Abdominal Fat Plays Important Role in Remission of Prediabetes

Prediabetes is a preliminary stage of type 2 diabetes with an increased risk of heart attack, kidney and eye diseases and various types of cancer. Scientists from the German Center for Diabetes Research (DZD) show that remission of prediabetes is possible. Prediabetes remission protects against type 2 diabetes and is associated with better kidney and vascular function in the long term, the researchers report in The Lancet Diabetes & Endocrinology.

The study focused on individuals with prediabetes who were successful in reducing their body weight by at least 5% through a 12-month lifestyle intervention. A comparison was drawn between responders, who were able to normalise their blood glucose, and non-responders, who continued to have elevated blood glucose levels. Both groups showed similar weight loss and reduction in liver fat. However, the reduction in visceral fat and the improvement in insulin sensitivity were significantly greater in the responders.

People with type 2 diabetes have an increased risk of kidney disease, heart attack or stroke and are exposed to higher mortality. Until a few years ago, type 2 diabetes was considered irreversible. Now we know that type 2 diabetes can be brought into a state of remission in some of those affected by a strong reduction in weight. The patients are then healthy, but not cured. However, the remission is rarely permanent: most patients develop type 2 diabetes again after 5 years.

Researchers at the DZD therefore investigated whether it is possible to reverse the preliminary stage of type 2 diabetes, prediabetes. In prediabetes, the blood sugar levels are already elevated, but not yet high enough to speak of type 2 diabetes. But people with prediabetes can also develop complications of the heart, kidneys and eyes.

In the Prediabetes Lifestyle Intervention Study (PLIS), a large multicentre study of the DZD, 1,105 people with prediabetes took part in a 1-year weight reduction programme. It consisted of a healthy diet and more physical activity. When the researchers looked at the participants who had lost at least 5% of their weight, they found that some had achieved remission, others had not - although the relative weight loss was the same for all.

Better insulin sensitivity due to less abdominal fat

Weight loss per se did not seem to be responsible for remission. However, those who had achieved remission were characterised by even better insulin sensitivity. They were more sensitive to the blood sugar-lowering hormone insulin. And they had lost more visceral abdominal fat. Visceral abdominal fat lies directly in the abdominal cavity and surrounds the intestines. It can affect insulin sensitivity, partly through an inflammatory response in the fat tissue.

Reducing visceral abdominal fat appears to be crucial in achieving remission in prediabetes. According to the DZD researchers, this should be the therapeutic goal in prediabetes. Until now, weight reduction has only been used to delay the onset of type 2 diabetes. But those who achieved remission in the study still had a greatly reduced risk of developing type 2 diabetes up to 2 years after the end of the programme. They also showed improved kidney function and better condition of their blood vessels.

According to the new results, the likelihood of remission increases when body weight is reduced by 5% and abdominal circumference by about 4 cm in women and 7 cm in men.

Original publication:

Sandforth A et al. (2023): Mechanisms of weight loss-induced remission of prediabetes: A Post hoc Analysis of the Randomized Controlled Multicenter Prediabetes Lifestyle Intervention Study (PLIS). Lancet Diabetes Endocrinology 2023