Weight Loss May Delay Type 1 Diabetes; African Foods Show Anti-Inflammatory Promise

A 2026 TrialNet analysis found that autoantibody-positive people with overweight or obesity who later reached a normal BMI had a lower observed risk of progressing to stage 3 type 1 diabetes. The analysis, published in Diabetes Care, examined 833 participants in the TrialNet Pathway to Prevention cohort, all positive for islet autoantibodies and with overweight or obesity at baseline. Therefore, the researchers were studying people who already had evidence of increased T1D risk rather than the general population. The finding does not prove that intentional weight loss prevents type 1 diabetes, but it raises the question of whether reducing metabolic demand could help vulnerable beta cells withstand autoimmune pressure for longer.

During a median follow-up of 4.1 years, 26.8% of participants reached a normal BMI range. After adjustment for baseline age, BMI z score, and T1D stage, BMI normalization was associated with a 48.4% lower hazard of progression to stage 3 T1D, with an adjusted hazard ratio of 0.516. The association was strongest in younger participants: among 421 youth, BMI normalization was associated with lower progression risk, while the association was not statistically significant among the 412 adults. Researchers also found associations with reduced progression from stage 1 to stage 2 and from stage 2 to clinical stage 3 disease, while the evidence was less clear for progression from stage 0 to stage 1. These differences matter when researchers study ways to delay type 1 diabetes because they suggest body size may have greater influence after islet autoimmunity has developed. However, further research is needed to determine whether changing weight or metabolic health can directly alter disease progression.

Type 1 diabetes is fundamentally an autoimmune disease. The immune system attacks pancreatic beta cells, gradually reducing the body's ability to produce insulin. Still, autoimmune destruction does not occur in metabolic isolation. Excess adiposity commonly increases insulin resistance. Consequently, beta cells must produce more insulin to keep glucose within a healthy range. A healthy pancreas may compensate for that demand. However, beta cells already under autoimmune attack have less functional reserve. Exploratory analyses involving measures of insulin sensitivity, insulin resistance, and beta-cell compensation altered the statistical relationship between BMI normalization and disease progression. The authors concluded that excess adiposity may accelerate progression through preclinical T1D, with metabolic factors potentially becoming more important after autoimmunity is established.

This was an observational analysis, not a randomized weight-loss trial. Participants were not randomly assigned to lose weight, maintain weight, or follow a particular lifestyle program. Participants who reached a normal BMI were younger and initially had lower BMI z scores, and they showed differences in several metabolic measurements. Although statistical adjustments can account for some differences, they cannot eliminate every potential confounding factor. BMI normalization in growing children deserves special caution, as a child's BMI can move into the normal range through changes in growth and body composition.

Separate research examined the role of indigenous African food groups in preventing and managing type 2 diabetes mellitus. Inflammation is the body's natural response to injury or infection, but ongoing inflammation can damage healthy tissues and blood vessels, interfere with how the body uses sugar and fat, and weaken the immune system. Over time, this ongoing inflammation can lead to diseases such as diabetes. The worldwide number of people living with diabetes rose from 200 million in 1990 to 830 million in 2022, and prevalence has been rising more rapidly in low- and middle-income countries than in high-income countries. In 2021, diabetes and kidney disease due to diabetes caused over 2 million deaths.

A review of 46 research articles conducted between 2010 and 2023 examined the role of indigenous African food groups in preventing and managing type 2 diabetes mellitus. The review found that many African food groups significantly reduce oxidative stress linked to type 2 diabetes, and several phenolic compounds in these food groups confer anti-inflammatory properties. The findings provide useful information for the development of African traditional therapeutic meals tailored for patients with type 2 diabetes in Africa.

The traditional African diet primarily consists of cereals, legumes, fruits, vegetables, milk and poultry, with a notable emphasis on edible insects and low red meat consumption. Many indigenous foods such as okra leaves, nightshade, amaranth and cowpeas are underutilized in modern cooking and farming. Over time, many Africans have shifted from traditional African diets, which are rich in fiber, polyphenols and antioxidants, to a western diet high in sugar, salt and unhealthy fats. This change has significantly increased the risk of type 2 diabetes.

Edible insects like ants, caterpillars, crickets and locusts release substances called angiotensin-converting enzyme and antioxidant hydrolyzates/peptides. Locust peptides can block certain enzymes involved in breaking down sugars and fats. The review also found common beneficial components in insects include chitin, polyphenols, antimicrobials and peptides/proteins, which can help reduce oxidative stress in people with diabetes. Caterpillars have two to five times more antioxidant capacity than orange juice or olive oil, and locusts have high levels of antioxidants and lipoxygenase. Lipoxygenase helps produce anti-inflammatory compounds that support cellular health and modulate inflammation.

African leaf vegetables such as cowpea, nightshade, amaranth and okra leaves can help lower blood sugar levels. In one study, patients with type 2 diabetes who consumed blackjack (Bidens pilosa) saw their fasting blood sugar drop after treatment. Blackjack is a traditional vegetable in southern Africa. The leaves can be cooked or they can be used to brew tea.