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Time Course of Normalization of Functional β-Cell Capacity in the Diabetes Remission Clinical Trial After Weight Loss in Type 2 Diabetes.

  • Zhyzhneuskaya, Sviatlana V1
  • Al-Mrabeh, Ahmad1
  • Peters, Carl1
  • Barnes, Alison2
  • Aribisala, Benjamin3
  • Hollingsworth, Kieren G1
  • McConnachie, Alex4
  • Sattar, Naveed5
  • Lean, Michael E J6
  • Taylor, Roy7
  • 1 Magnetic Resonance Centre, Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, U.K.
  • 2 Human Nutrition Research Centre, Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, U.K.
  • 3 Computer Science Department, Lagos State University, Lagos, Nigeria. , (Niger)
  • 4 Robertson Centre for Biostatistics, University of Glasgow, Glasgow, U.K.
  • 5 Institute of Cardiovascular and Medical Science, University of Glasgow, Glasgow, U.K.
  • 6 School of Medicine, Dentistry and Nursing, Glasgow University, Glasgow, U.K.
  • 7 Magnetic Resonance Centre, Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, U.K. [email protected]
Published Article
Diabetes care
Publication Date
Feb 14, 2020
DOI: 10.2337/dc19-0371
PMID: 32060017


To assess functional β-cell capacity in type 2 diabetes during 2 years of remission induced by dietary weight loss. A Stepped Insulin Secretion Test with Arginine was used to quantify functional β-cell capacity by hyperglycemia and arginine stimulation. Thirty-nine of 57 participants initially achieved remission (HbA1c <6.5% [<48 mmol/mol] and fasting plasma glucose <7 mmol/L on no antidiabetic drug therapy) with a 16.4 ± 7.7 kg weight loss and were followed up with supportive advice on avoidance of weight regain. At 2 years, 20 participants remained in remission in the study. A nondiabetic control (NDC) group, matched for age, sex, and weight after weight loss with the intervention group, was studied once. During remission, median (interquartile range) maximal rate of insulin secretion increased from 581 (480-811) pmol/min/m2 at baseline to 736 (542-998) pmol/min/m2 at 5 months, 942 (565-1,240) pmol/min/m2 at 12 months (P = 0.028 from baseline), and 936 (635-1,435) pmol/min/m2 at 24 months (P = 0.023 from baseline; n = 20 of 39 of those initially in remission). This was comparable to the NDC group (1,016 [857-1,507] pmol/min/m2) by 12 (P = 0.064) and 24 (P = 0.244) months. Median first-phase insulin response increased from baseline to 5 months (42 [4-67] to 107 [59-163] pmol/min/m2; P < 0.0001) and then remained stable at 12 and 24 months (110 [59-201] and 125 [65-166] pmol/min/m2, respectively; P < 0.0001 vs. baseline) but lower than that of the NDC group (250 [226-429] pmol/min/m2; P < 0.0001). A gradual increase in assessed functional β-cell capacity occurred after weight loss, becoming similar to NDC participants by 12 months. This was unchanged at 2 years with continuing remission of type 2 diabetes. © 2020 by the American Diabetes Association.

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