Morphology of the pancreas in type 2 diabetes: effect of weight loss with or without normalisation of insulin secretory capacity

Aims/hypothesis This study was designed to establish whether the low volume and irregular border of the pancreas in type 2 diabetes would be normalised after reversal of diabetes. Methods A total of 29 individuals with type 2 diabetes undertook a very low energy (very low calorie) diet for 8 weeks followed by weight maintenance for 6 months. Methods were established to quantify the pancreas volume and degree of irregularity of the pancreas border. Three-dimensional volume-rendering and fractal dimension (FD) analysis of the MRI-acquired images were employed, as was three-point Dixon imaging to quantify the fat content. Results There was no change in pancreas volume 6 months after reversal of diabetes compared with baseline (52.0 +/- 4.9 cm(3) and 51.4 +/- 4.5 cm(3), respectively; p = 0.69), nor was any volumetric change observed in the non-responders. There was an inverse relationship between the volume and fat content of the pancreas in the total study population (r =-0.50, p = 0.006). Reversal of diabetes was associated with an increase in irregularity of the pancreas borders between baseline and 8 weeks (FD 1.143 +/- 0.013 and 1.169 +/- 0.006, respectively; p = 0.05), followed by a decrease at 6 months (1.130 +/- 0.012, p = 0.006). On the other hand, no changes in FD were seen in the non-reversed group. Conclusions/interpretation Restoration of normal insulin secretion did not increase the subnormal pancreas volume over 6 months in the study population. A significant change in irregularity of the pancreas borders occurred after acute weight loss only after reversal of diabetes. Pancreas morphology in type 2 diabetes may be prognostically important, and its relationship to change in beta cell function requires further study.