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Archive - 01 - 2006

Study Using New Imaging Technology Detects Subtle Brain Changes in Patients With Type 1 Diabetes

Posted by dlife on Tue, Jan 31, 06, 11:52 AM 0 Comment

January 31, 2006 (Eurekalert) - Although people with diabetes are twice as likely as the general population to develop depression, the cause of this increased risk is not well understood. Now, a Joslin Diabetes Center-led collaboration has documented for the first time subtle changes in the gray matter of the brain of type 1 diabetes patients compared to control subjects who did not have diabetes. They made these observations using voxel-based morphometry (VBM), a relatively new magnetic resonance imaging (MRI) technology that allows researchers to take very sensitive measurements of small regions in the brain. For the first time, doctors have reason to ask if the increased risk of depression could in fact be due to changes in brain. "We have known for a long time that diabetes can damage the nerves that control the extremities and those that control internal organs like the heart and the intestine," says the study's principal investigator, Alan M. Jacobson, M.D., head of Behavioral and Mental Health Research at Joslin Diabetes Center. "This research helps document diabetes-related changes to the central nervous system. People tended to assume that the stress of dealing with a severe chronic illness and its complications was the sole source of depression. That still is an important issue, but now we have evidence that something else might be at work." Equally important, by showing the effectiveness of VBM for observing and evaluating changes in brain structure that appear to be related to diabetes, the study opens up whole new approaches to understanding the central nervous system in diabetes. This technology creates three-dimensional images of magnetic resonance imaging data, which researchers can then use to observe and evaluate structural changes, in this case, in the brain. "We've used this technology to look at patients with bipolar disorder or with classic neurodegenerative disorders, but this is the first study to use VBM to investigate brain changes in patients with diabetes," says co-investigator Perry Renshaw, M.D., Ph.D., who directs the Brain Imaging Center at McLean Hospital in Belmont, Mass. For the study, the researchers measured gray matter densities in areas of the brain responsible for memory, language processing and attention. When they compared the images of 82 patients who had type 1 diabetes for 15 to 25 years with minimal complications to those of 36 age-matched control subjects who did not have diabetes, they discovered lower levels of gray matter density in the group with diabetes. Among that group, they also found that these lower levels in density were associated with poorer glycemic control and higher frequency of hypoglycemic events that led to unconsciousness. "This study definitely does not mean that everyone who gets type 1 diabetes will suffer from clinically significant brain damage," Dr. Jacobson emphasizes. Indeed, he explains that in fact they observed little difference in cognitive function when patients with diabetes were compared to the participants in the control group. What is important, however, is the new tool researchers now have to examine what changes do occur, what drives them, and how they may affect brain functions, including those that lead to depression. Understanding changes in brain structure becomes particularly critical as more and more people with type 1 diabetes are living longer lives, explains co-investigator Gail Musen, Ph.D., also of Joslin. "We want to be able to understand how the metabolic changes of diabetes affect the risks these patients face so we can find ways to minimize them as they go on to live 50 or more years with this disease." Dr. Jacobson and his colleagues will continue now to follow the patients in the study to observe if and how the changes progress over time and whether high or low blood glucose influences that progression. Because they can also use MRI to measure the brain's response to stimuli like cognitive or emotional tests, they will also start looking at functional changes. "Now that we've identified unexpected structural changes in the brains of people with diabetes, we need to understand more about how these relate to changes in brain function," says Dr. Renshaw. "The more we understand the problem, the better solutions we can find."

Obese Children Twice as Likely to Have Diabetes

Posted by dlife on Mon, Jan 30, 06, 11:55 AM 0 Comment

U-M researchers estimate more than 229,000 American children currently have diabetes; of those children, one-third are obese January 30, 2006 ANN ARBOR, Mich. (UMHS Newsroom) Childhood obesity can carry with it some heavy health risks that often last well into adulthood heart disease, high blood pressure and depression, to name a few.Obese children also are twice as likely to have diabetes than children who are of normal weight, according to a new study from the University of Michigan Health System.The study, published in the February issue of Diabetes Care, is the most recent national study to estimate the prevalence of children with diabetes. It found that more than 229,000 children approximately 3.2 cases for every 1,000 American children under the age of 18 currently have diabetes. And one-third of those children are obese.The study, was conducted by researchers with the Child Health Evaluation Research (CHEAR) Unit in the Division of General Pediatrics at the U-M C.S. Mott Childrens Hospital. It is based on data from the National Survey of Childrens Health (NSCH), a population-based household telephone survey sponsored by the Maternal and Child Health Bureau, the National Center for Health Statistics, and the Centers for Disease Control and Prevention.As childrens waistlines have continued to grow so has concern that obesity will lead to even more children developing diabetes before theyve graduated from high school. And caring for the combination of these childrens diabetes and obesity may place more strain on the health care system, says study lead author Joyce Lee, M.D., with the Division of Pediatric Endocrinology and CHEAR Unit at U-M."Among school-aged children, obese children have a greater than twofold chance of having diabetes, compared with children of normal weight, says Lee. The large number of children with diabetes in the U.S., and the potential for increasing numbers of children developing diabetes with the obesity epidemic, has serious implications for how these children will receive appropriate health care now and as they grow into adulthood.For their study, Lee and her colleagues used a sub-set of information gathered from NSCH interviews with the parents and guardians of 102,353 children from January 2003 through July 2004. As part of the interviews, the parents and guardians were asked if their childs health care professional had ever told them that their child has diabetes. The children were grouped into three categories based on their body mass index, or BMI: not overweight, overweight and obese. BMI was calculated using the height and weight of the child reported by his parent or guardian. Children with a BMI above the 85th percentile for their age and sex are classified as overweight, while those with a BMI above the 95th percentile are considered obese. For example, a 10-year-old boy of average height would be defined as obese if he weighed approximately 101 pounds or greater, says Lee.These data provided researchers with evidence of an association between childhood obesity and diabetes. The study found that children ages 6 to 11 and ages 12 to 17 who were obese were more than twice as likely to have diabetes than children of the same age who were of normal weight. The study estimates that nationally, 229,240 children have diabetes. Prevalence of diabetes was higher among older children, and the disease was more common among non-Hispanic white children than non-Hispanic black or Hispanic children.While one form of diabetes, type 2, is usually associated with obesity, data used for this study did not distinguish between the two types. Still, results point to a greater need for public health strategies to curb childhood obesity and reduce the number of children with diabetes, says Lee.These data create cause for concern, especially with a nationwide shortage of specialists who care for children with diabetes, notes Lee. From a clinical, public health and health resources perspective, we need to address childhood obesity head-on to help reduce the future burden of diabetes in the U.S. In addition to Lee, Melissa L. McPheeters, Ph.D., MPH; and James G. Gurney, Ph.D., with the CHEAR team in the U-M Division of General Pediatrics; and William H. Herman, M.D., MPH, with the Department of Internal Medicine at the U-M Medical School and the Department of Epidemiology at the U-M School of Public Health, co-authored the study.The study was funded by a National Institutes of Health Pediatric Health Services Research Grant.

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