The findings, published in December 2019 in Cell Metabolism, suggest that individuals with type 2 diabetes who achieve remission after weight loss may relapse if they regain weight in part because this leads to an accumulation of fat in the liver. Researchers examined data on 57 overweight and obese people with type 2 diabetes who participated in a prior study, which was published in March 2019 in The Lancet Diabetes & Endocrinology. Those study authors’ goal was to see if following a low-calorie diet for three to six months would help participants lose at least 15 kilograms (about 33 pounds) and lower their blood sugar levels enough to achieve remission of diabetes. Researchers checked participants’ weight, blood sugar, and fat levels in the liver and pancreas after 5, 12, and 24 months. After five months, 28 people achieved the targeted weight loss and diabetes remission. By the end of two years, however, 13 of them had relapsed. People who achieved lasting remission lost more weight initially, kept more weight off than those who relapsed, and had less fat in the liver and pancreas by the end of the study. “Excess calorie intake over many years will initiate vicious cycles of fat accumulation within both the liver and the pancreas that eventually causes diabetes,” says lead study author Ahmad Al-Mrabeh, PhD, of Newcastle University in the England. “Decreasing liver fat can lead to remission of diabetes,” Dr. Al-Mrabeh says. When you do, he adds, “the liver stops sending out excess fat to the rest of the body, and therefore pancreas fat levels decrease.” RELATED: Study Suggests How Much Weight Loss Is Needed to Put Diabetes in Remission
The Relationship Between Weight and Type 2 Diabetes
Type 2 diabetes is a multifactorial disease, with genetics and lifestyle both contributing to risk. The disease is also associated with obesity and inactivity, and develops when the body can’t effectively use the hormone insulin to regulate blood sugar, according to the World Health Organization. The pancreas produces insulin, and must increase production when the body doesn’t use this hormone efficiently. Yet there’s a limit to how much insulin the pancreas can make, and diabetes results when the pancreas can no longer keep up with the body’s insulin demands to keep blood sugar levels in check. Left untreated, type 2 diabetes can increase the risk of kidney failure, heart attacks, strokes, blindness, lower limb amputations, and other potentially life-threatening complications. Regular exercise, eating well, and maintaining a healthy weight can help prevent type 2 diabetes. These lifestyle habits can also help lower blood sugar and minimize complications when people do develop diabetes, according to the World Health Organization. While weight loss has long been linked to diabetes remission, the current study offers fresh insight into how the two are related, says senior study author Roy Taylor, MD, also of Newcastle University. When people cut calories, the body will get the energy it needs by burning up fat that’s stored under the skin, Dr. Taylor says. By contrast, when people consume too much food, these fat stores fill up and then excess fat starts accumulating in the liver. “Excess liver fat will lead to higher supply of fat to all tissues, including the pancreas,” Taylor says. When fat builds up in the pancreas, this interferes with insulin production, making it harder for the body to regulate blood sugar and contributing to diabetes. When people achieve diabetes remission through weight loss, regaining weight can restart the process of fat accumulation in the liver, and then the pancreas, and lead to relapse, according to the study. RELATED: Which Types of Diabetes Can Be Put in Remission?
Sustained Remission Leads to Lower Levels of Pancreatic Fat
At the start of the study, all of the participants tended to have higher A1Cs. A1C is a blood test used to diagnose diabetes and determine how well blood sugar is being controlled. It shows the percentage of hemoglobin (a molecule on red blood cells) that is coated with sugar, and reflects average blood sugar levels over two to three months. Readings above 6.5 signal diabetes, according to the Mayo Clinic. People who never achieved remission in the study started out with more severe diabetes, with average A1C readings of 7.9, compared with average A1C readings of 7.4 among people who did experience remission. Weight loss initially brought about similar reductions in the percentage of fat in the liver and pancreas for people who achieved diabetes remission, as well as for those who didn’t. After five months, people in remission had 3.4 percent liver fat compared with 2.6 percent in people who didn’t achieve remission — but this difference wasn’t statistically meaningful. Participants also experienced similar decreases in fat levels in the pancreas after five months: a decline of 0.91 percentage points among people who went into remission and 0.17 points for those who didn’t. This difference also wasn’t statistically meaningful. By the end of the two-year follow up period, though, pancreatic fat levels had dropped by 1.65 percentage points among people with sustained remission and only 0.51 percentage points among those who didn’t. One limitation of the study is that it was small, and researchers based their two-year analysis on only 20 people who sustained remission and 13 people who relapsed. It’s also not clear from the study whether people took medication for diabetes, what they ate, or how much they exercised — factors that can influence whether people achieve remission. “It would have been helpful if the study included more information about how weight loss was accomplished,” says Sheri R. Colberg, PhD, professor emerita of exercise science at Old Dominion University in Norfolk, Virginia. RELATED: 6 Great Exercises for People With Diabetes
What the Study Suggests About Weight Loss and Type 2 Diabetes
“The most important message is that people have to do whatever they can with their lifestyle to improve their insulin sensitivity,” says Dr. Colberg, who wasn’t involved in the study. Insulin sensitivity refers to how efficiently the body can use the hormone to convert sugars into energy. “Dietary restriction can help with this — and insulin resistance decreases even before significant weight loss — but weight regain is very common,” Colberg adds. Both a low-carb diet and consistent workouts can help people with diabetes lose weight and lower blood sugar, she says. But many people who rely on diet alone to maintain weight loss regain many of the pounds they lose, Colberg says. Exercisers, on the other hand, can keep weight off when they continue to be active. “Physical activity is likely the most important way to keep muscles insulin sensitive and to avoid excess carbs being converted into fat and stored in the liver and pancreas,” Colberg says. RELATED: 7 Exercise Motivation Tips for People With Type 2 Diabetes
