Erratum. Very Low-Calorie Diet and 6 Months of Weight Stability in Type 2 Diabetes: Pathophysiological Changes in Responders and Nonresponders. Diabetes Care 2016;39:808–815

Aims/hypothesisThis study was designed to establish whether the low volume and irregular border of the pancreas in type 2 diabetes would be normalised after reversal of diabetes.MethodsA total of 29 individuals with type 2 diabetes undertook a very low energy (very low calorie) diet for 8 weeks followed by weight maintenance for 6 months. Methods were established to quantify the pancreas volume and degree of irregularity of the pancreas border. Three-dimensional volume-rendering and fractal dimension (FD) analysis of the MRI-acquired images were employed, as was three-point Dixon imaging to quantify the fat content.ResultsThere was no change in pancreas volume 6 months after reversal of diabetes compared with baseline (52.0 ± 4.9 cm3 and 51.4 ± 4.5 cm3, respectively; p = 0.69), nor was any volumetric change observed in the non-responders. There was an inverse relationship between the volume and fat content of the pancreas in the total study population (r =−0.50, p = 0.006). Reversal of diabetes was associated with an increase in irregularity of the pancreas borders between baseline and 8 weeks (FD 1.143 ± 0.013 and 1.169 ± 0.006, respectively; p = 0.05), followed by a decrease at 6 months (1.130 ± 0.012, p = 0.006). On the other hand, no changes in FD were seen in the non-reversed group.Conclusions/interpretationRestoration of normal insulin secretion did not increase the subnormal pancreas volume over 6 months in the study population. A significant change in irregularity of the pancreas borders occurred after acute weight loss only after reversal of diabetes. Pancreas morphology in type 2 diabetes may be prognostically important, and its relationship to change in beta cell function requires further study.Electronic supplementary materialThe online version of this article (doi:10.1007/s00125-016-3984-6) contains peer-reviewed but unedited supplementary material, which is available to authorised users.

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Morphology of the pancreas in type 2 diabetes: effect of weight loss with or without normalisation of insulin secretory capacity

Al‐Mrabeh

Hollingsworth

Steven

et al. 2016

Diabetologia

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Liver triacylglycerol content and gestational diabetes: effects of moderate energy restriction

et al. 2016

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Aims/hypothesis Women with a history of gestational diabetes mellitus (GDM) have raised liver triacylglycerol. Restriction of energy intake in type 2 diabetes can normalise glucose control and liver triacylglycerol concentration but it is not known whether similar benefits could be achieved in GDM. The aim of this work was to examine liver triacylglycerol accumulation in women with GDM and the effect of modest energy restriction. Methods Sixteen women with GDM followed a 4 week diet (5 MJ [1200 kcal]/day). Liver triacylglycerol, before and after diet and postpartum, was measured by magnetic resonance. Insulin secretion and sensitivity were assessed before and after diet. Twenty-six women who underwent standard antenatal care for GDM (matched for age, BMI, parity and ethnicity) were used as a comparator group.Results Fourteen women, who completed the study, achieved a weight loss of 1.6 ± 1.7 kg over the 4 week dietary period. Mean weight change was −0.4 kg/week in the study group vs +0.3 kg/week in the comparator group (p = 0.002). Liver triacylglycerol level was normal but decreased following diet (3.7% [interquartile range, IQR 1.2-6.1%] vs 1.8% .1%], p = 0.004). There was no change in insulin sensitivity or production. Insulin was required in six comparator women vs none in the study group (eight vs two required metformin). Blood glucose control was similar for both groups. The hypo-energetic diet was well accepted. Conclusions/interpretation Liver triacylglycerol in women with GDM was not elevated, unlike observations in nonpregnant women with a history of GDM. A 4 week hypoenergetic diet resulted in weight loss, reduced liver triacylglycerol and minimised pharmacotherapy. The underlying pathophysiology of glucose metabolism appeared unchanged.

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Pathogenesis and remission of type 2 diabetes: what has the twin cycle hypothesis taught us?

Al‐Mrabeh

2020

Cardiovascular Endocrinology &Amp; Metabolism

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Type 2 diabetes has been regarded a complex multifactorial disease that lead to serious health complications including high cardiovascular risks. The twin cycle hypothesis postulated that both hepatic insulin resistance and dysfunction rather than death of beta (β) cell determine diabetes onset. Several studies were carried out to test this hypothesis, and all demonstrated that chronic excess calorie intake and ectopic fat accumulation within the liver and pancreas are fundamental to the development of this disease. However, these recent research advances cannot determine the exact cause of this disease. In this review, the major factors that contribute to the pathogenesis and remission of type 2 diabetes will be outlined. Importantly, the effect of disordered lipid metabolism, characterized by altered hepatic triglyceride export will be discussed. Additionally, the observed changes in pancreas morphology in type 2 diabetes will be highlighted and discussed in relation to β cell function.

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Erratum. Very Low-Calorie Diet and 6 Months of Weight Stability in Type 2 Diabetes: Pathophysiological Changes in Responders and Nonresponders. Diabetes Care 2016;39:808–815

Cited by 8 publications

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Morphology of the pancreas in type 2 diabetes: effect of weight loss with or without normalisation of insulin secretory capacity

Morphology of the pancreas in type 2 diabetes: effect of weight loss with or without normalisation of insulin secretory capacity

Liver triacylglycerol content and gestational diabetes: effects of moderate energy restriction

Pathogenesis and remission of type 2 diabetes: what has the twin cycle hypothesis taught us?

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