Fig. 2.

The Counterbalance study. Thirty people with type 2 diabetes of up to 23 years duration lost approximately 15 kg in weight then maintained steady weight for 6 months. Those achieving non-diabetic fasting plasma glucose levels were classified as responders and those whose levels remained in the diabetic range, as non-responders. In (b-d) the three columns for each group represent (from left to right) baseline on usual drug therapy; after weight loss, on an isoenergetic diet; and after a further 6 months of weight stability. (a) The change in HbA_1c in responders (circles) and non-responders (triangles). (b) There was a similar and sustained decrease in liver fat content in both groups despite ongoing overweight or obesity. (c) In the responders, pancreas fat decreased to low levels, but in the non-responders only fell to levels equivalent to baseline responder levels. (d) At baseline, the first-phase insulin response was higher in responders and increased to normal levels, whereas the grossly deficient baseline level in non-responders hardly changed. Although non-responders normalise both liver fat content and liver insulin sensitivity, plasma glucose remains elevated in the absence of normalised beta cell function and low fasting plasma insulin levels [9]. *p < 0.05; **p < 0.01 vs baseline. To convert HbA_1c values from % to mmol/mol, subtract 2.15 and multiply by 10.929. Triglyceride is elsewhere referred to as triacylglycerol. Copyright: ADA [9]. Copyright and all rights reserved. Material from this publication has been used with the permission of ADA