EASD2021 Can you reverse type 2 diabetes?

hello again now for some time there's been a whisper well actually not so much a whisper more like a raw that diabetes can be reversed through dramatic weight loss not everyone agrees and it's a contentious area amongst diabetologists so to bring together some various opinions on this we have professor roy taylor from the university of newcastle and professor michael nauk from the raw uh hello to both of you hello hello so roy this is your particular bag and uh in the uk we're very familiar with uh roy taylor because he's been saying it's very much been in the headlines all this week that if you can't fit into the trousers that you were wearing when you were 21 then you are potentially at risk of diabetes so roy you're very clear on this just tell us more yes just to clarify that message that's been carried by newspaper headlines newspapers tend to pick up things perhaps in an improper context for people who have type 2 diabetes but they've got a normal or near normal bmi they can get rid of it but let me wind back to the start of this story because this is 2006 when we finally got all our information on hepatic insulin sensitivity and uh what happened to liver fat and suddenly all the pieces of jigsaw dropped into place i was able to draw up the twin cycle hypothesis of the cause of type 2 diabetes which was published in diabetes in 2008 and of course it's no good having a hypothesis you've got to go out and try and destroy it and so we set up an acid test for this we took a group of people with very ordinary type 2 diabetes and put them on a low-calorie diet specifically designed to be practical and acceptable it turned out that it was and the average weight loss was exactly what i had wished for which is 15 kilograms and lo and behold all the predictions of the twin cycle hypothesis came true liver fat fell to normal from very high levels the fat export from the liver fell and it stopped silting up in the ectopic sites one of which is inside the pancreas now we've known for a long time that in vitro if you expose insulin producing cells beta cells to excess fat chronically then they will begin to lose their ability to treat insulin so the counterpoint study set things on the map but in order to test the hypothesis we'd only studied people in the first four years of type 2 diabetes and to condense the next decade of research rapidly we've been able to show that it's duration dependent after 10 years following diagnosis the chance of getting full remission is relatively small we've been able to confirm the mechanisms repeatedly including the most contentious part of the mechanism involving the pancreas and we're now in the position of being able to say yes this approach to weight loss is so simple it can be rolled out in primary care for everybody not by doctors but by the nurses it's so simple the snag is keeping the weight off long term now we can lose weight rapidly people tell us it's much easier than the long term bit but even so in our direct study at two years 36 were still free of diabetes and even in that short study there was a major signal that cardiovascular disease was less certainly new cancers were dramatically reduced and put together that was a significant reduction in overall risk to health so at two years yes that's big news so why don't you stop there having just outlined where we've come from which is testing ideas and then probing them with cutting-edge methods uh to look inside the body to see what happens michael would you like to respond to that because is it about the amount of weight loss or the percentage of weight loss and can it be sustained well the sustainability issue is is the difficult part as roy has just uh mentioned uh because many people succeed in in reducing their body weight acutely let's say for for three months or so but of course we don't want the benefits of weight loss just for a short period of time so we aim at diabetes remission uh for as much time as we can achieve maybe i should add that there is another way of inducing such major weight loss and that is bariatric surgery uh so gastric bypass sleeve gastrectomy different procedures and they really can achieve major weight loss minus 20 percent plus which usually persists for a very long time and usually in those who undergo this surgery with pre-existing type 2 diabetes often experience diabetes remission so remission is possible but as roy says that you know this is weight loss that can be uh patients can be assisted with their weight loss by a nurse rather than a doctor or a surgical procedure is obviously a big advantage but i think you take your message further wouldn't you roy that actually you really need to be getting hold of people at a time of life when they might be tipping into type dive two diabetes and that's the time to get them that's the time when you can make most difference yes that's absolutely right although we need to be quite realistic here in order to take action and go down the dietary road to uh substantial weight loss about 15 kilograms for most people then people have to be motivated to do it now the diagnosis of pre-diabetes that's a very useful form of words because that conveys to people yes that this disease that they know might there is a risk to eyesight might pose a risk to limb premature death it's a bad sounding number people will respond at that level now the work that i've presented at easd this week is very pertinent here because it deals with people who look as though they're slim well we can tell them they're not slim because they've got to have normal amounts of fat inside the liver interestingly if you compare it with the population norm