Prior to developing into type 2 diabetes, prediabetes raises the risk of heart attack, kidney, eye, and other cancers. There isn’t a recognized pharmacological therapy for prediabetes at the moment. Researchers at the German Center for Diabetes Research (DZD) have now demonstrated the mechanisms by which prediabetes can be put into remission, or a condition in which blood glucose levels return to normal. The DZD multicenter trial further demonstrates that long-term improvement in renal and vascular function is linked to long-term protection against type 2 diabetes and prediabetes remission. The researchers write in The Lancet diabetic & Endocrinology that it’s interesting because the underlying mechanisms are distinct from those in type 2 diabetic remission.
People with type 2 diabetes are more likely to experience heart attacks, renal problems, strokes, and death. Up until a few years ago, type 2 diabetes was believed to be untreatable. We now understand that significant weight loss can significantly reduce the risk of type 2 diabetes in a large number of people. The majority of people often develop type 2 diabetes once more within a few years, therefore this remission rarely lasts. Due to their higher risk of developing type 2 diabetes as well as issues with the heart, kidneys, and eyes, among other things, people with prediabetes may need to know this.
But what triggers the remission of prediabetes? In order to answer this query, researchers from the Department of Diabetology, Endocrinology, and Nephrology at the University Hospital of Tübingen and the Institute of Diabetes Research and Metabolic Diseases (IDM) at Helmholtz Munich performed a post-hoc analysis on participants with prediabetes from the Prediabetes Lifestyle Intervention Study (PLIS).
In a one-year lifestyle intervention involving a balanced diet and more exercise, 1,105 people with prediabetes participated in this randomized-controlled multicenter trial run by the DZD. The 298 participants who had lost at least 5% of their body weight as a result of the intervention were next evaluated by the researchers. Participants who had responded were those whose fasting, 2-hour, and HbA1c levels had returned to normal after a year, indicating that they had entered remission. Non-responders were people who lost weight but still had prediabetes and did not go into remission.
Contrary to what the researchers had hypothesized, there was no difference in relative weight loss between responders and non-responders, indicating that it was not weight loss that separated those who entered remission from those who did not. Individuals who were able to attain remission, as opposed to non-responders, showed a noticeable improvement in insulin sensitivity. In essence, they were better able to increase their sensitivity to the hormone insulin, which decreases blood glucose levels, than those who did not respond. The amount of insulin secreted did not change in either group, though. This distinction is important since type 2 diabetes remission mostly rely on increased insulin secretion.
The researchers compared the two groups in order to pinpoint the reason behind responders’ elevated insulin sensitivity. Despite reducing the same amount of body weight, the responders had reduced their abdomen fat more than the non-responders. The intestines are encircled by visceral abdominal fat, which is situated inside the abdominal cavity. An inflammatory response in adipose tissue is partly responsible for its effect on insulin sensitivity.
In fact, those subjects who achieved remission also had lower blood levels of inflammatory proteins. “Since the responders showed a reduction in abdominal fat in particular, it will be important in the future to identify the factors that promote the loss of this fat depot,” says Arvid Sandforth, one of the two primary authors. Surprisingly, the reduction of liver fat, which is a significant risk factor for the onset of diabetes, did not differ between the two groups. Even two years after the conclusion of the lifestyle intervention, the chance of acquiring type 2 diabetes was reduced by 73% in those who achieved remission. Additionally, they displayed fewer indicators of renal injury and improved blood vessel health.
To delay the emergence of type 2 diabetes, prediabetes is currently treated with weight loss and lifestyle changes, but without glucose-based objectives to direct the treatment process. The new analysis from the DZD closes this gap: Remission should be the new therapeutic goal for persons with prediabetes, according to the newly available evidence. According to co-first author Prof. Dr. Reiner Jumpertz-von Schwartzenberg, this could alter treatment strategies and reduce the risk of complications for our patients.The study found that remission in prediabetes is defined as a fasting blood glucose level of less than 100 mg/dl (5.6 mmol/l), a 2-hour glucose level of less than 140 mg/dl (7.8 mmol/l), and a HbA1c level of less than 5.7 percent. When body weight is decreased and waist circumference shrinks by at least 4 cm in women and 7 cm in men, the likelihood of remission rises. According to researchers, these characteristics can now be applied as biomarkers.
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