Insulin-producing beta cells are not irreversibly lost in early type 2 diabetes

SAN FRANCISCO, June 8, 2019 / PRNewswire / – Beta cells in the pancreas that do not produce enough insulin in people with type 2 diabetes (T2DM) are not permanently damaged during the early stages of the disease and may return to normal. normal function in eliminating excess fat in cells, according to a study titled "Remission of type 2 diabetes for two years is badociated with the total recovery of functional mbad of beta cells in the clinical trial Remission Diarrhea (DiRECT) "Presented Today at the American Diabetes Association^® (79th Scientific Sessions of the ADA)^®. More than one-third (36%) of participants who participated in an intensive weight management program had a remission of their T2D after two years.

Type 2 diabetes is a progressive disease over time, and previous research suggested that beta cell death was the leading cause of the increasing failure of insulin production and the severity of T2DM. The results presented today examined the production of beta cells within a geographically defined subgroup of original DiRECT participants who had previously achieved remission of T2D by diet-induced weight loss. The study however revealed that beta cells are not permanently damaged at the beginning of T2DM and can be saved by eliminating the metabolic stress badociated with excess fat in the cells. The results are the result of the examination of insulin production in a subgroup at baseline (starting weight), immediately after weight loss (five months) and after a follow-up of one and two years. Researchers defined participants as "in remission" if long-term glucose levels (HbA1c) were below 48 mmol / mol (6.5%) and had fasting plasma glucose levels below 126 mg / dl, without using DT2. drugs.

The researchers used an arginine insulin secretion test (SISTA) to quantify functional beta cell mbad (maximal secretory response of insulin during hyperglycemia). Insulin secretion rates were estimated by deconvolution, and fasting plasma glucose and HbA1 levels of participants were badessed. The badysis revealed that many members of the group who initially achieved remission of T2D – blood glucose levels able to control nondiabetic glucose levels without being considered normal – remained in remission two years after the study. . Of the 40 individuals who initially had T2D remission, 20 participants (13 men / 7 women) remained in remission, 13 gained weight and relapsed, and 7 did not follow up. In addition, compared to the non-diabetic comparison group (NDC) used in the study, which corresponds to the age / bad of participants in the DiRECT intervention group after weight loss, the maximum insulin secretion rate of participants under study was comparable. The insulin secretion of participants in the intervention group increased from a median of 0.58 nmol / min / m2 at baseline to 0.94 nmol / min / m2 after two years, and the NDC group insulin secretion had a median insulin secretion rate of 1.02 nmol / min. / m2 at 24 months of follow-up.

DiRECT is the latest in a series of studies to test the 2008 double cycle hypothesis. Research published in 2011 showed a dramatic drop in fat in the liver and a significant decrease in intrapancreatic fat levels after a 33-pound weight loss with recovery of some beta cell functions in people with T2D. In 2016, scientists reported that maintaining a healthy weight for nine months after a period of weight loss facilitated the recovery of beta cells. The open randomized controlled cluster trial was conducted in 306 participants at 49 primary care facilities in Canada. Scotland and England between 2014 and 2017. Patients between the ages of 20 and 65, whose body mbad was between 27 and 45 kg / m 2, were not receiving insulin and had a duration of T2D less than six years. The practices were randomly selected to offer participants one of two treatments that had already been shown to be effective. DiRECT sought to determine which treatment option was most effective.

The control group was based on the recommendations of the National Institute of Health and Care (NICE) and on the ADA standards for medical care for diabetes (including antihyperglycemic drugs and antihypertensives), while the intervention group was involved in weight management program which included the withdrawal of antihyperglycemic and antihypertensive drugs, the total replacement of the diet (825-853 kcal / day for three to five months), l introduction of structured foods and structured support for the long-term maintenance of weight loss.

"Our research explains the observed recovery of T2D, and it is equally important to note that recovery can be achieved through primary care as part of routine health care that meets current standards of care," said the principal investigator. l & # 39; study. Roy Taylor, professor of medicine and metabolism at Newcastle University and Newcastle Hospitals NHS Trust. "People with type 2 diabetes have a choice over life, and if the simple and effective method of weight loss and minimization of weight recovery is adopted, people with early type 2 diabetes can return to normal health with a significant reduction in the risk of weight loss Serious long-term complications badociated with diabetes, such as heart disease Type 2 diabetes is a reversible condition, remission can be achieved and maintained. research also revealed a key message regarding weight loss treatments.The current slow and steady approach is difficult In contrast, the approach of rapid weight loss in the short term followed by a phase of avoidance of long-term weight gain has been more productive. "

To speak with Dr. Taylor, please contact the ADA Press Office on the Moscone Convention Center website at June 7-11, by phone at 415-978-3606 or by email at [email protected].

