What can functional brain imaging teach us about remission of type 2 diabetes?

Abstract

With a paradigm shift in attitudes to type 2 diabetes (T2D), “weight‐loss responsive” diabetes is now thought of as a curable disease state. As a result, national programmes are being orchestrated to induce T2D remission soon after diagnosis with aggressive dietary interventions – such as very‐low‐calorie diets (VLCD). However, dietary interventions to achieve weight loss and diabetes remission lack the same long‐term sustainability and cardiovascular risk reduction evidence as bariatric surgery. Improving our understanding of the neural implications of T2D that promote disadvantageous eating behaviours will enable prevention of disease as well as mitigation against a vicious cycle of metabolic dysfunction and associated cognitive complications. Here we summarise how functional MRI (fMRI) studies have helped to fashion our understanding of the neurobiology of human appetite and obesity. We explore how these neural correlates are affected by insulin resistance and T2D itself as well as its different treatment approaches. Finally, we comment on the need for more personalised approaches to maintaining metabolic health and how fMRI studies may inform this.

Basic science lays the foundation to success

“…In developing future outstanding UK researchers in diabetes, Diabetes UK supports both basic and clinical professionals through the award of several career‐enhancing funding programmes, namely the 5‐year RD Lawrence and Harry Keen Fellowships. This year, we are fortunate to have excellent articles from both current (Mcilroy, 2 Moffett, 3 Leete 4 ) and former (Hodson, 5 Yaghootkar 6 ) RD Lawrence and Harry Keen (Salem 7 ) fellows. The breadth of expertise on offer covers an array of topics including the use of therapeutic strategies in restoring adipose tissue function in rare disorders of lipodystrophy 2 and in diabetes‐induced fertility problems, 3 and an accessible overview of histological advances made in characterisation of type 1 diabetes development and the endotype concept 4 .…”

“…In addition, we commissioned articles from presenters at the conference “Imaging” symposium. Hanieh Yaghootkar reports on how fat distribution is linked to type 2 and diabetes complications, 6 while former Harry Keen fellow Victoria Salem explains how brain imaging can be used to teach us about the remission of type 2 diabetes 7 …”