Development and potential reversal of type 2 diabetes: How critical is vitamin A in the regulation of insulin responsiveness and lipid homeostasis?

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The rapid increase in number of people affected by type 2 diabetes is matter of grave concern. Diabetes is a world-wide problem and has risen from 108 million in 1980 to 422 million in 2014. In the Philippines, one out of every six Filipino has either pre-diabetes or diabetes. Recent studies have shown that type 2 diabetes develops by excess, yet reversible, fat accumulation in liver and pancreas. There is also some evidence suggesting that vitamin A may contribute to this condition, but the underlying mechanisms are not yet fully understood. Furthermore, it is not yet clear why some people develop type 2 diabetes faster than others, even with a similar liver fat content. The proposed study therefore aims to understand if vitamin A increases the metabolic stress that is caused by a fatty liver, and if changes in vitamin A metabolism could contribute to an increase in liver fat, therefore inducing a vicious cycle of liver fat accumulation and acceleration of the development of diabetes. The study will finally evaluate if diet-induced weight loss among diabetics in the Philippines could improve all aspects of diabetes control, and if a low energy liquid diet is culturally acceptable. Finally, the project may help to develop new prevention strategies to enable the Ministry of Health to reduce the burden of diabetes and its complications in the Philippines.