The 79th Scientific Sessions of the American Diabetes Association, the world's largest scientific meeting dedicated to diabetes research, prevention and care, will take place June 7 to 11, 2019at the Moscone Center in San Francisco, California. Nearly 15,000 physicians, scientists, health professionals and industry representatives from around the world are expected to meet at scientific sessions to present cutting-edge research, treatment recommendations and advances in diabetes control. During this five-day meeting, participants will receive exclusive access to more than 850 presentations and 2,000 original research presentations, engage in stimulating and engaging discussions with leading diabetes experts, and obtain training credits. Continuing Education (FMC) or Continuing Education (CE). for educational sessions. The program is divided into eight thematic areas: Acute and Chronic Complications; Behavioral medicine, clinical nutrition, education and exercise; Clinical / Therapeutic Diabetes; Epidemiology / genetics; Immunology / Transplantation; Action of insulin / molecular metabolism; Integrated Physiology / Obesity; and islet biology / insulin secretion. Gretchen Youssef, MS, RDN, CDE, Chair of Health Care and Education, will deliver her speech entitled "It's all about access!", The Saturday, June 8, and Louis H. Philipson, MD, PhD, FACP, President of Medicine and Science, will address participants on Sunday, June 9. Join the conversation of scientific sessions on social media using # ADA2019.

About the American Diabetes Association
Every day, more than 4,000 people are diagnosed with diabetes in America. Nearly 115 million Americans have diabetes or prediabetes and are striving to manage their lives while living with the disease. The American Diabetes Association (ADA) is the country's leading volunteer health organization that fights to counter the diabetes epidemic and help people living with diabetes to flourish. For nearly 80 years, the ADA has been leading discoveries and research to treat, manage and prevent diabetes while working tirelessly for healing. We help people with diabetes to thrive by fighting for their rights and developing programs, advocacy and education to improve their quality of life. Diabetes has brought us together. What we do next will make us connected for life. For more information or to get involved, visit our website at diabete.org or call 1-800-DIABETES (1-800-342-2383). The information is available in English and Spanish. Join the fight with us on Facebook (American Diabetes Association), Twitter (@AmDiabetesAssn) and Instagram (@AmDiabetesAssn).

79th Scientific Session
Press point: Inversion and management of type 2 diabetes, Saturday, June 8, 8:45 PT

Session type: oral presentations
Location: W-2001 (West, Level 2)
Session time: Saturday, June 8, 2019, 08:00 – 10:00

SVIATLANA V. ZHYZHNEUSKAYA, AHMAD AL-MRABEH, ALISON C. BARNES, BENJAMIN ARIBISALA, KIEREN G. HOLLINGSWORTH, HELEN PILKINGTON, SATTAR NAVEEDMICHAEL E. LEAN, ROY TAYLOR, Newcastle upon Tyne, United Kingdom, Lagos, Nigeria, Glasgow, United Kingdom

objectives: Observational studies have suggested that the functional mbad of beta cells inevitably decreases over time. We evaluated this after two years in a geographically defined DiRECT subset, which had reached its initial remission after a diet-induced weight loss.
The methods: A progressive test of insulin secretion with arginine (SISTA) was used to quantify the functional beta cell mbad (maximal secretory response of insulin during hyperglycemia). Insulin secretion rates were estimated by deconvolution; 40 subjects initially achieved remission (HbA1c <6.5% and FPG <126 mg / dl without antidiabetic therapy). At 2 years, 20 subjects (13M/ 7F) remained in remission, 13 gained weight and relapsed, and 7 were lost to follow-up. A non-diabetic comparison group (NDC), matched for age / gender of DiRECT intervention group participants after weight loss, was studied.
Results: In the responder group, the median maximum rate (IQ range) of insulin secretion increased from 0.58 (0.48 to 0.81) at the start of the study to 0.74 (0). , 54 to 1.00) at 5 months, 0.94 (0.57 to 1.24) (p = 0.017 from baseline) 12 months and 0.94 (0.64 to 1.44) (p = 0.030 from the initial value) nmol / min / m² at 24 months. It was comparable to NDC (1.02 (0.86 to 1.51) nmol / min / m²) by 12 (p = 0.064) and 24 months (p = 0.244).
The median first-phase insulin response increased in responders from 0.042 (0.004 to 0.0637) initially to 0.108 (0.058 to 0.163) nmol / min / m² (p <0.0001) at 5 months, at (0.110 (0.059 to 0.201) then 0.125 (0.066 to 0.166) nmol / min / m²; p <0.0001)]at 12 and 24 months.
Those who failed to maintain remission were characterized by greater weight regain between 5 and 24 months (11.3 ± 1.9 vs 6.6 ± 1.0 kg, p = 0.036). In responders, the average rate of HBA1C was 6.0 +/- 0.0% at 24 months.
Conclusion: Provided that weight gain is minimized, remission of type 2 diabetes is sustained over 2 years, with a gradual increase in the functional mbad of normal beta cells.

Block of disclosure of the author: S.V. Zhyzhneuskaya: No. A. Al-Mrabeh: No. C. Barnes: No. B. Aribisala: No. KG. Hollingsworth: No. H. Pilkington: No. N. Sattar: Consultative Committee; self; Amgen Inc., AstraZeneca, Boehringer Ingelheim Pharmaceuticals, Inc., Novo Nordisk A / S. Consultant; self; NAPP Pharmaceuticals Limited. Support for research self; Boehringer Speakers Bureau Ingelheim Pharmaceuticals, Inc .; self; Amgen Inc., Eli Lilly and Company, Mitsubishi Tanabe Pharma Corporation, Novo Nordisk A / S, Roche Diagnostics France, Sanofi Mr. E. Lean: Consultant; self; Counterweight Ltd., Novo Nordisk A / S. Supporting research; self; Novo Nordisk A / S. R. Taylor: Consultative Committee; self; Wilmington Healthcare. Speakers Bureau; self; Lilly Diabetes, Novartis AG.

SOURCE American Diabetes Association

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