> Diabet Med. 2012 Oct 17. doi: 10.1111/dme.12039.
> The 2012 Banting Lecture Reversing the twin cycles of Type 2 diabetes.

> It has become widely accepted that type 2 diabetes is inevitably life-long,
> with irreversible and progressive beta cell damage. However, the restoration
> of normal glucose metabolism within days after bariatric surgery in the
> majority of people with type 2 diabetes disproves this concept. There is now
> no doubt that this reversal of diabetes depends upon the sudden and profound
> decrease in food intake, and does not relate to any direct surgical effect.
> The Counterpoint study demonstrated that normal glucose levels and normal
> beta cell function could be restored by a very low calorie diet alone. Novel
> magnetic resonance methods were applied to measure intra-organ fat. The
> results showed two different time courses: a) resolution of hepatic insulin
> sensitivity within days along with a rapid fall in liver fat and
> normalisation of fasting glucose levels; and b) return of normal beta cell
> insulin secretion over weeks in step with a fall in pancreas fat. Now that
> it has been possible to observe the pathophysiological events during
> reversal of type 2 diabetes, the reverse time course of events which
> determine the onset of the condition can be identified. The twin cycle
> hypothesis postulates that chronic calorie excess leads to accumulation of
> liver fat with eventual spill over into the pancreas. These self-reinforcing
> cycles between liver and pancreas eventually cause metabolic inhibition of
> insulin secretion after meals and onset of hyperglycaemia. It is now clear
> that Type 2 diabetes is a reversible condition of intra-organ fat excess to
> which some people are more susceptible than others.
> PMID: 23075228