Type 2 diabetes ‘reversible’ says leading prof at EASD
Speaking at the European Association for the Study of Diabetes, which has been taking place in Lisbon this week, Professor Roy Taylor, from Newcastle University, went through an overview of his findings gained from almost four decades studying the condition.
In the talk he highlighted how his he believed his work has confirmed his Twin Cycle Hypothesis – that type 2 diabetes is caused by excess fat actually within both the liver and pancreas.
He said that this causes the liver to respond poorly to insulin. As insulin controls the normal process of making glucose, the liver then produces too much glucose. Simultaneously, excess fat in the liver increases the normal process of export of fat to all tissues. In the pancreas, this excess fat causes the insulin producing cells to fail, according to Professor Taylor.
The Counterpoint study which was published in 2011, showed that if excess food intake was sharply decreased through a very low calorie diet, all these abnormal factors would be reversed.
Professor Taylor said the study showed a profound fall in liver fat content resulting in normalisation of hepatic insulin sensitivity within seven days of starting a very low calorie diet in people with type 2 diabetes. Fasting plasma glucose became normal in seven days. Over eight weeks, the raised pancreas fat content fell and normal first phase insulin secretion became re-established, with normal plasma glucose control.
Professor Taylor said: “The good news for people with type 2 diabetes is that our work shows that even if you have had the condition for 10 years, you are likely to be able to reverse it by moving that all important tiny amount of fat out of the pancreas. At present, this can only be done through substantial weight loss.”
The Counterbalance study published in 2016, demonstrated that Type 2 diabetes remains reversible for up to 10 years in most people, and also that the normal metabolism persists long term, as long as the person doesn’t regain the weight.
Professor Taylor explained the science behind the mechanisms: “Work in the lab has shown that the excess fat in the insulin producing cell causes loss of specialised function. The cells go into a survival mode, merely existing and not contributing to whole body wellbeing. Removal of the excess fat allows resumption of the specialised function of producing insulin. The observations of the clinical studies can now be fully explained.”
He added: “Surprisingly, it was observed that the diet devised as an experimental tool was actually liked by research participants. It was associated with no hunger and no tiredness in most people, but with rapidly increased wellbeing. The ‘One, Two’ approach used in the Counterbalance study was a defined two phase programme. The Phase 1 is the period of weight loss – calorie restriction without additional exercise. A carefully planned transition period leads to Phase 2 – long term supported weight maintenance by modest calorie restriction with increased daily physical activity.”
This approach consistently brings about 15kg of weight loss on average, he said.
After the details were posted on the Newcastle University website, this has been applied clinically and people who were highly motivated have reported that they have reversed their type 2 diabetes and continued to have normal glucose levels (normoglycaemic) over years.
A further study in general practice, the Diabetes Remission Clinical Trial (DiRECT) funded by Diabetes UK is now underway to determine the applicability of this general approach to routine Primary Care practice with findings due before the end of the year.
For more information about Professor Taylor’s work, click here.