“Reversal of Type 2 Diabetes,” published online in Diabetologia 09 June 2011, was the
subject of last week’s blog (#88) here. In the
course of doing “due diligence,” my brilliant on-line editor, found a companion
piece in Diabetic Medicine: a Journal of the British Diabetic Association dated
2013 January 15 by two of the authors, E. L Lim and R. Taylor, plus S. Steven,
also of Newcastle. It is titled, “Population Response to Information on
Reversibility of Type 2 Diabetes.” She also found a related link that
particularly impressed me: One of the authors of both papers, R. Taylor, presented
“The 2012 Banting Lecture” at the American Diabetes Association annual meeting.
His subject: “Reversing the Twin Cycles of Type 2 Diabetes,” the very same
stuff! The lecture is given by the winner of the Banting Medal for Scientific Achievement Award, the highest
scientific award of the American Diabetes Association. About finding
this current paper, my editor commented: “I mostly
wanted to see what areas of expertise these authors had…! I think (they) are on
to something important and also wanted to see what they were up to currently.
There's an ongoing effort to shorten the time between research and clinical
practice. So their reporting on people trying out their ideas was especially
interesting to me. In the med world, this is pretty fast turnaround.” What
a consummate professional my editor is!
How lucky I am to have her!
"Population response to information on reversibility of Type 2 diabetes."
Source
Magnetic
Resonance Centre, Institute of Cellular Medicine, Newcastle University,
Newcastle upon, Tyne, UK.
Abstract
AIMS:
Following
publication of the Counterpoint Study (on the reversibility of Type 2 diabetes
using a very low energy diet), the extent of public interest prompted the
authors to make available, on a website, general information about reversing
diabetes. Shortly thereafter, individuals began to feed back their personal
experiences of attempting to reverse their diabetes. We have collated this
information on the effects of energy restriction in motivated individuals with
Type 2 diabetes that has been achieved outside a research setting.
METHODS:
Emails,
letters and telephone communications received between July 2011 and September
2012 were evaluated (n = 77: 66 men, 11 women). Median diabetes duration was
5.5 years (3 months-28 years). Reversal of diabetes was defined as achieving
fasting capillary blood glucose < 6.1 mmol/l and/or, if available, HbA(1c)
less than 43 mmol/mol (6.1%) off treatment.
RESULTS:
Self-reported
weight fell from 96.7 ± 17.5 kg at baseline to 81.9 ± 14.8 kg after weight loss
(P < 0.001). Self-reported fasting blood glucose levels fell from 8.3 mmol/l
(5.9-33.0) to 5.5 mmol/l (4.0-10.0) after the weight loss period (P <
0.001). Diabetes reversal was considered to have occurred in 61% of the
population. Reversal of diabetes was observed in 80, 63 and 53% of those with
> 20, 10-20 and < 10 kg weight loss, respectively. There was a
significant correlation between degree of weight loss and reported fasting
glucose levels (Rs -0.38, P = 0.006). Reversal rates according to diabetes
duration were: short (< 4 years) = 73%, medium (4-8 years) = 56% and long
(> 8 years) = 43%.
CONCLUSION:
These
data demonstrate that intentional weight loss achieved at home by
health-motivated individuals can reverse Type 2 diabetes. Diabetes reversal
should be a goal in the management of Type 2 diabetes. © 2013 The Authors, Diabetic
Medicine © 2013 Diabetes UK.
"The 2012 Banting Lecture
Reversing the twin cycles of Type 2 diabetes."
Source
Magnetic
Resonance Centre, Newcastle University, Newcastle upon Tyne, UK.
Abstract
It has
become widely accepted that type 2 diabetes is inevitably life-long, with
irreversible and progressive beta cell damage. However, the restoration of
normal glucose metabolism within days after bariatric surgery in the majority
of people with type 2 diabetes disproves this concept. There is now no doubt
that this reversal of diabetes depends upon the sudden and profound decrease in
food intake, and does not relate to any direct surgical effect. The
Counterpoint study demonstrated that normal glucose levels and normal beta cell
function could be restored by a very low calorie diet alone. Novel magnetic
resonance methods were applied to measure intra-organ fat. The results showed
two different time courses: a) resolution of hepatic insulin sensitivity within
days along with a rapid fall in liver fat and normalization of fasting glucose
levels; and b) return of normal beta cell insulin secretion over weeks in step
with a fall in pancreas fat. Now that it has been possible to observe the
pathophysiological events during reversal of type 2 diabetes, the reverse time
course of events which determine the onset of the condition can be identified.
The twin cycle hypothesis postulates that chronic calorie excess leads to
accumulation of liver fat with eventual spill over into the pancreas. These
self-reinforcing cycles between liver and pancreas eventually cause metabolic
inhibition of insulin secretion after meals and onset of hyperglycaemia. It is
now clear that Type 2 diabetes is a reversible condition of intra-organ fat
excess to which some people are more susceptible than others. © 2012 The
Authors. Diabetic Medicine © 2012 Diabetes. (link to full text here)
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