diabetes by losing weight.

The researchers reported their findings at the Annual Meeting of the European Association for the Study of Diabetes.

Type 2 diabetes

Type 2 diabetes is the most common form of diabetes, accounting for around 91.2% of diabetes cases in the United States.

The condition occurs when a person’s body does not produce enough insulin or if the insulin no longer works effectively. Insulin normally helps glucose enter the cells of the body. In the absence of insulin, glucose stays in the blood, where it can damage organs and tissues.

This means that a person with type 2 diabetes has an increased risk of several health issues, including stroke, heart disease, issues with their feet, kidney disease, dental issues, and bladder problems.

According to researchers writing in the journal Nutrients, scientists for a long time believed that type 2 diabetes was incurable, so they primarily focused on how people should manage symptoms of the condition.

However, evidence now suggests that if individuals who are overweight or have obesity achieve and maintain weight loss, they can reverse type 2 diabetes.

Weight loss without overweight?

In the present small, preliminary study, researchers have gone one step further and examined whether weight loss might reverse type 2 diabetes even in those whose weight falls within the moderate BMI range.

Medical News Today spoke with the study’s first author, Dr. Ahmad Al-Mrabeh, a Transitional Research Fellow at the Centre for Cardiovascular Science at Queen’s Medical Research Institute at the University of Edinburgh in the United Kingdom.

He explained that they decided to explore whether weight loss could be effective at reversing type 2 diabetes for people with moderate BMI after looking at the results of their previous research.

“We observed that the metabolic profile changed markedly after following a low calorie diet even when the change in body weight was […] minor. We, therefore, wanted to test whether inducing modest weight loss could achieve remission in those who are non-obese,” said Dr. Al-Mrabeh.

According to the principal investigator of the study, Prof. Roy Taylor, Director of the Newcastle Magnetic Resonance Centre at Newcastle University, U.K., “[o]ur previous research has shown that weight loss of 10–15% can achieve remission in people with type 2 diabetes who are overweight or obese.”

“Doctors tend to assume, however, that type 2 diabetes has a different cause in those who aren’t overweight. This means that, unlike those who are overweight, those who are of [moderate] weight aren’t usually advised to lose weight before being given diabetes drugs and insulin.”

“Instead, there’s a tendency to start them on insulin and other medication at a much earlier stage.”

“What we’ve shown is that if those of [moderate] weight lose 10-15% of their weight, they have a very good chance of getting rid of their diabetes.”

“This should be a wake-up call to doctors, and, with 1 in 10 of the 4.5 million people with type 2 diabetes in the U.K. of [moderate] weight at diagnosis, there is no time to be lost in getting the message across.”

 

– Prof. Taylor

Preliminary study

The study involved just 23 people. Of these, 12 individuals had a type 2 diabetes diagnosis with an average age of 58.3 years and an average BMI of 24.5. The remaining 11 did not have diabetes and were of similar age and BMI. This group acted as the control.

The Centers for Disease Control and Prevention (CDC) classify BMI scores of 18.5–24.9 as “healthy.”

All participants followed a low calorie diet for 2 weeks, consuming no more than 800 calories each day. The researchers then supported them to maintain their new weight for 4–6 weeks.

They completed this cycle two or three times until all participants had reduced their body weight by 10–15%.

The researchers measured each participants’ visceral fat and insulin sensitivity before, during, and after the study.

Remission in two-thirds

At the end of the study, the researchers matched the people with diabetes with control participants of the same age, sex, and BMI. The scientists found that the individuals with diabetes lost more than twice as much fat in their liver compared with the controls.

In the diabetes group, fat in the pancreas reduced from 5.1% to 4.5%. Also, their average triglyceride levels fell from 1.6 millimoles per liter to 1.0 millimoles per liter — a significant reduction similar to the control group.

Most significantly, two-thirds of the participants found that their type 2 diabetes went into remission and could stop taking their medication.

Prof. Taylor says that “[t]hese results, while preliminary, demonstrate very clearly that diabetes is not caused by obesity but by [carrying too much weight] for your own body. It’s due to having too much fat in your liver and pancreas, whatever your BMI.”

“In the liver, this excess fat prevents insulin from working normally. In the pancreas, it causes the beta cells to stop producing insulin.”

Dr. Al-Mrabeh said to MNT that the results may be reproducible in larger studies, “however, it is important to understand the mechanisms of excess fat buildup within these vital metabolic organs (liver and pancreas) in non-obese people.”

Speaking with MNT, Prof. Pål R. Njølstad, Leader of the Center for Diabetes Research at the University of Bergen, Norway, said that “[t]he findings are interesting and indicate that weight loss is also important in non-obese individuals with type 2 diabetes.”

Prof. Njølstad added that “[m]ore studies are needed with an increased number of study participants and increased time of follow up, in addition to investigating the effect of other factors, such as age, sex, and ethnicity.”

Dr. Al-Mrabeh said to MNT that he will continue developing the initial findings.

“I have recently moved to the University of Edinburgh to establish an independent research program looking into the mechanisms of how excess fat causes damage to the pancreas in type 2 diabetes. My aim is to dissect these mechanisms using both human and animal studies.”

Written by Timothy Huzar on September 30, 2021 — Fact checked by Jessica Beake, Ph.D.

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