New research from the team behind the DiRECT trial presented at the European Association for the Study of Diabetes Annual Meeting reveals how the pancreas regains lost size and shape when type 2 diabetes is put into remission through a low-calorie, weight management programme.
Our funded research into remission
The DiRECT trial, funded by Diabetes UK, has shown that over a third (36%) of people with type 2 diabetes who took part in the low-calorie, weight management programme were in remission two years later. The results are so striking that the NHS has now begun trialing low calorie, weight management programmes based on DiRECT in England and Scotland.
But the researchers want to understand more about the biological processes behind remission. Over the last few years they have found that remission is linked to a drop in fat levels in both the liver and the pancreas, and recovery of insulin-producing beta cells. But they need to understand more about how the weight management approach leads to remission to help make it a reality for as many people with type 2 diabetes as possible.
We’ve known for some time that the pancreas in people with type 2 diabetes is around 20-30% smaller than in people without the condition and is more irregularly shaped. But it’s never been clear if this is the cause or a result of developing type 2 diabetes.
To learn more about what happens to the pancreas when people go into remission, researchers studied 64 participants from the DiRECT trial. Using MRI scanners, the researchers were able to measure the volume, shape, and amount of fat in the pancreas, and follow how these changed over two years on the trial.
After two years on the programme, the size of the pancreas had increased by 20% in people who were in remission - almost to normal size. The researchers also found that in people in remission, pancreas shape was completely restored and levels of fat in the pancreas fell.
By comparison, in people who did not go into remission, the increase in pancreas volume was far smaller and the pancreas shape showed little change.
This is the first evidence we have that remission of type 2 diabetes helps to restore the health of the whole pancreas, unlocking answers about how remission works. This work highlights the importance of weight loss - specifically a weight loss of 10-15kg - in bringing about remission. We now know that this reduces the amount of fat in the pancreas, leading not only to beta cell recovery and increased insulin production, but also restoration of the whole organ.
Professor Roy Taylor of Newcastle University is co-lead on the DiRECT trial and led on this research. He said:
“It will be enormously encouraging for anyone with type 2 diabetes to learn that their small pancreas can return to normal size. Knowing what a treatment actually does inside the body is both motivating and reassuring.”
Dr Elizabeth Robertson is our Director of Research. She said:
“Our landmark DiRECT trial has revolutionised thinking about type 2 diabetes – we no longer consider it to be a life-long condition for everyone and know that remission is possible for some people. And we’re continuing to learn more about remission of type 2 every day. These new findings help to build a clearer picture of the biology behind remission, and how the health of the pancreas can be restored by weight loss.
However, we still have questions to answer, such as why remission isn’t possible for everyone. As NHS England begins its trial of a DiRECT-inspired weight management remission programme, it is key that we continue to explore these questions to make remission a possibility for as many people as possible.”
These new findings will be published in The Lancet Diabetes and Endocrinology.
We need your support
It is thanks to your generosity and support that we’re able to continue to fund ground-breaking research trials such as DiRECT. But we know there are still so many questions about remission that remain unanswered.
That’s why we’ve awarded our largest ever research grant to DiRECT, and why we’ve carried on backing this area of research throughout the last 12 years. From continuing to follow participants of the DiRECT trial to fully understand its long-term impact, to funding the ReTUNE trial to see if a similar approach to remission could work in people who are already a healthy weight, we’re fighting to make remission a reality for as many people as possible.
But we need your help.
If you donate today, you won’t just be supporting scientists in expanding their knowledge of diabetes remission, you’ll be helping to change the lives of people living with type 2 diabetes across the country.
Together we can make a difference.