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    Home > Active Ingredient News > Endocrine System > Losing fat in these 2 places can relieve diabetes?

    Losing fat in these 2 places can relieve diabetes?

    • Last Update: 2022-06-04
    • Source: Internet
    • Author: User
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    *Only for medical professionals to read and reference to relieve diabetes, it can also be done by losing weight! But it has to be reduced in the right place.
    .
    .
    As long as the management of type 2 diabetes (T2DM) is mentioned, it is difficult to bypass life>
    .

     In recent years, a group of metabolic disease experts, led by Professor Roy Taylor of the Department of Medicine and Metabolism at Newcastle University in the United Kingdom, have put forward a more radical view - changing life>Figure 1 Roy Taylor DiRECT study: After losing 10kg, over 60% of patients got rid of hypoglycemic drugs! Professor Roy Taylor believes that T2DM is a reversible disease state.
    Through life>
    .

     In 2017, he made the first sound of weight loss treatment of diabetes with a research paper published in the top journal "The Lancet" - this article is the DiRECT study that is still talked about by the academic community [2]
    .

    Figure 2 Screenshot of the DiRECT study article The DiRECT study included 306 overweight/obese patients with T2DM and replaced their daily diet with a meal replacement with only 850kcal/day (ordinary adults generally consume no less than 1400kcal per day)
    .

     In the first year of the study, 46% of the participants achieved diabetes remission, and the disease remission was closely related to weight loss, and the proportion of participants who lost more than 10 kilograms was as high as 64%
    .

    After one year of follow-up, 70% of the patients were still in remission despite discontinuation of antidiabetic drugs [2, 3]
    .

     Although this data is already considerable, we still have to ask - why do some people relapse and others do not? Is there a mechanism behind this? I think Professor Roy Taylor and his colleagues are also interested in this question
    .

     On April 1 this year, they reported the results of the ReTUNE study [4] they had conducted over the past two years in the British Diabetes Association: Losing fat in the liver and islets is the key to remission of T2DM, and this is a normal weight for patients with T2DM.
    Also works! ReTUNE study: Reduce liver and pancreas fat, 70% of patients get relief! Figure 3 The study was also published in the international journal Cell Metabolism.
    In the T2DM army, about 10% of the patients are of normal weight or even thin, and the ReTUNE study is aimed at this population
    .

    The study recruited 20 T2DM patients with a body mass index (BMI) of less than 27, discontinued their diabetes medication, and replaced their daily diet with a meal replacement (mainly soup, milkshake) with only 800 kcal per day.
    and non-starchy vegetables) for 3 cyclic weight loss treatments
    .

     *Cyclical weight loss treatment consists of a low-calorie diet lasting 2-4 weeks and a weight loss maintenance period of 4-6 weeks.
    A total of 3 cycles are required to complete the treatment
    .

    During the weight loss maintenance period, patients will be allowed to gradually return to their normal diet
    .

     In the one-year research trial, researchers used magnetic resonance imaging to monitor patients' important body composition changes, including visceral fat (VAT), subcutaneous fat (SAT), liver fat (Liver Fat), and pancreatic fat (Pancreas Fat).
    ), glycated serum total cholesterol (TG), serum very low density lipoprotein cholesterol (VLDL),
    etc.

    Figure 4.
    High fat content in the liver on MRI scan (left) and a significant reduction in fat content after a low-calorie diet (right).
    [5] After the 12-month trial, the results showed that about 70% of T2DM patients eventually achieved remission, of which 50% relieved after the first weight loss cycle
    .

    Achieving T2DM remission requires, on average, about 8% of body weight loss
    .

    In patients who achieved diabetes remission through weight loss, when all diabetes drugs were discontinued: glycated hemoglobin and fasting blood glucose were significantly reduced (Figure 5)
    .

    At the start of the study, T2DM patients had higher levels of liver and pancreas fat than normal people, but after weight loss began to gradually decrease to normal levels
    .

    Figure 5.
    Changes in indicators of T2DM patients in remission after weight loss Glycated hemoglobin: from 7.
    4 ± 0.
    2 to 6.
    0 ± 0.
    1%; p < 0.
    0001 Fasting blood glucose: 150.
    6 ± 11.
    8 to 101.
    5 ± 2.
    7 mg/dl; p < 0.
    0001 at subsequent follow-up In the study, the researchers also noticed that changes in liver fat directly determine the success or failure of weight loss treatment of diabetes
    .

     In addition to the patients who were refractory to remission at the beginning, there were also some patients who had a relapse (Relapser) after 12 months
    .

