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New DiRECT study uncovers the science behind remission

Prof Roy Taylor looking at an MRI scan on a computer screen

Our DiRECT trial continues to build our understanding of how type 2 diabetes develops, and what happens when people go into remission. The DiRECT team’s latest research sheds light on the important role of fat build-up in the liver.

The importance of liver fat

Professor Roy Taylor and the team have been studying people who took part in DiRECT – both those who did and didn’t go into remission.

Last year, the team found that as people who took part in DiRECT lost weight, they lost fat in their liver and pancreas. Alongside this, the insulin-producing beta cells in people who went into remission began to function again, producing the correct levels of insulin to regulate their blood sugar levels. Beta cells didn’t recover in people who didn’t go into remission – they had not survived the stress of having too much fat inside them.

In a new study published in Cell Metabolism, Professor Taylor and his team have been examining how the fat moves from the liver to the pancreas to cause this damage to the beta cells.

Fat is transported from the liver via the blood to all organs of the body in particles called ‘very low density lipoprotein’ (VLDL). In a person without type 2 diabetes, the liver produces only a small amount of VLDL. But if the liver builds up too much fat, it begins to export more to the rest of the body. This causes a build-up of fat in in the wrong places – including the pancreas, stopping it from working properly.

The results

The team studied 38 people who took part in DiRECT.

In people who went into remission, they found that levels of liver fat had dropped. As a result, their liver was producing less VLDL, and this coincided with less fat in the pancreas.

In people who went into remission but redeveloped type 2 diabetes, they saw an increase in liver fat, an increase in VLDL produced by the liver and, as a result, increased pancreas fat.

Overall, this evidence suggests that type 2 diabetes could be a result of fat building up in the liver and pancreas, explaining why weight loss leads to remission in some people.

Newcastle University’s Professor Roy Taylor, who led this work, said:

“We now have a culmination of work that says that through diet and persistence, some people can lose the fat inside important organs and potentially reverse their type 2 diabetes. The sooner this is done after diagnosis, the more likely it is that remission can happen.”

Dr Elizabeth Robertson is Director of Research here at Diabetes UK. She said:

“We now know that it’s possible for some people with type 2 diabetes to go into remission, thanks to the important work of the DiRECT team. But we also need to understand the mechanics of how remission happens, and that’s where this new study comes in, shedding light on exactly how weight loss can lead to remission.”

We’ve committed more than £2.8 million to DiRECT, led by Professor Roy Taylor, of Newcastle University, and Professor Mike Lean, of the University of Glasgow, to understand how to effectively put type 2 diabetes into remission. While the two-year results have been published, the researchers are following participants to understand more about the biology behind Type 2 diabetes remission.

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