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Abdominal fat may play an important role in the development of prediabetes. Milles Studio/Stocksy
  • Prediabetes, or borderline diabetes, can lead to a type 2 diabetes diagnosis and increase the risk of heart, kidney, and eye diseases and several types of cancer.
  • Scientists in Germany recently found that following a healthy diet and increasing physical activity may help reverse prediabetes in some patients.
  • Their research showed enhanced insulin sensitivity among participants who lost more visceral fat, the kind of abdominal fat surrounding the organs.
  • The results suggest that losing weight, specifically abdominal fat, may help reverse prediabetes.

People with prediabetes have excessively high blood sugar levels that are not high enough to be diagnosed as diabetes. The CDC warns that “Without intervention, many people with prediabetes could develop type 2 diabetes within five years.”

Prediabetes can also elevate the risk of heart attack, eye and kidney complications, and some cancers. An estimated 96 million adults in the United States have this condition, and 80% of these people are unaware that they do.

Unlike type 2 diabetes remission, prediabetes remission is marked by improved insulin sensitivity and reduced visceral adipose tissue (VAT).

Researchers at the Center for Diabetes Research (DZD) in Germany aimed to investigate how weight loss may induce remission in people with prediabetes.

Their recent analysis adds to mounting evidence that eating and lifestyle patterns may heavily influence metabolic function and the development, or curtailment, of diabetes symptoms.

The work suggests that remission of prediabetes may correlate with improved long-term kidney and vascular function as well.

These findings were published in The Lancet Diabetes & Endocrinology.

Since people with prediabetes have a greater risk of developing type 2 diabetes, health experts have been searching for ways to stave off the condition.

Further, because returning to healthy glucose regulation helps prevent the onset of type 2 diabetes, the DZD scientists proposed “the concept of remission of prediabetes in analogy to type 2 diabetes.”

Senior author Professor Dr. Andreas Birkenfeld, medical director of Medical Clinic IV at Tübingen University Hospital, and director of the Institute for Diabetes Research and Metabolic Diseases of Helmholtz Munich at the University of Tübingen, said:

“We aimed to explore the feasibility of commencing earlier and implementing preventive measures already at a stage that precedes type 2 diabetes, namely prediabetes, with the aim of reversing it.”

Prof. Birkenfeld and his team set out to uncover the mechanisms that can reverse prediabetes.

Insulin-body fat connection

The present study’s main outcomes were insulin sensitivity and secretion, visceral adipose tissue (VAT), and intrahepatic lipid content (IHL).

VAT is body fat or adipose fat that forms in the abdominal cavity and surrounds the intestines. Experts believe that an inflammatory response in adipose tissue may affect insulin sensitivity.

High IHL levels are associated with insulin resistance, type 2 diabetes, and heart and liver diseases.

The researchers assessed the Prediabetes Lifestyle Intervention Study (PLIS) and validated the results against participants from the Diabetes Prevention Program (DPP) study.

As part of the PLIS, scientists recruited 1,160 subjects from eight clinical study centers in Germany between 2021 and 2016. The volunteers received either a control lifestyle intervention, a standard DPP-based intervention, or an intensified intervention for 12 months.

DPP participants were recruited between 1996 and 1999 and randomly selected to receive either a standard lifestyle intervention, metformin, or placebo.

Responders were individuals who achieved remission by gaining healthy fasting plasma glucose, healthy glucose tolerance, and HbA1c less than 39 mmol/mol after 12 months of lifestyle intervention, placebo, or control intervention. Non-responders had numbers above these thresholds despite losing weight.

Of 1,160 PLIS participants, 298 (25.7%) lost 5% or more of their baseline body weight. Among the 298 individuals, 128 (43%) were responders and 170 (57%) were non-responders.

Surprisingly, Prof. Birkenfeld and his cohorts found that there was no difference in relative weight loss between the groups.

Those who achieved remission showed a remarkable improvement in insulin sensitivity, whereas non-responders did not.

The quantity of secreted insulin did not change in either group, though. This is an important difference compared to type 2 diabetes remission, which is contingent on enhanced insulin secretion.

Abdominal fat’s influence on insulin sensitivity

The German researchers ran a comparative analysis of the two groups to find what caused increased insulin sensitivity in the responders.

The experts saw that the responders had lost more abdominal fat compared to non-responders, even though they lost the same amount of body weight.

Waist reduction thresholds calculated that best-predicted remission was over 4.5 cm for women and 7.4 cm for men.

Medical News Today discussed the findings with Kimberly Gomer, a dietitian, and director of nutrition at Body Beautiful Miami in Miami, Florida, who was not involved in the study.

Gomer commented on the significance of fat loss in reversing prediabetes:

“The more insulin-resistant a person is, the more they are at risk for prediabetes and diabetes. In my private practice, I have always seen prediabetes and diabetes improve and many times go into remission when weight loss is achieved.”

“Prediabetes is directly connected to belly fat and visceral fat (the fat in and around the organs that causes the belly to stick out further). When belly fat is lost (which includes visceral fat), then the insulin resistance is lowered, which allows the blood sugar to be better controlled because that belly fat is not causing and aggravating insulin resistance.”
— Kimberly Gomer, nutritionist

MNT asked Kelsey Costa, registered dietitian nutritionist, and research communicator based in Connecticut, who was not involved in the study, about the strengths she saw in the research.

“The study deeply investigates the metabolic complications associated with high VAT and provides evidence that a significant reduction in VAT, particularly through weight loss, could be instrumental in improving insulin sensitivity and reversing prediabetes conditions,” she said.

Using surrogate parameters of insulin sensitivity or secretion was a significant limitation, though. However, the markers researchers used do correlate highly with the measurements.

The DZD team could not exclude the possible effect of confounders such as genetic, environmental, or other factors. They also noted that their findings might not apply to low-income countries with limited medical care available.

Moreover, most of the participants in both studies were white, which may limit generalizing the results to other ethnic groups.

Costa shared ways to help prevent prediabetes or type 2 diabetes.

“Some newer, less conventional lifestyle interventions for preventing prediabetes or type 2 diabetes include following a healthy plant-based diet and incorporating intermittent fasting. Studies have shown promising results in terms of improving insulin sensitivity and reducing the risk of developing diabetes with these approaches,” she said.

“Exercise, stress management techniques, and getting enough quality sleep also play crucial roles in preventing prediabetes and diabetes,” she added.

A new therapeutic target for diabetes

Professor Reiner Jumpertz-von Schwartzenberg, the study’s co-first author, said: “Based on the new data, remission should be the new therapeutic target in people with prediabetes. This has the potential to change treatment practice and minimize the complication rate for our patients.”

The research team also stated that their prediabetes remission criteria can now be used as biomarkers to determine whether a person has prediabetes.