Weight Loss Improves β-Cell Function in People With Severe Obesity and Impaired Fasting Glucose: A Window of Opportunity
Open Access
- 13 November 2019
- journal article
- research article
- Published by The Endocrine Society in Journal of Clinical Endocrinology & Metabolism
- Vol. 105 (4), e1621-e1630
- https://doi.org/10.1210/clinem/dgz189
Abstract
Background In people with obesity, β-cell function may adapt to insulin resistance. We describe β-cell function in people with severe obesity and normal fasting glucose (NFG), impaired fasting glucose (IFG), and type 2 diabetes (T2DM), as assessed before, 3 to 6 months after, and 2 years after medical weight loss to describe its effects on insulin sensitivity, insulin secretion, and β-cell function. Methods Fifty-eight participants with body mass index (BMI) ≥ 35 kg/m2 (14 with NFG, 24 with IFG, and 20 with T2DM) and 13 normal weight participants with NFG underwent mixed meal tolerance tests to estimate insulin sensitivity (S[I]), insulin secretion (Φ), and β-cell function assessed as model-based Φ adjusted for S(I). All 58 obese participants were restudied at 3 to 6 months and 27 were restudied at 2 years. Results At 3 to 6 months, after a 20-kg weight loss and a decrease in BMI of 6 kg/m2, S(I) improved in all obese participants, Φ decreased in obese participants with NFG and IFG and tended to decrease in obese participants with T2DM, and β-cell function improved in obese participants with NFG and tended to improve in obese participants with IFG. At 2 years, β-cell function deteriorated in participants with NFG and T2DM but remained significantly better in participants with IFG compared to baseline. Conclusions Short-term weight loss improves β-cell function in participants with NFG and IFG, but β-cell function tends to deteriorate over 2 years. In participants with IFG, weight loss improves longer-term β-cell function relative to baseline and likely relative to no intervention, suggesting that obese people with IFG are a subpopulation whose β-cell function is most likely to benefit from weight loss.Keywords
Funding Information
- National Institute of Diabetes and Digestive and Kidney Diseases (DK089503, DK020572)
This publication has 23 references indexed in Scilit:
- Gastric bypass and banding equally improve insulin sensitivity and β cell functionJCI Insight, 2012
- Beta cell function after weight loss: a clinical trial comparing gastric bypass surgery and intensive lifestyle interventionActa Endocrinologica, 2011
- Weight Loss Therapy Improves Pancreatic Endocrine Function in Obese Older AdultsObesity, 2008
- Mechanisms linking obesity to insulin resistance and type 2 diabetesNature, 2006
- Improvements in insulin sensitivity and β‐cell function (HOMA) with weight loss in the severely obeseDiabetic Medicine, 2003
- Reduction in the Incidence of Type 2 Diabetes with Lifestyle Intervention or MetforminThe New England Journal of Medicine, 2002
- Long-term changes in insulin action and insulin secretion associated with gain, loss, regain and maintenance of body weightDiabetologia, 2000
- The natural history of insulin secretory dysfunction and insulin resistance in the pathogenesis of type 2 diabetes mellitusJCI Insight, 1999
- Relationships Between Diabetes Duration, Metabolic Control and β‐cell Function in a Representative Population of Type 2 Diabetic Patients in SwedenDiabetic Medicine, 1994
- Twenty-four-hour profiles and pulsatile patterns of insulin secretion in normal and obese subjects.JCI Insight, 1988