OBJECTIVEThis study determined whether the decrease in pancreatic triacylglycerol during weight loss in type 2 diabetes mellitus (T2DM) is simply reflective of whole-body fat or specific to diabetes and associated with the simultaneous recovery of insulin secretory function.
RESEARCH DESIGN AND METHODSIndividuals listed for gastric bypass surgery who had T2DM or normal glucose tolerance (NGT) matched for age, weight, and sex were studied before and 8 weeks after surgery. Pancreas and liver triacylglycerol were quantified using inphase, out-of-phase MRI. Also measured were the first-phase insulin response to a stepped intravenous glucose infusion, hepatic insulin sensitivity, and glycemic and incretin responses to a semisolid test meal.
RESULTSWeight loss after surgery was similar (NGT: 12.8 6 0.8% and T2DM: 13.6 6 0.7%) as was the change in fat mass (56.7 6 3.3 to 45.4 6 2.3 vs. 56.6 6 2.4 to 43.0 6 2.4 kg). Pancreatic triacylglycerol did not change in NGT (5.1 6 0.2 to 5.5 6 0.4%) but decreased in the group with T2DM (6.6 6 0.5 to 5.4 6 0.4%; P = 0.007). Firstphase insulin response to a stepped intravenous glucose infusion did not change in (P = 0.005). No differential effect of incretin secretion was observed after gastric bypass, with more rapid glucose absorption bringing about equivalently enhanced glucagon-like peptide 1 secretion in the two groups.
CONCLUSIONSThe fall in intrapancreatic triacylglycerol in T2DM, which occurs during weight loss, is associated with the condition itself rather than decreased total body fat.Type 2 diabetes mellitus (T2DM) has reached epidemic proportions, affecting 9.2% of the U.S. population and costing the country $322 billion in 2012 (1). The condition is widely recognized to be caused by a combination of insulin resistance and insulin secretory failure. However, insulin resistance alone does not cause blood glucose to rise (2), and T2DM occurs only when the acute insulin response of pancreatic b-cells becomes inadequate to control blood glucose (3,4). The etiologic process underlying this is still uncertain. Inhibition by excess intracellular fatty acids or their metabolites is a potential mechanism (5-7). We have previously demonstrated in people with T2DM that weight loss over 8 weeks can normalize the acute insulin response and