Pancreas Function Could Return to Normal Following Diabetes Remission, Study Suggests

Roy Taylor, PhD

An analysis of data from the DiRECT study suggest achieving remission of type 2 diabetes could help to restore the pancreas of these patients to its normal state.

Results of the study, which was conducted by investigators from Europe, suggest achieving remission of type 2 diabetes could lead to the restoration of the pancreas’s insulin-producing capacity to levels of nondiabetic patients.

"Large amounts of insulin cause tissues to grow, or at least maintain their size. Normally, inside the pancreas the amounts of insulin present after a meal are very high. But in type 2 diabetes this does not happen. This new study suggests that achieving remission of type 2 diabetes restores this healthy, direct effect of insulin on the pancreas,” said lead investigator Roy Taylor, PhD, professor at the Newcastle University in the United Kingdom, in a statement.

Despite results of previous studies have supported the notion that remission of diabetes was linked to improvements in size and shape of the pancreas, some have argued this was well-controlled diabetes. In an effort to further outline the impact of diabetes remission on the function and size of the pancreas, Taylor and a team from Newcastle University designed their study to examine the topic in patients from Diabetes Remission Clinical Trial (DiRECT).

In DiRECT, patients were randomized to either an intervention or routine diabetes management group and followed for at least 24 months. For the purpose of the current analysis, investigators focused on the cohort of 64 participants randomized to the intervention arm of the study and these patients were matched with non-diabetic controls. For the purpose of analysis, patients in the study who achieved an HbA1c level of less than 6.5%, a fasting blood glucose of less than 7.0 mmol/l, and were free from use of antidiabetes medications were classified as responders.

As part of DiRECT, participants underwent magnetic resonance imaging, which was used by investigators to ascertain anatomical and fat fraction images of the pancreas. From these images, investigators were able t determine intrapancreatic fat content and the irregularity of the pancreas borders. Additionally, investigators noted insulin secretion was measured through use of at the Stepped Insulin Secretion Test with Arginine.

At baseline, the mean pancreas volume was 61.7 cm3 among all participants with type 2 diabetes and 79.8 cm3 in the nondiabetic cohort (P <.0001). At 24 months, investigators noted pancreas volume had increased by 9.4 cm3 (95% CI, 6.1-12.8) among responders and just 6.4 cm (95% CI, 2.5-10.3) among non-responders (P=.0008).

At baseline, pancreas borders were more irregular among those with type 2 diabetes than in the nondiabetic group (fractal dimension 1.138 [SD, 0.027] vs 1.097 [SD, 0.025]; P <.0001), but investigators pointed out this had normalized by 24 months among patients classified as responders (1.099 [SD, 0.028]). Additionally, intrapancreatic fat declined by 1.02 percentage points (95% CI, 0.53-1.51) among responders and 0.51 percentage points (95% CI, -0.17 to 1.19) in non-responders (P=.23).

"Our findings provide proof of the link between the main tissue of the pancreas which makes digestive juices and the much smaller tissue which makes insulin, and open up possibilities of being able to predict future onset of type 2 diabetes by scanning the pancreas,” added Taylor in the aforementioned statement.

This study, “2-year remission of type 2 diabetes and pancreas morphology: a post-hoc analysis of the DiRECT open-label, cluster-randomised trial,” was published in The Lancet: Diabetes & Endocrinology.