Type 2 Diabetes Remission in the GLP-1 Era | Prof Roy Taylor

Simon Hill (0:04)

Just under three years ago now, you came on and we focused on that episode, on this question of, can you reverse type 2 diabetes or can you put it into remission? Three years on, have your thoughts on that question, have they evolved or changed in any material way?

Roy Taylor (0:24)

Well, I'm very pleased to say that the central matter of the potential reversibility of type 2 diabetes is absolutely solid.

Now, that's quite important because it was such a revolutionary change when I was able to announce that in 2011 And since then, we've really put the building block steadily in place. And so, it's been a matter of steady progress.

It's taken a long time to be assimilated, but there are national programs now that use my methods to achieve not only reversal of type 2 diabetes, but durable remission of type 2 diabetes. So, that's really quite exciting to see this all develop. And there are some other aspects that are on the horizon, especially in respect to pregnancy. So yes, we're in a good position with moving everything forwards.

Simon Hill (1:20)

Let's start with your model. Can you give us the two-minute version of the twin-cycle hypothesis or perhaps more accurately model, I should say, how a small sort of chronic calorie excess, as you explained to me last time, ends up causing this dysfunction in the liver and pancreas and to a point where someone is diagnosed with type 2 diabetes?

Roy Taylor (1:46)

Yes, if we rewind back to 2008, we had assembled all the basic building blocks to understand that fat in the liver was bad news in type 2 diabetes and that it was potentially able to be taken out of the liver by weight loss. And we knew some things about the way the insulin producing cells worked that could potentially tie it together.

Now, when the final building block dropped into place, it took me quite a while to figure out how all these things would be interrelated. But eventually, the twin-cytal emerged. And this was the idea that there was a cytal, a vicious cytal in the liver, which started going and that knocked onto a vicious cytal in the pancreas. And as they ground slowly on together, they would interact, the effect would be magnified. The end result was Type 2 Diabetes. Now I found that this was important because it was testable. Now any hypothesis is interesting, but it's only going to survive if it's tested to the full. We try and defeat the hypothesis, to try and overturn it. And so this hypothesis could easily be overturned by getting people with ordinary Type 2 Diabetes to lose weight.

And if all my predictions about what would happen in the liver, in the blood, and in the pancreas didn't happen and the diabetes didn't go away, the hypothesis was wrong. But it turned out the hypothesis was crashingly correct. And that's what we published in 2011 That was demonstrating just what causes Type 2 Diabetes. And it's really quite exciting to see the way that the mechanics of this disease works. Everything else flows from that. But of course, as soon as this was announced, people were saying, could I get rid of my diabetes? And so I had to turn my attention to possibly turning this into a tool that could be used in clinical practice.

And over several trials, we did that. It works very well. It's a challenge to anyone. But people who are motivated find it the easiest way to lose weight. And I should say, we're talking about losing quite a lot of weight. 15kg or about 2.5 stone.

That is possible. And we're able to say with confidence, this is the best way of dealing with early type 2 diabetes. And now we have our national program that puts this into practice in England.

Simon Hill (4:40)

Can you remind us what are the conditions that predispose someone to storing fat in the incorrect place, to storing fat within the liver, which kind of kickstarts that twin cycle model that you speak to in the first place?

Roy Taylor (4:58)

The critical factor is the matter of eating.

Eating and burning energy, of course. If people are taking in just a few more calories every day, then they're actually burning in, running their body, having their heart beat, having their lungs expanding and tract, all that energy, as well as moving around, then those few extra calories are going to build up. And anyone's body can only deal one thing with it, and that's to turn it into fat, and it gets stored.

Now, that's the absolute starting point, but then the luck of the draw kicks in, because we know that some people can store a vast amount of fat and never get Type 2 diabetes. You might say they're quite lucky, but people have only a finite capacity for storing fat under the skin. Some people, like me, don't have very much capacity at all. And for those people, if they put on even a modest amount of weight, they can get the fat building up in the liver and start off this horrible process. So here we have a combination of the genetic predisposition, but the absolute switch on or switch off, which is the amount of fat that's being stored in the body.