Better blood sugar control reverses diabetes-related brain damage, study finds

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Researchers from the Stanford University School of Medicine and Nemours Children's Health Center in Jacksonville collaborated to lead this proof-of-concept pilot study, the most thorough study of the issue to dateinvestigation.

Senior author Nelly Mauras, MD, a pediatric endocrinologist at Nemus Children's Health Center in Jacksonville and professor of pediatrics at the Mayo Clinic School of Medicine, said: "These results areType 1 diabetes offers hope that damage to the developing brain may be reversible with tight glucose control. Using an automated hybrid closed-loop system -- an insulin delivery system linked to a continuous glucose monitor -- is associated with better blood sugar concentrations, which translated into quantifiable differences in brain structure and cognition in our study."

The study was conducted through the Children's Diabetes Research Network (DirecNet) at five centers.DirecNet, funded by the National Institutes of Health (NIH), includes longitudinal data from a cohort of children with diabetes over approximately 8 years.The DirecNet study reinforces that high blood sugar levels are responsible for negative brain changes in children and adolescents with diabetes, including the effects of lower-than-normal IQs.

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Dr. Mauras and DirecNet investigators recruited 42 adolescents between the ages of 14 and 17 who were diagnosed with type 1 diabetes before age 8 and were receiving insulin.The teens were randomly assigned to one of two groups -- one using a hybrid closed-loop insulin delivery system and the other receiving standard diabetes care.The researchers performed cognitive assessments and multimodal brain imaging on all participants before and after the six-month study period.

A hybrid closed-loop insulin delivery system that, when used properly and consistently, can increase the time blood sugar is in a healthy range.It is especially helpful in stabilizing blood sugar during sleep, when it is more difficult to detect and treat early signs of hypoglycemia.The system uses a closed blood glucose monitor (CGM) that measures blood sugar every 5 minutes via sensors under the skin.The CGM connects wirelessly to an insulin pump, which adjusts insulin doses based on the latest CGM readings.

Participants using the closed-loop blood sugar control system showed significant improvements over the standard care group in key brain markers indicative of normal adolescent brain development -- in other words, their results were more pronouncedApproaching teens who don't have diabetes.The closed-loop group also showed higher cognitive (IQ) outcomes and brain functional activity, more in line with normal adolescent brain development.

"We already know that better control of blood sugar levels in people with type 1 diabetes can prevent or reduce damage to some biological systems (eg, kidneys, eyes, nerves, blood vessels)"Our new study joins other studies to highlight that better control of blood sugar levels in children with type 1 diabetes may reduce damage to the mature brain and lead to measurable improvements in brain development and function," said lead author and co-chiefInvestigator Dr. Allan Reiss, the Howard C. Robbins Professor of Psychiatry and Behavioral Sciences and a professor of radiology at Stanford University, said.

Type 1 diabetes is an autoimmune disease in which the body's immune system mistakenly destroys the insulin-producing cells in the pancreas.Its cause is not fully understood, and there is currently no treatment.An estimated 244,000 children and adolescents in the U.S. suffer from the disease, which sometimes causes serious health problems that develop rapidly or appear later in life.This study builds on previous research showing that strict blood sugar control reduces the incidence of diabetes complications such as blindness, kidney failure and amputations.

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