Better Blood Sugar Control Could Reverse Diabetes-Related Brain Damage



According to the latest study, Type 1 diabetes-related brain damage in teenagers may be treatable.

In a study recently published in the journal Nature Communications, researchers found that teens with Type 1 diabetes who closely monitor their blood sugar levels may be able to decrease the disease's negative effects on the brain, effects that have been observed even in younger children. According to the findings, better glucose control may potentially improve the structure and function of the brain in children with Type 1 diabetes, bringing them closer to their non-diabetic peers.

This proof-of-concept pilot trial, the most extensive study on the subject to date, was directed by researchers from Stanford University School of Medicine and Nemours Children's Health in Jacksonville.

Pediatric endocrinologist Nelly Mauras, MD, of Nemours Children's Health Jacksonville and professor of pediatrics at Mayo Clinic College of Medicine, is the paper's senior author and co-principal investigator. She said, "These results offer hope that harm to the developing brain from Type 1 diabetes might be reversible with rigorous glucose control." The use of an automated hybrid closed-loop system, which consists of an insulin delivery system connected to a continuous glucose monitor, was linked to lower blood glucose levels, which translated in our study into quantifiable alterations in brain structure and cognition.

The five-center Network for Diabetes Research in Children conducted the study (DirecNet). An eight-year longitudinal data set on a cohort of kids with and without diabetes is part of the National Institutes of Health (NIH)-funded DirecNet. Studies from DirecNet have bolstered the argument that elevated blood sugar levels are to blame for the detrimental changes in the brains of children and teenagers with diabetes, including impacts like lower than average IQ.

42 adolescents, aged 14 to 17, with Type 1 diabetes who were taking insulin therapy were enrolled by Dr. Mauras and the DirecNet researchers. One set of the youths received regular diabetic care, while the other received treatment utilizing a hybrid closed-loop insulin delivery device. Before and after the six-month trial period, the researchers tested each participant's cognitive abilities and used multimodal brain imaging.

The length of time that blood sugar is in a healthy range can be extended when a hybrid closed-loop insulin delivery device is used correctly and consistently. As early indicators of hypoglycemia are harder to spot and treat when you're sleeping, it specifically aids in blood sugar stabilization during that time. Through a sensor beneath the skin, the system measures blood sugar every five minutes using a closed glucose monitor (CGM). An insulin pump that wirelessly links to the CGM regulates the dosage of insulin in accordance with the most recent CGM data.

Participants who used the closed-loop glucose management device improved much more than the standard care group in key brain measures indicating typical teenage brain development, so their outcomes were more similar to those of adolescents without diabetes. Additionally, the closed-loop group demonstrated improved cognitive (IQ) results and functional brain activity, which were more consistent with typical adolescent brain development.

We've known for a while that people with Type 1 diabetes who have improved blood glucose control can avoid or lessen harm to a variety of biological systems (for example, kidney, eyes, nerves, blood vessels). The Howard C. Robbins Professor of Psychiatry and Behavioral Sciences and a Professor of Radiology at Stanford, Allan Reiss, MD, is the lead author and co-principal investigator of the study. "Our new research joins with other studies to highlight that better control of blood glucose levels in children with Type 1 diabetes can potentially reduce injury to the maturing brain and lead to measurable improvements in brain development and function as well," he said.

The immune system of the body incorrectly kills insulin-producing cells in the pancreas in type 1 diabetes, an autoimmune illness. There is currently no known remedy and its causes are not well understood. It is estimated that 244,000 children and adolescents in the United States have this illness, which can occasionally lead to major health issues that emerge suddenly or later in life. The results of this investigation support other studies that demonstrate that careful blood sugar control reduces the incidence of diabetic sequelae like blindness, kidney failure, and amputations.

The Eunice Kennedy Shriver National Institute of Child Health and Human Development and the Juvenile Diabetes Research Foundation provided funding for the study.

By NEMOURS 

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