medwireNews: Outwardly lean people who have type 2 diabetes have increased intra-organ fat, reductions in which occur in line with weight loss-induced diabetes remission, say researchers.
Remission resulting from weight loss also led to marked improvements in multiple metabolic indices, with some, but not all, falling in line with those of people without type 2 diabetes.
The findings come from two studies presented at the virtual 57th EASD Annual Meeting by Roy Taylor (Newcastle University, UK) and Ahmad Al-Mrabeh (University of Edinburgh, UK), involving participants from the previously published DiRECT and the ongoing ReTUNE study.
In his presentation, Taylor emphasized the concept of a “personal fat threshold,” whereby “people who develop type 2 diabetes have stored more fat in their own body than their own body can manage,” irrespective of arbitrary BMI thresholds.
All DiRECT participants had BMIs of 27–45 kg/m2, but those with type 2 diabetes had average liver fat of around 15%, compared with around 5% in those without.
The ReTUNE study involves people with a BMI below 27 kg/m2; the 12 participants with type 2 diabetes had average liver fat of approximately 4.5%, which although lower than in the control DiRECT participants was significantly elevated compared with the 11 ReTUNE control participants, in whom it was just 2%.
It was the same for pancreatic fat, which was approximately 8% versus 6.5% in the DiRECT diabetes and control groups, respectively, and around 5% versus 3.5% in the corresponding ReTUNE groups.
Diet-induced weight loss resulted in significant reductions in liver fat in both the DiRECT and ReTUNE participants with diabetes, falling to levels similar to in the controls. Pancreatic fat also decreased significantly, although it remained above control levels.
Contrasting with the DiRECT design, the ReTUNE participants aimed to lose weight in three 8-week phases targeting weight loss of 5%, 10%, and 15% relative to baseline. But the approach was similar, involving an 800 calorie/day diet followed by food reintroduction and weight maintenance.
In preliminary findings, eight (67%) of the 12 participants achieved diabetes remission following 10% weight loss, which was similar to the 60% remission rate seen in DiRECT.
As reported by Al-Mrabeh, the ReTUNE participants also achieved normalization of fasting insulin and both fasting and postprandial triglycerides, and improvements in insulin sensitivity and beta-cell function.
Taylor concluded that the ReTUNE findings so far support the “personal fat threshold” model, a concept that he said is “very useful to explain to patients.”
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