DiRECTstudy
‘Rebooting’ insulin-producing cells key to Type 2 diabetes remission
Published on: 2 August 2018
A landmark trial has revealed further important insights into exactly how weight loss can put Type 2 diabetes into remission.
The research, led by Professor Roy Taylor at Newcastle University, suggests that for remission to be possible, insulin-producing beta cells in the pancreas need to recover and make the right amount of insulin again.
In their latest Diabetes UK-funded study, published in Cell Metabolism, researchers at Newcastle University explored exactly how weight loss can put Type 2 diabetes into remission, and why it might work for some people and not others.
DiRECT trial
The work was part of the Diabetes Remission Clinical Trial (DiRECT).
They measured levels of fat in the liver and pancreas, alongside other metabolic tests, in a subset of people taking part in DiRECT. They looked for differences between 29 ‘responders’ (people in remission) and 16 ‘non-responders’ (people not in remission) over 12 months.
Researchers found that the greatest difference between two groups lay within their insulin-producing beta cells.
After losing weight, the beta cells of people in remission started to work properly again, releasing the right amount of insulin the body needs. Their insulin production continued to improve over the course of the study.
There was no change in the amount of insulin being made by non-responders – their beta cells had not survived the stress of being surrounded by too much fat.
‘Responders’ had also lived with Type 2 diabetes for slightly less time, compared to ‘non-responders’ (average of 2.7 years vs. 3.8 years). Both groups lost a similar amount of weight - 16.2 kg for responders vs. 13.4 kg for non-responders - which was linked to a similar reduction and normalising of fat levels in their liver and pancreas.
Further evidence
These findings add evidence to the theory that shedding liver and pancreas fat is a vital component of putting Type 2 diabetes into remission.
Previous Diabetes UK supported research has shown that beta cells in Type 2 diabetes temporarily lose their ability to function normally. But can recover if stress from high levels of internal fat is removed.
Crucially, results from this latest study suggest that remission is then only possible if beta cells have the capacity to be ‘rebooted’. Researchers don’t yet know why beta cells are more likely to recover in some people than others, or how to identify those most likely to go into remission.
Professor Roy Taylor, Director of Newcastle University’s Magnet Resource Centre, said: “These results provide a dramatic window into the body, allowing us to see exactly what is happening as people change from having Type 2 diabetes to being healthy.”
DiRECT involves 298 people and is jointly led by Professor Taylor, of Newcastle University, and Professor Mike Lean, of the University of Glasgow. The study aims to test if a new weight management approach can put Type 2 diabetes into remission for the long-term.
The programme involves a low-calorie diet, reintroduction of healthy food, and long-term support to maintain weight loss. Initial findings in December 2017 revealed that almost half the participants (46%) receiving the programme were in remission after 12 months and not taking medication for diabetes.
Diabetes UK has committed more than £2.8 million to DiRECT. The trial is ongoing and researchers will continue to measure participants’ physiology, and investigate beta cell function, to understand more about the biology behind Type 2 diabetes remission.
Understanding exactly what happens inside the body when blood glucose levels return to normal could give important insights into the causes of Type 2 diabetes and how to prevent it.
Promising findings
Dr Elizabeth Robertson, Director of Research at Diabetes UK, said: “DiRECT has already provided evidence to suggest that some people can put their Type 2 diabetes into remission, but we didn’t yet know why.
“This latest study builds on these promising findings and helps us understand how weight loss can help some people to kick-start their insulin production again.
“DiRECT has the potential to transform the lives of millions of people and we’re looking forward to the second-year results as the trial continues.
“But we’re still waiting for all of the evidence, so it’s very important that anyone with Type 2 diabetes considering a low-calorie diet speaks to their diabetes healthcare professional first.”
Reference
Cell Matabolism. Doi: 10.1016/j.cmet.2018.07.003
Press release adapted with thanks to Diabetes UK
