The DiRECT principles: giving Type 2 diabetes remission programmes the best chance of success

Hopkins, M.; Taylor, Roy; Lean, Michael E. J.

doi:10.1111/dme.14126

Cited by 11 publications

(11 citation statements)

References 5 publications

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“…The beneficial effect of nutritional restriction and subsequent weight loss is a clear demonstration of the role that lipotoxicity plays on T2D development and progression [242]. In the DiRECT study, intensive nutritional intervention ameliorated T2D by resorption of ectopic lipid accumulation, particularly the pancreatic ones, was considered of paramount importance [243][244][245][246].…”

Section: Non-pharmacological Approachesmentioning

confidence: 99%

Lipotoxicity and Diabetic Nephropathy: Novel Mechanistic Insights and Therapeutic Opportunities

Opazo-Ríos

Mas

Marín-Royo

et al. 2020

IJMS

188

147

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Lipotoxicity is characterized by the ectopic accumulation of lipids in organs different from adipose tissue. Lipotoxicity is mainly associated with dysfunctional signaling and insulin resistance response in non-adipose tissue such as myocardium, pancreas, skeletal muscle, liver, and kidney. Serum lipid abnormalities and renal ectopic lipid accumulation have been associated with the development of kidney diseases, in particular diabetic nephropathy. Chronic hyperinsulinemia, often seen in type 2 diabetes, plays a crucial role in blood and liver lipid metabolism abnormalities, thus resulting in increased non-esterified fatty acids (NEFA). Excessive lipid accumulation alters cellular homeostasis and activates lipogenic and glycogenic cell-signaling pathways. Recent evidences indicate that both quantity and quality of lipids are involved in renal damage associated to lipotoxicity by activating inflammation, oxidative stress, mitochondrial dysfunction, and cell-death. The pathological effects of lipotoxicity have been observed in renal cells, thus promoting podocyte injury, tubular damage, mesangial proliferation, endothelial activation, and formation of macrophage-derived foam cells. Therefore, this review examines the recent preclinical and clinical research about the potentially harmful effects of lipids in the kidney, metabolic markers associated with these mechanisms, major signaling pathways affected, the causes of excessive lipid accumulation, and the types of lipids involved, as well as offers a comprehensive update of therapeutic strategies targeting lipotoxicity.

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Section: Non-pharmacological Approachesmentioning

confidence: 99%

Lipotoxicity and Diabetic Nephropathy: Novel Mechanistic Insights and Therapeutic Opportunities

Opazo-Ríos

Mas

Marín-Royo

et al. 2020

IJMS

188

147

View full text Add to dashboard Cite

show abstract

“…A growing number of clinical experts are discussing the concept of remission as a treatment goal, [13][14][15][16] inspired by the outcomes observed following weight loss, 17 fasting/fasting mimicking diets, 18 bariatric surgery, 19 and, more recently, intensive lifestyle modifications. 20 Given the current upwards trend in diabetes incidence, recognizing the need for sufficiently intensive lifestyle change in diabetes treatment is essential to advance solutions that treat the cause of disease and contain the spiraling cost 5 of diabetes management.…”

Section: • •mentioning

confidence: 99%

Type 2 Diabetes Remission and Lifestyle Medicine: A Position Statement From the American College of Lifestyle Medicine

Kelly

Karlsen

Steinke

2020

American Journal of Lifestyle Medicine

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Objectives. The present review represents the position of the American College of Lifestyle Medicine on type 2 diabetes (T2D) and remission treatment. Background. Research now reveals that sufficiently intensive lifestyle interventions can produce remission of T2D with similar success to bariatric surgery, but with substantially fewer untoward side effects. Methods. A literature review was conducted to examine lifestyle modifications targeting T2D remission, with most studies using a combination of blood glucose markers and treatment history. Results. There were notable differences in the dosing intensity of lifestyle interventions between therapeutic interventions and subtherapeutic interventions. Studies with therapeutic dosing typically used very low energy diets (600-1100 kcal/day) with a weighted mean remission rate of 49.4%, while studies with subtherapeutic dosing typically used more moderate caloric restrictions (reducing energy intake by 500-600 kcal/day) and the weighted mean remission rate was 6.9%. Conclusions. Remission should be the clinical goal in T2D treatment, using properly dosed intensive lifestyle interventions as a primary component of medical care for T2D patients.

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“…Current consensus supports the use of the term 'remission' and agrees that it should be limited to the context of type 2 diabetes [2]. Characteristics that favor remission, such as successful weight loss, short duration of diabetes and absence of complications, have also been identified [3]. The terms 'partial remission' or honeymoon are preferred for type 1 diabetes [4].…”

Section: Choice Of Wordsmentioning

confidence: 99%

What’s in a Name? Redefining Type 2 Diabetes Remission

Kalra

Singal²,

Lathia

2021

Diabetes Ther

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Diabetes remission is a concept that is marked by ample attention, but lack of unanimity. This opinion piece explores existing definitions of diabetes remission and proposes a contemporary and comprehensive framework to help define this clinical state. Type 2 diabetes remission is defined as a healthy clinical state characterized by achievement of HBA1c below the targeted level, maintained for at least 6 months, with or without continued use of lifestyle modification and/or metformin, provided that this is not due to complications, comorbid conditions or concomitant therapy. Diabetes Remission: Infographic

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The DiRECT principles: giving Type 2 diabetes remission programmes the best chance of success

Cited by 11 publications

References 5 publications

Lipotoxicity and Diabetic Nephropathy: Novel Mechanistic Insights and Therapeutic Opportunities

Lipotoxicity and Diabetic Nephropathy: Novel Mechanistic Insights and Therapeutic Opportunities

Type 2 Diabetes Remission and Lifestyle Medicine: A Position Statement From the American College of Lifestyle Medicine

What’s in a Name? Redefining Type 2 Diabetes Remission

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