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Recent work has shown that type 2 diabetes can be reversed to a durable, non-diabetic state in the majority of people with disease duration less than 6 years. This can be brought about by a well tolerated low calorie diet achieving around 15kg weight loss. Those who became and remained non-diabetic maintained weight loss of 10.5kg after 2 years of follow up. Remission was associated with a dramatic fall in liver fat content to low normal, largely maintained over 2 years. The elevated pancreas fat content of type 2 diabetes also fell during the initial period of low calorie diet, although not completely to normal. However, the underlying mechanisms of change in intra-organ triglyceride differ sharply. One of the major functions of the liver is to export triglyceride in the form of VLDL-TG and additionally, the high metabolic rate of this organ will permit rapid oxidation for triglyceride for immediate energy requirements. In contrast, neither the exocrine nor endocrine cells of the pancreas can export triglyceride, and decrease in intra-organs levels can only come about by fall in rate of supply from VLDL-TG and relatively slow intra-organ usage for energy. The specific adverse effects of the excess triglyceride in each organ differ sharply. The relative processes will be illustrated by data on the acute changes brought about by hypocaloric dieting and the longer term changes maintained by avoidance of return to previous body weight. Overall, type 2 diabetes can now be understood as a state of excess fat in both liver and pancreas which is potentially reversible with major health benefits.
Roy Taylor qualified in medicine at the University of Edinburgh, and is Professor of Medicine and Metabolism at Newcastle University and Newcastle Hospitals NHS Trust. He founded the Newcastle Magnetic Resonance Centre in 2006 to develop innovative research techniques for all medical specialities. In 2011 he showed that type 2 diabetes was a simple, reversible condition of excess fat within liver and pancreas. His subsequent work has clarified the underlying abnormalities of lipid metabolism, all of which are potentially correctable by substantial weight loss. The elucidation of the pathophsyiology of type 2 diabetes has led to practical application with demonstration of durable remission achieved by primary care staff. Professor Taylor also developed the system now used throught the United Kingdom for screening for diabetic eye disease, with major reduction in blindness due to diabetes across the UK.