    Compared with patients with sustained remission, relapsed patients experienced "regain" of liver and pancreas from month 12 of the trial (Fig.
    6), a phenomenon that was not seen in patients with sustained remission
    .

    Figure 6 Relapsed patients with liver and pancreas "regain fat" Note: Patients with sustained remission also experienced an increase in liver fat, but only the liver fat of the relapsed patients was statistically different from that of the healthy population, said Professor Roy Taylor.
    The recovery of obesity leads to more VLDL flow to the pancreas, which promotes the recovery of obesity and inflammation of the pancreas, thereby destroying the function of pancreatic islet β-cells and eventually leading to the recurrence of T2DM (Figure 7)
    .

    This fat transfer process also exists in the normal T2DM disease process, and this process is also a key pathway for weight loss treatment of T2DM
    .

    Figure 7 The relationship between liver, pancreas fat and diabetes The latest ReTUNE study clearly reveals a new idea for the cure of T2DM - getting rid of hypoglycemic drugs, and simply through life>
    .

     Expert interviews with the medical community How operational are the methods mentioned in this study? Is it worth promoting clinically in China? Professor Zou Dajin said that T2DM in Chinese people is actually divided into 4 categories, so let’s analyze from these categories: the first category of patients is underweight, mainly due to poor pancreatic islet function, which probably accounts for the majority of T2DM patients.
    about 15%
    .

    And these patients with a BMI below 21kg/m2 are not suitable for Roy Taylor's study, because the main problem of these patients is lack of muscle, not excess body fat
    .

    The second largest group of patients, as Taylor described, are people with a normal body mass index but excess body fat
    .

    The body mass index is normal, for example, the BMI of the Chinese population is between 21 and 25kg/m2
    .

    But Taylor's study actually included an average BMI of around 25kg/m2, which belongs to overweight people in China.
    Therefore, if the body fat percentage of this type of patients exceeds 25% for men and 30% for women, and C The peptide level is relatively good, so it is still very possible to use Taylor's method to reverse islet function
    .

    In fact, most of the diabetic patients in China are overweight.
    The third largest group of patients is the BMI between 24 and 27.
    9kg/m2.
    These overweight people actually account for 40% to 50% of diabetes in China.
    Therefore, this part of the patients reversed The possibility of BMI is equivalent to the type of patients with a relatively light body mass index in the Taylor study, because in foreign countries, a BMI above 28kg/m2 is considered overweight, but this range is considered obese in China
    .

    The last major category is that the BMI of Chinese diabetic patients has exceeded 28kg/m2, which is the best group for reversal
    .

    Therefore, according to this ratio, 15% of the patients are relatively thin and the islet function is not very good, these people are impossible to reverse; 20% to 30% of the patients have a normal body mass index, but their body fat percentage It may also be overweight, so this group of patients is also more suitable as a reversal population; however, the best diabetes reversal population is of course overweight patients with a BMI greater than 24~28kg/m2, which accounts for nearly 40%; and About 15% of patients are completely obese
    .

    Therefore, to sum up, in China, we actually have nearly 70% of diabetic patients, which can be reversed through Taylor's return study
    .

    What conditions need to be met for the medical community to achieve reversal of T2DM? Is there a specific method? In the "Chinese Expert Consensus on Reversing Type 2 Diabetes" published by Professor Zou Dajin last year, we have an "ABCD" assessment for T2DM
    .

    A stands for Antibody, which is an antibody
    .

    We must be negative for islet cell antibodies.
    If the islet cell antibody is positive, it means that you have a situation where your immunity has been destroyed, and there is no way to solve this situation, so we must test the islets first.
    Antibodies to cells; B is BMI
    .

    Chinese people's BMI should preferably be above 25kg/m2, and the possibility of reversal will be the greatest.
    If your BMI does not exceed 25kg/m2, but your waist circumference is >90cm for men and >85cm for women, it also means that your body is healthy.
    Fat is excessive, abdominal obesity exists, and this is also eligible
    .

    So at this point, BMI and waist circumference index should be understood
    .

    C stands for C-peptide, and it is necessary to measure the level of C-peptide on an empty stomach and C-peptide 2 h after a meal
    .

    Fasting C-peptide must be >1.
    1ng/ml, because above this level, it means that the islet function is in the normal range; C-peptide >2.
    5ng/ml 2h after a meal, it means that its islet function exceeds the normal baseline (fasting).
    2.
    5 times the value), but the damage is not very serious; D stands for Duration, that is, the duration of diabetes, preferably a newly diagnosed diabetic patient, and patients with a duration of less than 5 years have a very high chance of reversal
    .

