Type 2 diabetes: the problem and the solution


  • Roy Taylor Newcastle Magnetic Resonance Centre, Campus for Ageing and Vitality, Newcastle upon Tyne




T2DM, aetiology, pathophysiology, pancreas fat, personal fat threshold, remission


Lee Y, Hirose H, Ohneda M, Johnson JH, McGarry JD, Unger RH. Beta-cell lipotoxicity in the pathogenesis of non-insulin-dependent diabetes mellitus of obese rats: impairment in adipocyte-beta-cell relationships. Proc Natl Acad Sci USA 1994;91(23):10878-82. https://doi.org/10.1073/ pnas.91.23.10878

Gregg EW, Cheng YJ, Narayan KM, Thompson TJ, Williamson DF. The relative contributions of different levels of overweight and obesity to the increased prevalence of diabetes in the United States: 1976-2004. Prev Med 2007;45(5):348-52. https://doi.org/10.1016/j/ypaed.2007.07.020

Taylor R. Pathogenesis of Type 2 diabetes: Tracing the reverse route from cure to cause. Diabetologia 2008;51:1781-9. https://doi.org/10.1007/ s00125-008-1116-7

Lim EL, Hollingsworth KG, Aribisala BS, Chen MJ, Mathers JC, Taylor R. Reversal of type 2 diabetes: normalisation of beta cell function in associa- tion with decreased pancreas and liver triacylglycerol. Diabetologia 2011;54:2506-14. https://doi.org/10.1007/s00125-011-2204-7

Steven S, Lim EL, Taylor R. Population response to information on reversibil- ity of Type 2 diabetes. Diabet Med 2013;30(4):e135-8. https://doi.org/ 10.1111/dme.12116

Pinnick K, Neville M, Clark A, Fielding B. Reversibility of metabolic and morphological changes associated with chronic exposure of pancreatic islet beta-cells to fatty acids. J Cell Biochem 2010;109(4):683-92. https://doi.org/10.002/jcb.22445

Talchai C, Xuan S, Lin HV, Sussel L, Accili D. Pancreatic beta cell dedifferen- tiation as a mechanism of diabetic beta cell failure. Cell 2012;150(6):1223-34. https://doi.org/10.1016/j.cell.2012.07.029

Steven S, Hollingsworth KG, Small P, et al. Weight loss decreases excess pancreatic triacylglycerol specifically in type 2 diabetes. Diabetes Care 2016;39:158-65. https://doi.org/10.2337/dc15-0750

Riddle MC, Cefalu WT, Evans PH, et al. Consensus Report: Definition and Interpretation of Remission in Type 2 Diabetes. Diabetes Care 2021;44 (10): 2438-44. https://doi.org/10.2337/dci21-0034

Taylor R, Leslie WS, Barnes AC, et al. Clinical and metabolic features of the randomised controlled Diabetes Remission Clinical Trial (DiRECT) cohort. Diabetologia 2017;61:589-98. https://doi.org/10.1007/s00125-017-4503-0

Lean MEJ, Leslie WS, Barnes AC, et al. Durability of a primary care-led weight- management intervention for remission of type 2 diabetes: 2-year results of the DiRECT open-label, cluster-randomised trial. Lancet Diabetes Endocrinol 2019;7(5):344-55. https://doi.org/10.1016/S2213-8587(19)30068-3

Rehackova L, Araujo-Soares V, Steven S, Adamson AJ, Taylor R, Sniehotta FF. Behaviour change during dietary Type 2 diabetes remission: a longitu- dinal qualitative evaluation of an intervention using a very low energy diet. Diabet Med 2020;37:953-62. https://doi.org/10.1111/dme.14066

Xin Y, Davies A, McCombie L, et al. Type 2 diabetes remission: economic evaluation of the DiRECT/Counterweight-Plus weight management pro- gramme within a primary care randomized controlled trial. Diabet Med 2019;36(8):1003-12. https://doi.org/10.1111/dme.13981

Jesuthasan A, Zhyzhneuskaya S, Peters C, et al. Sex differences in intraor- gan fat levels and hepatic lipid metabolism: implications for cardiovascular health and remission of type 2 diabetes after dietary weight loss. Dia- betologia 2022;65:225-33. https://doi.org/10.1007/s00125-021-05583-4

Al-Mrabeh A, Zhyzhneuskaya SV, Peters C, et al. Hepatic Lipoprotein Export and Remission of Human Type 2 Diabetes after Weight Loss. Cell Metab 2020;31(2):233-49 e4. https://doi.org/10.1016/j.cmet.2019.11.018

Taylor R, Holman R. Normal weight individuals who develop Type 2 dia- betes: the personal fat threshold. Clinical Science 2015;128:405-10. https://doi.org/10.1042/CS20140553

Taylor R. Life Without Diabetes. London: Short Books; 2020.