it doesn't look too bad but if you compare it appropriately with people in the same range of bmi then it's about two and a half times raised and we see with weight loss in this group now this group only need 10 kilograms weight loss first of all they get back to the waist size that they had when they were 21 that's where the strap line comes from and secondly the diabetes goes away and goes away well in three-quarter in two-thirds of the group that we've studied so far we have identified some people with monogenic diabetes one person with slow onset type one we've got to be very careful with diagnosis in this group so yes for younger people and bear in mind that the decade in which the greatest weight gain occurs throughout life is in the 20s this is a potent message so we could put into a little little packet if you like if you've got a family history of diabetes make sure that you don't put on weight beyond the age of 21 that would be a very sound message that i hope michael would agree with i take entirely the point about other means of weight loss we've got exciting drugs on the horizon that might help us but bear in mind my work was directed towards understanding the mechanisms finding out what caused diabetes i believe we've done that but it's a matter of the application that we're now talking about and i think the application to young people is especially engaging michael i have to tell you that in in the uk when we saw all those headlines everybody i met said is anyone fitting into their trousers that they had when they were 21. so there was a there was a bit of kind of oh no we're all doomed uh going on so i i i i happen to know that roy is in the trousers that not in the same trousers obviously but he's in the trousers that he way size that he had when he was 21 but there's an awful lot of us that are that are not michael how do you feel about that well this is certainly not applicable to my bodyweight history and uh the the problem associated with this i think uh roy is exactly right that the the decade between uh 20 and 30 years is when you start putting on uh weight but who at this age would go to see a physician because he has put on three kilograms of of weight i think we have to raise the awareness and uh we have to design programs that uh make it possible that at that stage you can do something because you certainly need an intense program and if roy says physicians are probably not good for that it should be a nurse-based program that is because you need repeated encounters uh you will have to deal with disappointments and uh changes in body weight in the wrong direction and all these things so this uh is uh requires a lot of effort sorry come back roy could i could i comment there because uh that's really very important michael makes a really important point that people in their 20s have got things to do they don't want to be sitting in doctors waiting rooms no no no but this is not a message we want to have medicalized programs putting over we need to get it into the woodwork so that granny tells the young people you make sure you don't put on weight beyond when you finish growing malad now it's a matter of an apple a day keeps the doctor away it's getting the idea out into society now at the present time society is blithely unaware that it is not biologically necessary to put on weight beyond the early twenties there's no extra bone that's growing there's no extra brain that's growing unfortunately any extra weight gain sadly is fat or fatty tissue more strictly so we need to raise awareness gently in such a way that doesn't either drive people to uh foolish dieting and also doesn't cause undue uh worry but we have to try and normalize the matter of just keeping an eye on the weight to make sure that you don't increase in clothes size do you think we've established that i mean clearly we see it in with bariatric surgery do you think we've established that type 2 diabetes in its early stages is reversible because it seems to be something that is still pretty hotly contested by quite a number of um people in primary care i don't know whether uh whether that feeling is right throughout diabetes michael what's your thought on that well we need dedicated programs if if we just do things like we used to do them it will not happen so the direct study is a very good example of a dedicated team that really was very successful in making these type 2 diabetic patients lose weight and maintaining that weight loss for at least a period of one or two years and this gave us the idea to talk about diabetes remission because suddenly this happened and we didn't have a name for it but if you have diabetes and suddenly you have a normal hba1c and you have lost substantial body weight uh how are you going to call it and this gives the idea and it's an idea for the future so that hopefully more people will benefit from programs like this one with the aim of of putting an end to their diabetes well roy you've certainly put it on the front pages and people are much more aware of it we've been talking all throughout these sessions on esd tv about the importance of raising awareness of diabetes and absolutely this message that lose a lot of weight and you can put it into remission if it's early and the message to the about your trouser size that really has hit home so thank you to you both for coming to talk to us about this today it's very much appreciated pleasure thank you my pleasure there's more to come bye for now [Music]

Channel: European Association for the Study of Diabetes

Views: 14,616

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Id: LrYWe3TRTP0

Length: 14min 51sec (891 seconds)

Published: Wed Oct 06 2021