Losing Abdominal Fat May Be An Effective Way To Avoid Or Reverse Prediabetes


Prediabetes, a precursor to type 2 diabetes, elevates the risk of heart attack, kidney disease, eye problems, and various cancers. Despite the absence of an approved drug therapy, researchers from the German Center for Diabetes Research (DZD) have discovered methods to induce remission in prediabetes, normalizing blood glucose levels. Their multicenter study reveals that achieving prediabetes remission not only guards against type 2 diabetes but also improves long-term kidney and vascular function. Interestingly, the mechanisms behind prediabetes remission differ from those in type 2 diabetes, as reported in The Lancet Diabetes & Endocrinology.

Previously, type 2 diabetes patients faced heightened risks of heart attacks, kidney issues, strokes, and higher mortality rates, with the condition believed to be irreversible until recently. It is now understood that substantial weight loss can lead to type 2 diabetes remission in a significant number of cases. However, this remission is often temporary, as most individuals tend to develop type 2 diabetes again within a few years.

“We aimed to explore the feasibility of commencing earlier and implementing preventive measures already at a stage that precedes type 2 diabetes, namely prediabetes, with the aim of reversing it,” Prof. Dr. Andreas Birkenfeld, Senior Author, Medical Director of Medical Clinic IV at Tübingen University Hospital, and Director of the Institute for Diabetes Research and Metabolic Diseases of Helmholtz Munich at the University of Tübingen, said.

Understanding the factors that lead to remission in patients with prediabetes is of paramount importance, especially considering the heightened risk these individuals face in developing type 2 diabetes, along with associated complications such as heart, kidney, and eye issues. In an effort to unravel the mystery behind prediabetes remission, researchers from the Institute of Diabetes Research and Metabolic Diseases (IDM) at Helmholtz Munich and the Department of Diabetology, Endocrinology, and Nephrology at the University Hospital of Tübingen delved into a comprehensive analysis.

Their investigation focused on participants from the Prediabetes Lifestyle Intervention Study (PLIS), a randomized-controlled multicenter study involving 1,105 individuals with prediabetes. These participants underwent a year-long lifestyle intervention program, incorporating a balanced diet and increased physical activity. The study honed in on 298 individuals who achieved a minimum weight loss of five percent due to the intervention. Among this subgroup, researchers categorized participants into responders and non-responders based on whether their fasting blood glucose, 2-hour glucose, and HbA1c levels had normalized within twelve months, indicating remission, or whether they still exhibited prediabetic markers despite weight loss.

Surprisingly, the study’s findings defied initial expectations. It was revealed that the key factor distinguishing those who experienced remission from those who did not was not the extent of weight loss. Instead, individuals who achieved remission exhibited a significant improvement in insulin sensitivity compared to their non-responsive counterparts. In simpler terms, they became more responsive to insulin, the hormone responsible for lowering blood glucose levels, far more than those who did not respond. Remarkably, the quantity of insulin secreted remained unchanged in both groups. This discovery stands in stark contrast to the remission process in type 2 diabetes, where increased insulin secretion plays a pivotal role.

In essence, this research sheds light on a critical aspect of prediabetes management, highlighting the importance of enhancing insulin sensitivity as a pathway to remission. These findings have the potential to revolutionize prediabetes interventions, paving the way for more targeted and effective strategies to mitigate the progression to type 2 diabetes and associated complications.


Reducing Abdominal Fat May Help Reverse Prediabetes

To investigate the reason behind the heightened insulin sensitivity observed in responders, researchers performed a comparative analysis between the two groups. Despite both groups losing an equal amount of body weight, responders exhibited a greater reduction in abdominal fat, particularly the visceral fat situated within the abdominal cavity around the intestines. This visceral fat is known to influence insulin sensitivity, partly due to the inflammatory response it triggers in adipose tissue.

True enough, participants who went into remission were also found to have fewer inflammatory proteins in their blood. “Since the responders showed a reduction in abdominal fat in particular, it will be important in the future to identify the factors that promote the loss of this fat depot,” said Arvid Sandforth, one of the two lead-authors. Surprisingly, there were no differences between both groups in the reduction of liver fat, another crucial risk factor when it comes to eventually developing diabetes.

Individuals who attained remission experienced a 73% decrease in the risk of developing type 2 diabetes, a reduction that persisted even two years after the conclusion of the lifestyle intervention. Additionally, they exhibited decreased indicators of kidney damage and improved condition of their blood vessels.

Right now, treatment of prediabetes includes weight reduction and lifestyle improvement in order to delay the onset of type 2 diabetes – but this is done in absence of glucose-based targets to guide the process when it comes to treatment. The DZD’s new analysis has managed to fill this gap: “Based on the new data, remission should be the new therapeutic target in people with prediabetes. This has the potential to change treatment practice and minimize the complication rate for our patients,” said co-first author Prof. Dr. Reiner Jumpertz-von Schwartzenberg.

The research findings indicate that prediabetes remission can be achieved when fasting blood glucose levels drop below 100 mg/dl (5.6 mmol/l), 2-hour glucose levels fall below 140 mg/dl (7.8 mmol/l), and HbA1c levels are lower than 5.7 percent. Remission is more likely to occur when individuals reduce body weight and decrease waist circumference by approximately 4 cm in women and 7 cm in men. Scientists assert that these criteria can serve as biomarkers for evaluating prediabetes remission.