    Therefore, if you want to give a patient reversal therapy, it is best to first perform an "ABCD assessment" on the patient to assess whether the patient meets these reversal conditions, so as to ensure the effectiveness and rationality of the treatment
    .

    In the daily life of the medical community, what can diabetic patients do to protect the function of pancreatic beta cells and do a good job in self-management of diabetes? Professor Zou Dajin We all know that the decline of islet beta cell function is one of the central links in the occurrence and development of T2DM
    .

    Therefore, protecting and maintaining the normal function of pancreatic β-cells is also the key to reversing T2DM.
    At present, our medical community is very clear about the damage factors of β-cells
    .

    The first is staying up late, which can keep beta cells from getting enough rest
    .

    Because in the case of staying up late, some of the glucocorticoids that antagonize insulin will be secreted more, so that the islet cells need to continue to secrete a large amount of insulin to fight these stress hormones
    .

    The second is eating and drinking
    .

    Often eating late-night snacks, or drinking sweet and carbonated beverages, these are very harmful to the islets
    .

    Nowadays, many young people keep their beverages in their hands, and even drink it as water every day, which is very undesirable
    .

    When you stop these bad eating habits in time, the islet function may also be repaired
    .

    The third is obesity
    .

    At present, the obesity rate of teenagers in China is rising sharply.
    Most of the middle and primary schools only focus on learning, but not on physical exercise, so that the body has very little muscle composition, but the percentage of body fat is far beyond the standard
    .

    According to Taylor, once there is too much fat, it will be deposited in the liver, leading to fatty liver; and fatty liver will import fat into the pancreas in the form of very low-density lipoprotein, making the fat deposited in the pancreas more and more In the end, this deposition will interfere with islet function and cause lipotoxicity; and obesity can also cause so-called "insulin resistance", that is, the effect of insulin in lowering blood sugar is folded or tripled, so that it cannot be very To deal with blood sugar well, at this time, in order to better deal with blood sugar, the human body will desperately and uninterruptedly secrete more insulin to keep blood sugar stable
    .

    But over time, this condition can lead to a very severe decline in pancreatic islet function, which can eventually lead to diabetes
    .

    The fourth is not to exercise
    .

    Often sit or lie down, usually do not exercise, the islet function can not bear
    .

    Fifth, bad mood
    .

    Usually, you should be not anxious, impatient, and anxious, and have a good state of mind and sleep, which can also reduce the damage to the islet function caused by emotions and frequent stress
    .

    These adverse factors that damage pancreatic beta cells can be summed up in a couplet: the first couplet is "no one can eat and drink", and the bottom couplet is "stressed to stay up late and become obese"
    .

    Therefore, the protection of pancreatic islet function is actually closely related to our daily life
    .

    When we remove these factors that make insulin resistant, diabetes is less likely to occur
    .

    Interview with expert Zou Dajin, professor and chief physician of the Tenth People's Hospital Affiliated to Tongji University, doctoral supervisor, honorary director of the Obesity Institute of Tongji University School of Medicine, director of the Shanghai Thyroid Disease Research Center.
    The first to the fourth vice president, the first chairman of the Obesity Professional Committee of the Chinese Medical Association, the vice chairman of the sixth, seventh and eighth Diabetes Branch of the Chinese Medical Association, and the first leader of the obesity group of the Chinese Medical Association Diabetes Branch , the second and third deputy editors of "Chinese Journal of Diabetes", the sixth deputy editor of "Shanghai Medicine", the former director of the Endocrinology Department of Changhai Hospital, Second Military Medical University (1999-2013) the former director of the Shanghai Medical Association Diabetes Society, Vice-chairman of the Endocrinology and Metabolism Branch of Shanghai Medical Doctor Association has won the second prize of military scientific and technological progress, the second prize of military medical achievement, etc.
    Editor-in-chief of monographs: "Practical Obesity", "You Can Beat Diabetes", "Diabetes Complications" Research directions: Obesity and Reversal of Type 2 Diabetes References: [1] Li, Xiaojue et al.
    Journal of diabetes vol.
    11,7 (2019): 593-598.
    doi:10.
    1111/1753-0407.
    12887[2]Lean, Michael Ej et al.
    Lancet (London, England) vol.
    391,10120 (2018): 541-551.
    doi:10.
    1016/S0140-6736(17)33102-1[ 3] https:// Ahmad et al.
    Cell metabolism vol.
    31, 2 (2020): 233-249.
    e4.
    doi:10.
    1016/j.
    cmet.
    2019.
    11.
    018[5]https:// https:// diets/
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