Everyone has a ’personal fat threshold’ that, if exceeded, will allow the development of type 2 diabetes (T2D), even if they are of normal or lower body weight.
Having a BMI over 30 is a risk factor for T2D and landmark research from the University of Newcastle previously showed how and why an intensive weight loss program can put T2D into remission in people living with obesity. or overweight.
But not all people with T2D are overweight. About 15% of T2D diagnoses occur in people of normal weight, and the condition is generally assumed to have a different cause in those cases.
The ReTUNE (Reversing Type 2 Diabetes on Normalizing Energy Intake in the Nonobese ) study looked at whether weight loss can also reverse the condition in people with a BMI in the "normal" range or just above him (BMI below 27 kg/ m2).
This would support the idea that each of us has a "personal fat threshold" , a level of body fat that we can handle, and if we exceed it, we will develop T2D, even if our weight appears normal.
Twenty men and women with T2D (average BMI 24.8 kg/m2, average age 59.0 years) participated in the study, which was funded by Diabetes UK. They followed a weight loss program in which they consumed 800 calories a day (from low-calorie soups, smoothies and non-starchy vegetables) for two weeks, followed by four to six weeks in which they kept their new weight stable. They completed up to three rounds of this weight maintenance/diet cycle until they lost 10-15% of their body weight.
Their results at the end of the study were compared with those of a control group: 20 people without diabetes matched by age, sex and BMI.
Fourteen of the 20 participants (70%) with type 2 diabetes went into remission, a proportion similar to previous studies involving participants living with type 2 diabetes and overweight and obesity. Remission consisted of an HbA1c (average blood sugar level) of less than 48 mmol/mol for at least 6 months and without any medication . Participants had lost an average of 7.7 kg in remission (10.7% of baseline weight). Weight remained stable between 6 and 12 months.
The average BMI fell from 24.8 to 22.4 and total body fat fell from 32.1% to 27.7%. (Matched to the control group of people without diabetes who had an average BMI of 21.5 and 24.6% total body fat).
Special MRI scans showed that fat levels within the liver and pancreas were substantially reduced. Although the average amount of fat in the liver of study participants would be considered normal at 4.1%, this figure was around three times higher than in healthy controls of the same weight and was reduced to 1. 4%, close to the healthy control level. Fat in the pancreas fell from an average of 5.8% to 4.3% and the activity of insulin-producing cells returned to normal.
The researchers say their results clearly demonstrate that T2D is caused by the same factors in people of normal weight as in those living with overweight or obesity. This is important because doctors tend to assume that type 2 diabetes has a different cause in people with lower body weight and therefore they are generally not advised to lose weight before starting diabetes medications and, eventually, insulin.
“But if they lost around 10% of their weight, they would have a good chance of putting their type 2 diabetes into remission,” says Professor Roy Taylor, of the University of Newcastle, Newcastle, UK, the trial’s principal investigator.
The results should also help dispel the stigma that can be attached to a T2D diagnosis, Professor Taylor says. He explains: “The results also support the personal fat threshold concept that anyone with type 2 diabetes has a little more fat on board than they can individually handle. This is determined by your genes . Each of us has a threshold level below which we can safely store fat and this has little to do with BMI. “If you develop type 2 diabetes, you simply have more fat inside your body than you can handle, even if you appear thin.
“This excess fat spills into the liver and pancreas, stopping normal function and causing type 2 diabetes. You only need half a gram of extra fat in the pancreas to prevent normal insulin production. I am often asked, "Why do I have type 2 diabetes when all my friends are older than me and don’t have diabetes?" The present work answers this enigma.
“This should help remove some of the stigma associated with type 2 diabetes. It is clearly a condition that is not ’caused’ by being above any BMI level, but by storing too much fat within the liver and pancreas, regardless of His weight .
Researchers recommend that anyone who has someone with T2D in their family get their blood sugar checked every year, regardless of their weight. Regular check-ups are also recommended for anyone who has had diabetes during pregnancy or who is not of white European ethnicity.
This press release is based on the 255th oral presentation at the annual meeting of the European Association for the Study of Diabetes (EASD). The material has been peer reviewed by the conference selection committee. There is no complete document at this stage.
