Insulin sensitivity: Lifestyle changes can stop condition developing into type 2 diabetes

A recent study has revealed how enhancing sensitivity to insulin through lifestyle intervention can put prediabetes into remission.

Scientists at the German Center for Diabetes Research (DZD) investigated how and why people with prediabetes can enter remission, meaning their blood glucose levels go back to normal.

Remission from prediabetes was found to protect against developing type 2 diabetes and lower the risk of developing kidney and vascular issues.

The condition prediabetes comes before developing type 2 diabetes and increased the likelihood of suffering a heart attack, kidney and eye disease and numerous cancers.

There is no drug therapy that is currently approved to treat the condition.

The risk of heart attacks, kidney disease and strokes are greater for people with type 2 diabetes, and there is an overall greater mortality risk. Many people with type 2 diabetes can enter remission through weight loss yet these people in remission typically develop type 2 diabetes again within two years.

Senior author Professor Dr Andreas Birkenfeld said: “We aimed to explore the feasibility of commencing earlier and implementing preventive measures already at a stage that precedes type 2 diabetes, namely prediabetes, with the aim of reversing it.”

Professor Dr Andreas Birkenfeld is Medical Director of Medical Clinic IV at Tübingen University Hospital, and Director of the Institute for Diabetes Research and Metabolic Diseases of Helmholtz Munich at the University of Tübingen.

The randomised-controlled trial involved 1,105 participants with prediabetes who were put on a healthy diet and upped their physical activity. After a year, 298 participants lost at least 5% of their weight.

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These 298 participants were then organised into responders and non-responders. Responders had entered remission as their fasting blood glucose, two-hour glucose and HbA1c levels had returned to normal. Non-responders still had prediabetes.

Evidently, weight loss was not the factor that determined whether people entered remission or not as there was no difference in weight loss for responders and non-responders. Instead, researchers found that insulin sensitivity in responders improved significantly compared to non-responders. However, the amount of insulin secreted by all 298 participants remained unaltered.

Although there was no difference in weight loss, researchers identified that responders had lost more visceral abdominal fat, which surrounds the intestines, compared to non-responders.

Arvid Sandforth, one of the two lead authors, added: “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.”

There was also no difference in the reduction of liver fat between responders and non-responders, which is a key risk factor in developing type 2 diabetes.

Overall, those who reached remission were 73% less likely to develop type 2 diabetes, had lower markers of kidney damage and had better blood vessel health.

Current treatment of prediabetes involves weight loss and lifestyle improvement but does not involve glucose-based targets.

Professor Dr Reiner Jumpertz-von Schwartzenberg, co-first author of the DZD’s study, said: “Based on the new data, remission should be the new therapeutic target in people with prediabetes. This has the potential to change treatment practice and minimise the complication rate for our patients.”

The study defined remission in prediabetes as being when fasting blood glucose reaches below 100 mg/dl (5.6 mmol/l), two-hour glucose below 140 mg/dl (7.8 mmol/l) and HbA1c below 5.7%. It added that losing weight and reducing waist circumference by 4cm in women and 7cm in men increases the probability of remission. Researchers suggested to use these criteria as biomarkers.

The study was published in the journal The Lancet Diabetes & Endocrinology.