Wednesday, May 15, 2019

Retrospective #89: “Reversal of Type 2 Diabetes” Revisited

Yesterday’s Retrospective #88, “Reversal of Type 2 Diabetes,” when it was originally published in 2013, prompted my brilliant editor to do a search on the Newcastle University authors, including corresponding editor, R. Taylor. And lo and behold, she found a companion piece in Diabetic Medicine, a Journal of the British Diabetic Association dated 2013 January 15, titled, “Population Response to Information on Reversibility of Type 2 Diabetes.”
She also discovered that R. Taylor presented the prestigious, “The Banting Lecture” at the American Diabetes Association 2012 annual meeting. His subject: “Reversing the Twin Cycles of Type 2 Diabetes,” was the very same material he presented in Diabetologia in 2011! The Banting Lecture is given annually by the winner of the Banting Medal for Scientific Achievement Award, the highest scientific award of the American Diabetes Association.
About how she found 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!  And how lucky I am to have her!
Below are verbatim extracts of the abstracts from the “Population Response…” and R. Taylor’s Banting Lecture.
Population response to information on reversibility of Type 2 diabetes.
Steven S, Lim EL, Taylor R.
Magnetic Resonance Centre, Institute of Cellular Medicine, Newcastle University, Newcastle upon, Tyne, UK.
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.
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.
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%.
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.
Taylor R.
Magnetic Resonance Centre, Newcastle University, Newcastle upon Tyne, UK.
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 showed 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 [is] possible to observe the pathophysiological events during reversal of type 2 diabetes, the reverse time course of events which determine the onset...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. 

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