How weight loss can reverse prediabetes: new study

A new study published in The Lancet Diabetes & Endocrinology journal has revealed the mechanisms of how weight loss can lead to remission of prediabetes, a condition that affects millions of people worldwide and increases the risk of developing type 2 diabetes and its complications.

What is prediabetes and how can it be reversed?

Prediabetes is a state of impaired glucose metabolism, where the blood sugar levels are higher than normal but not high enough to be diagnosed as diabetes. People with prediabetes have a higher risk of developing type 2 diabetes, heart disease, stroke, kidney disease, and eye problems.

The good news is that prediabetes can be reversed with lifestyle interventions, such as diet, exercise, and weight loss. Previous studies have shown that losing 5-10% of body weight can reduce the risk of progressing to type 2 diabetes by 50-70%. However, the underlying mechanisms of how weight loss affects glucose regulation are not fully understood.

What did the study find?

The study, led by researchers from Germany and the USA, analyzed data from two large randomized controlled trials: the Prediabetes Lifestyle Intervention Study (PLIS) and the Diabetes Prevention Program (DPP). Both trials involved participants with prediabetes who were assigned to either a standard or an intensified lifestyle intervention or a placebo or control group for 12 months. The lifestyle interventions aimed to achieve weight loss through dietary changes and physical activity.

How weight loss can reverse prediabetes: new study

The researchers compared the participants who achieved remission of prediabetes, defined as returning to normal fasting glucose, normal glucose tolerance, and normal HbA1c levels, with those who did not. They also measured various indicators of insulin sensitivity, insulin secretion, body fat distribution, and liver fat content.

The main findings of the study were:

  • Weight loss was the strongest predictor of prediabetes remission. Participants who lost at least 10% of their body weight within six months had a 90% chance of achieving remission, compared to those who lost less than 5%.
  • Weight loss improved insulin sensitivity in all tissues, especially in the liver and adipose tissue. This means that the body became more efficient at using glucose and lowering blood sugar levels.
  • Weight loss also increased insulin secretion in response to glucose stimulation. This means that the pancreas was able to produce more insulin when needed.
  • Weight loss reduced visceral adipose tissue (VAT), which is the fat that surrounds the internal organs and is associated with inflammation and metabolic disorders. VAT reduction was more pronounced in participants who received the intensified lifestyle intervention than those who received the standard intervention.
  • Weight loss reduced intrahepatic lipid (IHL) content, which is the fat that accumulates in the liver and causes fatty liver disease. IHL reduction was also more pronounced in participants who received the intensified lifestyle intervention than those who received the standard intervention.

What are the implications of the study?

The study provides new insights into the biological mechanisms of how weight loss can reverse prediabetes and prevent type 2 diabetes. It also highlights the importance of early intervention and achieving substantial weight loss within six months of diagnosis.

The study also suggests that different lifestyle interventions may have different effects on body fat distribution and liver fat content, which may influence glucose regulation. Therefore, personalized approaches may be needed to optimize weight loss outcomes for people with prediabetes.

The study authors conclude that “weight loss-induced remission should be considered as a therapeutic goal in people with prediabetes”.

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