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

Diabetologia. 2016 Aug;59(8):1753-9. doi: 10.1007/s00125-016-3984-6. Epub 2016 May 14.


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.

Keywords: Fractal analysis; Magnetic resonance imaging; Pancreas morphology; Reversal of type 2 diabetes; Very low energy diet; Volume rendering.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Blood Glucose / metabolism
  • Diabetes Mellitus, Type 2 / metabolism*
  • Diabetes Mellitus, Type 2 / pathology
  • Female
  • Humans
  • Insulin / metabolism
  • Insulin-Secreting Cells / metabolism
  • Magnetic Resonance Imaging
  • Male
  • Middle Aged
  • Pancreas / metabolism*
  • Pancreas / pathology
  • Weight Loss / physiology


  • Blood Glucose
  • Insulin