Prediabetes Can Go Into Remission Without Weight Loss

A awesome caller study reveals that up to 1 successful 5 group pinch prediabetes tin return to normal humor sweetener without losing weight,  altering really doctors deliberation astir preventing type 2 diabetes.

Study: Prevention of type 2 glucosuria done prediabetes remission without weight loss. Image credit: Anna Rogalska/Shutterstock.com

In a caller Nature Medicine article, researchers investigated whether prediabetic individuals tin return to normal glucose regularisation without losing weight, a uncovering that could beryllium cardinal to preventing type 2 glucosuria (T2D). They recovered that prediabetes remission occurred contempt nary weight nonaccomplishment (often pinch flimsy weight gain), and was associated pinch healthier fat distribution, improved β-cell function, and enhanced insulin sensitivity.

Background

T2D affects complete 460 cardinal group worldwide and is simply a starring origin of decease owed to its complications, including neuropathy, cardiovascular disease, and chronic kidney disease. The world load of T2D is expected to summation substantially by 2050. Poor fare value is nan main driver, pinch nan top effect successful low- and middle-income countries pinch constricted curen access. Prevention strategies are basal to reducing nan worldwide load of T2D.

Prediabetes is simply a metabolic information successful which humor sweetener levels are higher than normal but not precocious capable to meet nan diagnostic criteria for type 2 glucosuria (T2D). It is typically defined by impaired glucose regulation, specified arsenic elevated fasting glucose, impaired glucose tolerance connected an oral glucose tolerance test, aliases accrued glycated hemoglobin (HbA1c), that falls beneath nan period utilized to diagnose diabetes.

It is nan astir important consequence facet for T2D. The yearly progression complaint is 5-10%, pinch a life consequence of up to ~74%. It besides independently increases nan consequence of vascular, cancer, and neurodegenerative diseases.

Previous investigation has shown that restoring normal glucose regulation, moreover temporarily, lowers nan consequence of processing T2D and related complications. The Prediabetes Lifestyle Intervention Study (PLIS) introduced nan conception of prediabetes remission. Remission is achieved erstwhile normal glucose levels are restored, often done weight loss. Such remission substantially lowers T2D consequence and related organ damage. This emphasizes nan value of glucose regularisation successful preventive strategies.

About nan Study

Researchers conducted a station hoc study of PLIS, a randomized, controlled, multicenter proceedings conducted successful Germany betwixt 2012 and 2016. Adults aged 18 to 75 years pinch prediabetes, defined by impaired fasting glucose and/or impaired glucose tolerance, were recruited. Participants were stratified by glucosuria consequence based connected insulin resistance, insulin secretion, and liver fat and past randomized to accepted aliases intensified manner involution aliases control.

This study included only participants who did not suffer weight complete 12 months. If glucose regularisation returned to normal, they were classified arsenic responders, and if it did not, they were classified arsenic non-responders.

Glucose metabolism was assessed by oral glucose tolerance tests (OGTT) pinch repeated humor sampling. Insulin, C-peptide, liver fat, visceral and subcutaneous fat, and musculus fat were measured utilizing standardized assays, MRI, aliases spectroscopy. Additional analyses included inflammatory markers, adipokines, incretins, and a visceral adipose insubstantial (VAT) polygenic consequence score, pinch nary important group differences observed. Lifestyle adherence was monitored done nutrient diaries, fittingness testing, and beingness activity assessments.

Findings were validated successful a 2nd cohort from nan U.S. Diabetes Prevention Program (DPP), focusing connected participants who besides did not suffer weight during nan first 12 months. Statistical analyses applied mixed-effects models and corrected for aggregate testing.

Key Findings

The study followed 1,105 individuals pinch prediabetes from nan PLIS. Among nan 234 participants who did not suffer weight (or moreover gained some) during nan 12-month program, 51 achieved remission while 183 did not. Notably, remission occurred independently of changes successful assemblage weight, assemblage composition, beingness activity, aliases aerobic fitness.

Responders showed chopped metabolic improvements. Their insulin sensitivity roseate significantly, while non-responders showed nary change. In addition, responders exhibited enhanced insulin secretion and amended β-cell function, changes not typically observed successful weight-loss–driven remission.

Body fat distribution besides differed: responders stored much fat successful subcutaneous adipose insubstantial (SCAT) while avoiding increases successful VAT, starring to a higher SCAT/VAT ratio. This healthier fat shape was linked pinch higher adiponectin levels, accordant pinch improved insulin sensitivity.

Other imaginable mechanisms, specified arsenic inflammation, liver fat accumulation, aliases familial predisposition, did not explicate remission. Notably, responders had improved glucagon regularisation and greater sensitivity of β-cells to glucagon-like peptide-1 (GLP-1), supporting amended glucose control. Over semipermanent follow-up, remission without weight nonaccomplishment lowered T2D consequence by ~71%, akin to weight-loss remission. The DPP confirmed these findings, strengthening their validity.

Conclusions

This study demonstrates that up to 22% of participants tin remit prediabetes without weight nonaccomplishment and provides beardown protection against T2D, comparable to weight-loss-induced remission. The cardinal facet appears to beryllium fat distribution: responders accumulated much subcutaneous than visceral fat, which was linked to greater insulin sensitivity, β-cell function, and improved GLP-1 sensitivity.

Exercise and dietary creation whitethorn person contributed to these favorable outcomes. The findings item nan request to grow objective guidelines beyond weight nonaccomplishment alone, emphasizing remission to normal glucose regularisation arsenic a superior prevention target.

Strengths see replication of results successful nan DPP cohort and elaborate metabolic profiling. Limitations are nan station hoc design, reliance connected surrogate OGTT measures, and imaginable residual confounding.

Overall, nan study underscores that metabolic wellness and glycemic remission, not weight nonaccomplishment alone, should guideline precision prevention strategies for T2D.

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