EASD 2020 — Type 2 diabetes remission may reverse abnormal pancreas morphology


  • Pavankumar Kamat
  • Conference Reports
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Takeaway

  • Type 2 diabetes (T2D) remission achieved through a low-calorie, weight management program may restore the morphology of abnormal pancreas.

Why this matters

  • Although patients with T2D have abnormalities in volume and shape of the pancreas, it is not clearly known if the changes are the consequence or the cause of the condition.

Study design

  • Analysis of 64 patients with T2D from the DiRECT trial and 64 non-diabetic control individuals matched for age, weight, and sex.
  • Individuals with T2D were considered responders if they achieved an HbA1c
  • Funding: Diabetes UK.

Key results

  • Patients with T2D had a significantly smaller pancreatic volume at baseline compared with non-diabetic control individuals (average, 63.8 cm3 vs 79.8 cm3; P<.0001>
  • Regardless of the remission status, there was no variation in pancreatic volume between baseline and 5 months after weight loss.
  • However, at 24 months, the volume of the pancreas increased by 12.6 cm3 in responders vs 4.5 cm3 in non-responders (P<.0001>
  • Patients with T2D had significantly more irregular pancreatic borders compared with non-diabetic individuals (P<.0001>
  • However, at 24 months, the borders had normalized in responders, the difference with non-diabetic individuals being non-significant (P=.92).
  • Over the study duration, responders lost significantly more intra-pancreatic fat than non-responders (1.56% vs 0.51% reduction; P<.05>
  • At 5 months after the initial weight loss, there was a significant increase in first-phase insulin secretion from baseline only in responders (to 0.11 nmol/mL/minute; P<.0001 and was maintained at months.>

Limitations

  • Small sample size.

Expert commentary

Dr Elizabeth Robertson, Director of Research at Diabetes UK, said: "These new findings help to build a clearer picture of the biology behind remission, and how the health of the pancreas can be restored by weight loss."