Type 2 Diabetes Remission Tied To Reversal Of Abnormal Pancreas Morphology

People with type 2 diabetes who achieve remission following a weight management intervention may also experience reversal of abnormal pancreas morphology, a small study suggests.

Researchers examined data on 90 people with type 2 diabetes who were randomly assigned to a weight management intervention (n=64) or usual diabetes care (n=26), as well as for a control group of individuals without type 2 diabetes (n=25). Mean pancreas volume at baseline was 61.7 cubic centimeters (cm3) among the participants with type 2 diabetes and 79.8 cm3 among the nondiabetic controls.

At 24 months, researchers assessed pancreas morphology for 32 "responders," who had type 2 diabetes at baseline and achieved remission after weight loss, as well as 13 "non-responders," who had type 2 diabetes but didn’t achieve remission. At this point in time, pancreas volume increased by 9.4 cm3 in responders, compared with 6.4 cm3 in non-responders.

In addition, pancreas borders at baseline were more irregular among participants with type 2 diabetes than among nondiabetic controls (fractal dimension 1.138 v 1.097). But at 24 months, pancreas borders for responders were similar to those of nondiabetic controls (fractal dimension 1.099).

"This effect can be sustained as long as body weight is maintained," said lead study author Ahmad Al-Mrabeh of the Translational and Clinical Research Institute and Newcastle Magnetic Resonance Centre at Newcastle University in the UK.

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"We have people who remain free of diabetes for over 10 years after reversal; there is no reason why this cannot continue longer," Al-Mrabeh said by email.

At baseline, responders and non-responders differed in the duration of diabetes (mean 2.7 years v 3.8 years), HOMA2-IR (1.86% v 1.33%), and fasting insulin (pmol/L 85.0 v 65.6).

Intrapancreatic fat was similar between responders and nonresponders at baseline (8.7% v 7.8%) and higher among participants with type 2 diabetes than among the nondiabetic controls (6.2%). At 24 months, intrapancreatic fat decreased by 1.02 percentage points among responders and by 0.51 percentage points among nonresponders, but still remained higher than in nondiabetic controls.

One limitation of the study is that the gradual change in pancreas morphology suggests that a longer follow-up period might be needed to fully assess the impact of type 2 diabetes remission on the pancreas, the study team notes in Lancet Diabetes & Endocrinology.

Even so, the study results suggest that some changes in pancreas morphology may occur not just for people who achieve remission, but also for those who don’t, said Sheri Colberg, a professor emerita at Old Dominion University in Norfolk, Virginia, who wasn’t involved in the study.

"It is well known that a diabetes reversal is easier to achieve early in the disease and becomes more difficult over time, perhaps due to loss of pancreatic beta cells and other factors," Colberg said by email. "Based on their observations, it appears that weight loss will have clinically meaningful outcomes on pancreatic morphology even if blood glucose levels do not return to normal."

—Lisa Rapaport

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