Time course of normalization of functional β-cell capacity in the Diabetes Remission Clinical Trial after weight loss in type 2 diabetes

Zhyzhneuskaya, S. V., Al-Mrabeh, A., Peters, C., Barnes, A., Aribisala, B., Hollingsworth, K. G., McConnachie, A. , Sattar, N. , Lean, M. E.J. and Taylor, R. (2020) Time course of normalization of functional β-cell capacity in the Diabetes Remission Clinical Trial after weight loss in type 2 diabetes. Diabetes Care, 43(4), pp. 813-820. (doi: 10.2337/dc19-0371) (PMID:32060017)

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Abstract

Objective: To assess functional β-cell capacity in type 2 diabetes during 2 years of remission induced by dietary weight loss. Research Design and Methods: A Stepped Insulin Secretion Test with Arginine was used to quantify functional β-cell capacity by hyperglycemia and arginine stimulation. Thirty-nine of 57 participants initially achieved remission (HbA1c <6.5% [<48 mmol/mol] and fasting plasma glucose <7 mmol/L on no antidiabetic drug therapy) with a 16.4 ± 7.7 kg weight loss and were followed up with supportive advice on avoidance of weight regain. At 2 years, 20 participants remained in remission in the study. A nondiabetic control (NDC) group, matched for age, sex, and weight after weight loss with the intervention group, was studied once. Results: During remission, median (interquartile range) maximal rate of insulin secretion increased from 581 (480–811) pmol/min/m2 at baseline to 736 (542–998) pmol/min/m2 at 5 months, 942 (565–1,240) pmol/min/m2 at 12 months (P = 0.028 from baseline), and 936 (635–1,435) pmol/min/m2 at 24 months (P = 0.023 from baseline; n = 20 of 39 of those initially in remission). This was comparable to the NDC group (1,016 [857–1,507] pmol/min/m2) by 12 (P = 0.064) and 24 (P = 0.244) months. Median first-phase insulin response increased from baseline to 5 months (42 [4–67] to 107 [59–163] pmol/min/m2; P < 0.0001) and then remained stable at 12 and 24 months (110 [59–201] and 125 [65–166] pmol/min/m2, respectively; P < 0.0001 vs. baseline) but lower than that of the NDC group (250 [226–429] pmol/min/m2; P < 0.0001). Conclusions: A gradual increase in assessed functional β-cell capacity occurred after weight loss, becoming similar to NDC participants by 12 months. This was unchanged at 2 years with continuing remission of type 2 diabetes.

Item Type:Articles
Additional Information:This study was funded by Diabetes UK as a Strategic Research Initiative (award number 13/0004691) and was supported by facilities of the National Institute for Health Research Newcastle Biomedical Research Centre.
Status:Published
Refereed:Yes
Glasgow Author(s) Enlighten ID:McConnachie, Professor Alex and Lean, Professor Michael and Sattar, Professor Naveed
Authors: Zhyzhneuskaya, S. V., Al-Mrabeh, A., Peters, C., Barnes, A., Aribisala, B., Hollingsworth, K. G., McConnachie, A., Sattar, N., Lean, M. E.J., and Taylor, R.
College/School:College of Medical Veterinary and Life Sciences > Institute of Cardiovascular and Medical Sciences
College of Medical Veterinary and Life Sciences > Institute of Health and Wellbeing > Robertson Centre
College of Medical Veterinary and Life Sciences > School of Medicine, Dentistry & Nursing
Journal Name:Diabetes Care
Publisher:American Diabetes Association
ISSN:0149-5992
ISSN (Online):1935-5548
Published Online:14 February 2020
Copyright Holders:Copyright © 2020 by the American Diabetes Association
First Published:First published in Diabetes Care 43(4):813-820
Publisher Policy:Reproduced in accordance with the publisher copyright policy

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Project CodeAward NoProject NamePrincipal InvestigatorFunder's NameFunder RefLead Dept
190677Reversal of T2DM to normal glucose tolerance using non-surgical weight management with low-energy-liquid-diet and long-term maintenance, within routine NHS care.Michael LeanDiabetes UK (DIABETUK)13/0004691Med - Human Nutrition