ADA 2019—Beta-cell function loss is not always permanent


  • Emily Willingham, PhD
  • Conference Reports
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Takeaway

  • Beta cells that lose function do not always stay permanently damaged in type 2 diabetes (T2D).
  • In the DiRECT trial, participants followed a weight-loss program intended to produce yields comparable to bariatric surgery, and more than a third had T2D remission after 2 years.

Why this matters

  • The authors said in a statement that the findings indicate the possibility of using primary care tools to achieve T2D remission. 
  • Findings vary from RISE (Restoring Insulin Secretion) Adult Medication Study, showing no persistence in beta-cell improvement following treatment withdrawal.

Key results

  • 40 people achieved remission; 20 stayed so at 2 years, 13 gained weight and had a relapse, and 7 were lost to follow-up.
  • Insulin secretion in the group almost doubled over the 2-year period, from 0.58 nmol/minute/m2 (95% CI, 0.48-0.81) to 0.94 nmol/minute/m2 (95% CI, 0.64-1.44).
  • Those who had remission did not, however, reach normal HbA1c, fasting blood glucose values.
  • Better outcomes seen with more weight loss.

Study design

  • The intervention involved a weight-management program with withdrawal from antihypertensives and antihyperglycemic drugs, diet replacement with 825-853 kcal/day for 3-5 months, and carefully structured food introduction and support for weight-loss maintenance.

Limitations

  • Conference presentation of non-peer-reviewed findings in a small study population.

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