Cited by 299Diabetes Treatment and ManagementPancreatic function and diabetesDiabetes, Cardiovascular Risks, and Lipoproteins

Understanding the mechanisms of reversal of type 2 diabetes

Open access
Taylor, Roy, Al-Mrabeh, Ahmad, Sattar, Naveed·2019·The Lancet Diabetes & Endocrinology

Abstract

Clinical and pathophysiological studies have shown type 2 diabetes to be a condition mainly caused by excess, yet reversible, fat accumulation in the liver and pancreas. Within the liver, excess fat worsens hepatic responsiveness to insulin, leading to increased glucose production. Within the pancreas, the β cell seems to enter a survival mode and fails to function because of the fat-induced metabolic stress. Removal of excess fat from these organs via substantial weight loss can normalise hepatic insulin responsiveness and, in the early years post-diagnosis, is associated with β-cell recovery of acute insulin secretion in many individuals, possibly by redifferentiation. Collectively, these changes can normalise blood glucose levels. Importantly, the primary care-based Diabetes Remission Clinical Trial (DiRECT) showed that 46% of people with type 2 diabetes could achieve remission at 12 months, and 36% at 24 months, mediated by weight loss. This major change in our understanding of the underlying mechanisms of disease permits a reassessment of advice for people with type 2 diabetes.

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Registry

Crossref · 10.1016/s2213-8587(19)30076-2

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  • Additional evidence confirms that obesity is a contributing factor for type 2 diabetes, hypertension, and thrombotic episodes, as well as conditions linked to inflammation such as heart failure with preserved ejection fraction.

    “Additional evi dence confirms that obesity is a contributing factor for type 2 diabetes, hypertension, and thrombotic ep isodes, as well as conditions linked to inflammation such as heart failure with preserved ejection frac tion. 2-7”

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Authors
Taylor, R., Al-Mrabeh, A., & Sattar, N.
Affiliations
  • Newcastle University (GB)
  • University of Glasgow (GB)
Corresponding author
Taylor, Roy
Venue
The Lancet Diabetes & Endocrinology
Publisher
Elsevier BV
Published
2019-09
Volume
7
Issue
9
Pages
726-736
ISSN
2213-8587 (ISSN-L)
OpenAlex
W2946710786
Cited by
299
References
87
Citations by year
2026: 35 · 2025: 47 · 2024: 42 · 2023: 46 · 2022: 41 · 2021: 53 · 2020: 26 · 2019: 8 · 2017: 1
FWCI
4.91
Type
journal article
Language
en
Open access
Locations
  • The Lancet Diabetes & Endocrinology (publishedVersion)
  • PubMed (publishedVersion)
  • Newcastle University ePrints (Newcastle Univesity) (cc-by-nc-nd)
Funders
  • Newcastle University
  • National Institute for Health and Care Research
  • European Foundation for the Study of Diabetes
  • Novo Nordisk UK Research Foundation
  • Novo Nordisk
  • Amgen
  • NIHR Newcastle Biomedical Research Centre
  • Sanofi
  • Diabetes UK
Topics
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Treatment and Management
  • Health Sciences › Medicine › Surgery › Pancreatic function and diabetes
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes, Cardiovascular Risks, and Lipoproteins
Keywords
type 2 diabetes remission, weight loss, hepatic insulin resistance, hepatic lipid accumulation, pancreatic fat accumulation, beta-cell dysfunction, beta-cell recovery, glucose production, DIRECT trial, primary care
MeSH terms
Blood Glucose, Diabetes Mellitus, Type 2, Humans, Insulin Resistance, Liver, Pancreas, Weight Loss, Insulin-Secreting Cells

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