Type 2 diabetes remission likely for adults with ‘healthy’ BMI and 10% weight loss

From healio.com

Adults with type 2 diabetes and a BMI of 21 kg/m² to 27 kg/m² have high likelihood of diabetes remission if they lose 10% of their starting weight, researchers reported.

“Type 2 diabetes is often considered to be ‘caused’ by a higher body mass index, and certainly there is a strong link between increasing weight, increasing BMI and the incidence of type 2 diabetes,” Alison C. Barnes, RD, lead research associate and dietitian at the Human Nutrition Research Centre at Newcastle University, Newcastle upon Tyne, U.K., said during a presentation at the European Association for the Study of Diabetes annual meeting. “However, if we look at the numbers, 15% of new diagnoses of type 2 diabetes are actually in people who have a BMI within that healthy range.”

Most adults with type 2 diabetes and a BMI of 21 kg/m² to 27 kg/m² achieve diabetes remission with 10% or more weight loss. Data were derived from Taylor R, et al. Abstract #255. Presented at: European Association for the Study of Diabetes Annual Meeting; Sept. 19-23, 2022; Stockholm (hybrid meeting).

Researchers enrolled 20 adults with type 2 diabetes (mean age, 59 years; 65% women) who were at or within the healthy BMI range who underwent up to three cycles of 5% weight loss using a low-calorie diet of 800 calories daily of formula meal replacements and low starch vegetables. Researchers compared weight loss results with those for 20 adults without type 2 diabetes who were matched by age, sex and BMI. Participants maintained their weight loss for 46 weeks.

Overall, participants with type 2 diabetes experienced an average weight loss of 7.7 kg, or 10.7%, of initial body weight. Participants reported feeling “better and satisfied” with their weight at the conclusion of the study, Barnes said. Researchers also noted that participants were able to maintain their weight loss between 6 and 12 months (24.8 vs. 22.4 kg/m²). Waist measurement and body fat were reduced to normal levels in men with type 2 diabetes but remained higher among women with type 2 diabetes compared with matched participants.

Seventy percent of participants achieved diabetes remission, which was similar to that observed in previous studies of adults with higher BMI, according to Barnes.

In addition, researchers observed a mechanism underlying diabetes remission involving reducing fat in the liver and pancreas. Baseline liver fat levels were 2.5 times higher among participants with type 2 diabetes than in the matched control group but reduced to less than 2% by 24 weeks. This was also observed in previous studies, Barnes said.

As fat volume in the liver and pancreas decreased, blood glucose levels decreased and insulin levels increased, according to Barnes. Fasting plasma glucose responded quickly with HbA1c improving from 54 mmol/mol to 46 mmol/mol at 12 months. Insulin secretion also improved but remained below that of the matched control group.

“Regardless of BMI, people who are diagnosed with type 2 diabetes simply have more fat inside their body than they can cope with. The positive message is that there is a good chance of remission for people with a BMI of below 27 [kg/m²] if they’re able to lose around 10% of their starting weight,” Barnes said. “This data can offer a frameshift in our thinking; to see weight loss as a valuable therapeutic option for people who are diagnosed with type 2 diabetes at lower BMI.” 

https://www.healio.com/news/endocrinology/20220930/type-2-diabetes-remission-likely-for-adults-with-healthy-bmi-and-10-weight-loss