NEWCASTLE UPON TYNE, UK. The reversal of type 2 diabetes must a priori involve normalizing pancreatic beta cell function and reversing insulin resistance. An interesting study was published in 2011 describing the impact of an 8 week severe calorie restriction protocol (600 cal per day) tested on 11 obese individuals. Pancreatic beta cell function was measured along with liver insulin sensitivity, insulin response, liver glucose output, and fasting blood glucose. In addition, MRI was used to determine both liver and pancreatic fat levels. These latter two measurements relate the impact of fat deposition on liver insulin sensitivity and pancreatic beta cell function.

After only 7 days, fasting blood glucose and liver insulin sensitivity normalized and liver fat decreased by 30%. Over 8 weeks, beta cell function increased toward normal and pancreatic fats decreased. Following the intervention, the participants gained back some of the weight lost over 12 weeks, but the HbA1C remained steady and the fat content of both the pancreas and liver did not increase.

The authors interpret these results as indicating that type 2 diabetes has a single common cause, excess fat accumulation in the liver and pancreas. They also emphasize that this study demonstrated for the first time the early time course during which liver fat stores and glucose production fall in response to a dietary restriction in type 2 diabetics. These results also emphasize the general picture provided earlier in this newsletter that diabetes is strongly related to fat storage driven by insulin. However, the long-term durability of this intervention remains in question and must depend on the post study diet. Thus the general principles outlined in the discussion of obesity should apply.

It is important to emphasize that current drug interventions for type 2 diabetes do not reverse diabetes and mostly appear to be totally ineffective if the concern is complications. As pharmacists who follow their clients long term are known to comment, diabetics just get worse while taking their pills but they are lowering their blood sugar.

Lim EL, Hollingsworth KG, Aribisala BS, Chen MJ, Mathers JC, Taylor R. Reversal of type 2 diabetes: normalisation of beta cell function in association with decreased pancreas and liver triacylglycerol. Diabetologia 2011 October;54(10):2506-14