Diabetics with normal weight should lose weight?

▎Editor of WuXi AppTec's content team We know that the prevention and control of type 2 diabetes depends on the management of drugs and diet and life>
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Many studies have proved that for overweight or obese patients with type 2 diabetes, weight loss is beneficial to control the condition
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Scientists have long believed that type 2 diabetes patients with normal weight have different pathophysiological mechanisms
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Therefore, it is usually not recommended for these patients to lose weight, but they often start medication (including insulin) earlier
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Recently, at the 2021 European Association for the Study of Diabetes (EASD) annual meeting, Dr.
Ahmad Al-Mrabeh from the University of Edinburgh reported: For patients with type 2 diabetes with a normal body mass index (BMI), they lose 10% of their weight ~15% can alleviate the occurrence and development of type 2 diabetes
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This suggests that non-obese patients with type 2 diabetes may experience similar physiological changes as overweight/obese patients during remission
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Image source: 123RF In this study (ReTUNE), the researchers included 12 patients with type 2 diabetes with an average age of 58.
3 years and an average BMI of 24.
5kg/m2 (and all <27kg/m2)
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The average duration of diabetes in these diabetic patients was 2.
5 years; they were paired with 11 control groups of similar age and similar BMI (total fat rate was 25.
4%)
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Participants in the case group ate 800 kcal soup and milkshakes every day for 2 weeks, and then maintained their weight for 4 to 6 weeks
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This diet plan to reduce calories and maintain weight is repeated 2 to 3 times until the participants lose 10% to 15% of their weight, and glycosylated hemoglobin (HbA1c) is less than 48 mmol/mol
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At the same time, the researchers used magnetic resonance imaging to measure the visceral fat content of the participants and estimated the insulin sensitivity and beta cell responsiveness after a meal
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It was found that the participants in the case group lost an average weight of 8.
2 kg (11.
9% weight loss, from 69 kg to 61.
8 kg), while the overall fat rate dropped from 33.
1% to 27.
4% (p<0.
001)
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Among those participants who lost 10% to 15% of their weight: fasting blood glucose decreased from 7.
3 mmol/l to 6.
3 mmol/l (p<0.
05); HbA1c decreased from 53.
8 mmol/mol to 48.
0 mmol/mol (p<0.
05) ; Fasting plasma insulin decreased from 52.
2 pmol/L to 23.
7 pmol/L (p=0.
007); plasma triglycerides decreased from 1.
6 mmol/L to 1.
0 mmol/L (p=0.
002), similar to the control group
.

At the beginning of the experiment, the intrahepatic fat content (4.
4%) of the case group was more than twice that of the control group (1.
93%) (p=0.
02), but after the intervention, the intrahepatic fat content of the case group dropped to 1.
4 %(P=0.
004)
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In addition, the pancreatic fat content of the case group also decreased from 5.
1% to 4.
5% (p=0.
026), while the pancreatic fat level of the control group was 3.
4% (p=0.
13)
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The researchers pointed out: “High fat content in vital organs (liver and pancreas) is the key to type 2 diabetes
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Research data shows that if you have type 2 diabetes, the content of visceral fat (especially liver and pancreas) may exceed the standard , Thereby affecting metabolic function
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"In the ReTUNE test, normal energy intake can reverse the results of type 2 diabetes
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The
study also found that fat levels in the liver and pancreas were significantly reduced, which would activate/restore the activity of islet β cells (which produce insulin) in the pancreas
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ReTUNE The lead researcher of the study, Professor Roy Taylor of Newcastle University (Newcastle University), a diabetic, pointed out: “Although these results are preliminary, they clearly show that diabetes may be more due to excessive fat in the liver and pancreas, regardless of How about body mass index
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"Professor Roy Taylor explained: "Excess fat in the liver, on the one hand, will prevent insulin from working normally, on the other hand, it will prevent the beta cells in the pancreas from producing insulin
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There are 4.
5 million type 2 diabetes patients in the UK, and one in ten of them is of normal weight at the time of diagnosis.
This should be a wake-up call for doctors
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"Image source: 123RF Previously, the landmark diabetes relief clinical trial (DiRECT) showed that overweight (BMI of 35.
1kg/m2) type 2 diabetic patients lose weight, can relieve type 2 diabetes, improve blood pressure, and even restore pancreatic function
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at the meeting, Professor Taylor and Professor Al-Mrabeh people from Newcastle University, also presented the results of other studies
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researchers will test and change participants DiRECT ReTUNE tests in the intervention group were compared: participation in two trials who have reduced the weight by 10% to 15%
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in addition, the average fat content of all participants liver, pancreas fat content decreased significantly; significantly reduce the patient's weight, have a higher proportion achieved diabetes remission (HbA1c returned to normal, And stop the drug)
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Compared with overweight/obese patients, normal-weight people also have fewer difficulties in avoiding weight rebound
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Professor Taylor concluded: “At present, regardless of a person’s body mass index, a liver fat level of less than 5.
5% is healthy
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If a person has type 2 diabetes, their body fat will exceed their own capacity, even if they It looks slim
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Research results also show that liver fat levels vary with body weight.
It is currently believed that the seemingly healthy liver fat content may actually be harmful to people with lighter weight
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We need to change the way we assess liver fat and incorporate BMI Take it into consideration
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" Dr.
Lucy Chambers of the British Diabetes Association pointed out: "Body fat may also be one of the causes of type 2 diabetes in normal-weight people
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The
ReTUNE study is testing whether low-calorie weight loss programs can help reduce body fat, thereby Alleviate diabetes in people with normal weight, overweight and obesity, hoping to expand the feasibility of the plan
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"Related reading "The Lancet" is heavy! Diabetes treatment concept change: weight control should be the primary treatment goal! "Lancet" sub-publication depth: these innovative therapies are expected to change the future of the treatment of type 2 diabetes.
The Lancet, NEJM Announced together! Type 2 diabetes treatment may usher in the "new era", a dual-mechanism new drug has an eye-catching effect on reducing blood sugar and weight loss.
Organization joint statement: Type 2 diabetes can achieve "relief" and stop the drug! What does "relief" mean for patients? Reference [1] Fat Levels in Liver and Pancreas of Key Importance in Driving Type 2 Diabetes.
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