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Time course of normalisation of functional beta cell capacity in DiRECT after weight loss in type 2 diabetes

Lookup NU author(s): Dr Sviatlana Zhyzhneuskaya, Dr Ahmad Al-Mrabeh, Dr Carl Peters, Alison Barnes, Dr Benjamin Aribisala, Dr Kieren Hollingsworth, Dr Naweed Sattar, Professor Roy Taylor



Aim: To assess functional beta cell capacity in type 2 diabetes during 2 years of remission induced by dietary weight loss. Methods: A Stepped Insulin Secretion Test with Arginine (SISTA) was used to quantify functional beta cell capacity by hyperglycemia and arginine stimulation. 39/57 subjects initially achieved remission (HbA1c<6.5% (<48mmol/mol) and FPG <7 mmol/l on no antidiabetic drug therapy) with 16.4±7.7 kg weight loss, and were followed up with supportive advice on avoidance of weight regain. At 2 years, 20 subjects remained in remission in the study. A Non-Diabetic Control (NDC) group, matched for age/sex/weight after weight loss with the intervention group, was studied once. Results: During remission, median [IQ range] maximal rate of insulin secretion increased from 581 [480-811] at baseline to 736 [542-998] at 5 months, 942 [565-1240] at 12 months (p=0.028 from baseline), and 936 [635-1435] pmol/min/m2 at 24 months (p=0.023 from baseline; n=20/39 of those initially in remission). This was comparable to NDC (1016 [857- 1507] pmol/min/m2 ) by 12 (p=0.064) and 24 months (p=0.244). Median first phase insulin response increased from baseline to 5 months (42 [4-67] to 107 [59-163] pmol/min/m2 ; p<0.0001), then remained stable at 12 and 24 months (110 [59-201] and 125 [65-166] pmol/min/m2 respectively; p<0.0001 vs. baseline) but lower than that of the NDC group (250 [226-429] pmol/min/m2 ; p<0.0001). Conclusion: A gradual increase in assessed functional beta cell capacity occurred after weight loss, becoming similar to Non-Diabetic Controls by 12 months. This was unchanged at 2 years with continuing remission of type 2 diabetes.

Publication metadata

Author(s): Zhyzhneuskaya SV, Al-Mrabeh A, Peters C, Barnes AC, Aribisala B, Hollingsworth KG, McConnachie A, Sattar N, Lean MEJ, Taylor R

Publication type: Article

Publication status: Published

Journal: Diabetes Care

Year: 2020

Volume: 43

Issue: 4

Pages: 813-820

Print publication date: 01/04/2020

Online publication date: 14/02/2019

Acceptance date: 29/12/2019

Date deposited: 11/02/2020

ISSN (print): 0149-5992

ISSN (electronic): 1935-5548

Publisher: American Diabetes Association


DOI: 10.2337/dc19-0371


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