Type 2 Diabetes Reversed by Losing 'Sick Fat'

With commentary by J. Michael Gonzalez-Campoy, MD, medical director and CEO of the Minnesota Center for Obesity, Metabolism and Endocrinology.

A new study from Newcastle University in the U.K., confirms earlier findings that type 2 diabetes can be caused by fatty build-up in the pancreas, and goes on to show that losing a small amount of that fat—less than one gram—from the pancreas can literally stop the disease in its tracks.

pancreasIn the small study, published online in Diabetes Care and also presented at the World Diabetes Conference in Vancouver last week, researchers measured 18 obese people with type 2 diabetes and 9 obese people without diabetes, for body weight, fat levels in the pancreas (using a special MRI scan) and insulin response. All participants then underwent bariatric surgery and had their measurements taken again eight weeks later.

Interestingly, although both groups lost the same amount of weight—around 13 percent of their initial body weight—the people without diabetes saw no change in pancreatic fat, but the people with type 2 diabetes did. In fact, though they started out with more fat in their pancreas, the operation reduced it (by 1.2 percent over the 8 weeks), and those participants were able to go off their diabetes medication immediately.

“Endocrine disease, or adiposopathy, is a medical term for ‘sick fat,’” explains DiabeticLifestyle Medical Advisory Board Member J. Michael Gonzalez-Campoy, MD, medical director and CEO of the Minnesota Center for Obesity, Metabolism and Endocrinology. “One of the things that makes sick fat is when fat cells in the body get saturated, forcing tissues like the liver and pancreas to take up the excess.” For these study participants, bariatric surgery caused enough weight loss so that their regular fat tissue was able to process fat in the body more efficiently, Dr. Gonzalez-Campoy says. “That leads to fats getting out of tissues—like the pancreas and liver—where it was deposited when the fat cells could no longer handle it.”

The study authors, led by Roy Taylor, MD, of Newcastle University, believe these findings show that excess fat in the diabetic pancreas is specific to type 2 diabetes and plays an active role in preventing insulin from being made normally. In this study, draining the extra fat from the pancreas caused insulin secretion to return to normal levels, leaving patients diabetes-free.

“The study confirms that bariatric surgery-induced weight loss reverses adiposopathy, or sick fat,” Dr. Gonzalez-Campoy says, noting that this information is not brand new. “But the observation in bariatric surgery patients with and without diabetes is new, and confirms prior knowledge: It validates that in patients with overweight and obesity a treatment goal is to treat adiposopathy—to reverse adipose tissue dysfunction and its effects on other organs, like the pancreas.”

Bariatric surgeries have skyrocketed in the United States over the last several decades—increasing by more than five times between 1998 and 2002, from 13,386 to 71,733, and then more than doubling by 2013, to 179,000, according to the American Society for Metabolic and Bariatric Surgery. And it’s not just because more people are obese, but because more surgeons have honed their expertise at the procedure; the surgery has been marketed more aggressively to the public; Medicare now covers bariatric surgery, which has led to more surgeries in older patients; and laparoscopy has made the procedure easier and safer, Dr. Gonzalez-Campoy says.

Although patients in this study lost weight via bariatric surgery, it’s not the only way to shed fat from the pancreas. According to Dr. Gonzalez-Campoy, good old diet and exercise will also do the trick—if you lose enough to decrease the “fatty infiltration” of the pancreas. “There is no official formula for this,” he says, since individuals vary in how much fat they can tolerate in the pancreas before type 2 diabetes sets in. “But we consider a five to 10 percent weight loss enough to reverse the steatohepatitis, or fatty liver, and steatopancreatitis, or fatty pancreas, of endocrine disease.”

Dr. Taylor, who is director of Newcastle Magnetic Resonance Centre at Newcastle University, has said, “What is interesting is that regardless of your present body weight and how you lose weight, the critical factor in reversing your type 2 diabetes is losing that 1 gram of fat from the pancreas.”

Updated on: July 26, 2017
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