Having type 2 diabetes and being overweight, then, can combine to have a greater effect on brain structures.

"There's a general agreement that type 2 diabetes is a risk factor for various types of both structural and functional abnormalities in the brain," said Dr. Donald C. Simonson, a co-author of the study and an endocrinologist specializing in diabetes. "Simple obesity also shows the same type of abnormalities ... in a milder stage. You can see where it's not quite exactly normal but not quite as bad as someone with diabetes.

"So, if you have both, will it be worse than if you have them alone? That's what we looked at in this particular study," said Simonson, who teaches at Harvard's T.H. Chan School of Public Health.

Dr. In Kyoon Lyoo, lead author and a professor at the Ewha Brain Institute at Ewha Womens University in Seoul, South Korea, wrote in an email, "As obesity has been known to be associated with metabolic dysfunction, inflammation, and brain changes independently of diabetes, we expected that brain alterations might be more pronounced in overweight/obese participants with type 2 diabetes."

Lyoo, Simonson and their colleagues designed a study around 50 overweight or obese people age 30 to 60 who had been diagnosed with type 2 diabetes.

Fifty normal-weight people diagnosed with type 2 diabetes and 50 normal-weight people without diabetes also participated. These additional participants were age and sex matched to the original group. Those diagnosed with diabetes were also matched for disease duration. Standard body mass index ranges defined "overweight" (having a BMI of 25 to 29.9), "obese" (greater than 30) and "normal weight" (18.5 to 25).

The researchers used magnetic resonance imaging to examine each participant's brain structure, including the thickness of the cerebral cortex and white matter connectivity. Gray matter in the brain contains the neuron cell bodies, whereas white matter contains bundles of nerve fibers and its job is to process and send signals along the spinal cord.

The researchers chose to study thickness and connectivity "because these could be sensitive markers of diabetes-related brain changes, and could be reliably quantified by using magnetic resonance imaging," Lyoo explained.

Participants also were tested for memory, psychomotor speed and executive function, since these are known to be affected in people with type 2 diabetes.

The results aligned with the researchers' initial assumptions, Lyoo said.

Clusters of gray matter were significantly thinner in the temporal, prefrontoparietal, motor and occipital cortices in the brains of diabetic participants than in the non-diabetic group, the study found. More thinning of the temporal and motor cortices could be seen in the overweight/obese diabetic group compared with normal-weight diabetics. Separately and collectively, these areas of the brain impact motor control, executive function, body awareness, concentration and other cognitive functions.

"Most of the things we looked at, you could see that there was a progression, and the obese patients with diabetes were worse than the lean patients with diabetes, and they were both worse than the age-matched controls," Simonson said.

In particular, the temporal lobe appears vulnerable to the combined effects of type 2 diabetes and being overweight or obese, the researchers say. The temporal lobe is implicated in language comprehension and long-term memory.

The brain has been the last frontier in the study of complications of diabetes, Simonson said.

"Diabetic retinopathy, eye disease, is reasonably well-understood," he said. "The same is true of kidney disease, amputations -- we understand much better what causes them and how to prevent them.

"But the brain has been the proverbial black box. It's incredibly complicated, and you can't directly study it. You can't go in and take samples," he said. "The last several years, the techniques of MRI got good enough that we could really look carefully at the brain."

Most of the initial work in the very late 1990s was done in Alzheimer's, schizophrenia, depression and other classic psychiatric diseases, but then scientists began to look at other diseases including diabetes, explained Simonson. At this point, researchers around the world began to see connections.

"You can see a person with depression has thinning of the surface of the brain in certain areas, and you go in and do the same study with somebody with diabetes, and they have thinning in the exact same areas," Simonson said. And diabetes may be a predisposing or risk factor for developing Alzheimer's, he said.

"You see the same types of abnormalities in a milder form in the brain in people with diabetes that you see in people with Alzheimer's disease," Simonson said.

According to Dr. William T. Cefalu, chief scientific, medical and mission officer of the American Diabetes Association, the study is consistent with previous research.

"The presence of overweight and obesity have been shown in other studies to be associated with early structural changes in the brain, and may contribute to cognitive issues," said Cefalu, who was not involved in the new study. "The current study implies that obesity/overweight status in individuals with diabetes may also contribute."

That said, longer-term and more definitive studies are needed to evaluate that aspect.

In the end, Simonson said, another question is more important: "What can you do to prevent it? That's the big question."

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Diabetes, weight can combine to alter brain, study says - CNN

By Walter Villa | Apr 27, 2017 Sepcial to espnW

Courtesy the Reese family

Senior night was emotional for Cate, left, and Ali Reese, not to mention all the friends and family in the stands.

When Cate Reese was 2 years old, she scampered on tiny legs from the front door of the family townhouse to the back. Then she did it again. And again. And again.

Fifteen years later, the 6-foot-3 junior forward for Cypress Woods (Cypress, Texas) and the No. 14 prospect in the espnW HoopGurlz Super 60 for 2018 class is still in constant motion. Reese beats opponents from rim to rim. She fidgets in the huddle. She chews gum incessantly. Movement every second.

"It's crazy how much gum I buy," said her mom, Cheryl. "I buy 10 packs at a time, and she blows through it."

Reese has been a starter since her freshman year, when she helped lead Cypress Woods to its only state title. She averaged 22.3 points and 13.2 rebounds this past season, making first-team all-state.

Not even the life-altering news she got a year ago has been able to stop her.

On April 4, 2016, Reese was told she had Type 1 diabetes, a diagnosis that stunned her even though her older sister, Ali, has dealt with the same disease for the past eight years. Cate had hoped to avoid that fate.

"Initially, it was devastating for Cate," Cypress Woods coach Virginia Flores said. "I pulled her into my office and asked her what was getting to her the most about her situation. ... To her, everything and everyone is beatable. But diabetes is not something you defeat. It's something you manage. So when she said, 'This is forever,' my heart just broke for her in that moment."

She's learned a lot about her disease and herself since that day.

"It's made me see life through a different perspective," she said. "You only get one life to live. I'm grateful I can still play. I'm still here."

Courtesy the Reese family

Basketball programs across the country are trying to land Cate Reese, right, for college. It could be that she'll stick by her sister's side.

Reese was a premature baby, and she was kept in the hospital's neonatal intensive care unit for three weeks because her lungs were not developed enough at birth.

Cheryl said she never saw her daughter cry or even move.

She was brought home on a memorable Thanksgiving eve. Soon after, came the pulling, pushing, crying. And crawling. Before long, her favorite saying: "Are you going to eat that?"

She was precocious, too. At age 4, she told her parents she was no longer Catherine or Catie. She was Cate. "I guess I was pretty sassy," Reese said.

She started playing basketball at age 7, and she has grown in her game and in her stature. She is six inches taller than her sister and mother and maybe just a hair taller than Bill, her father.

Bill, by the way, wasn't much of an athlete and didn't expect Cate to be nearly this good.

"She was always tall, but she was gawky," he said. "I always used to tell her, 'You are going to be this tall [player] at the end of the bench.'"

Courtesy the Reese family

Ali Reese, left, recognized the danger signs in Cate and has helped guide her through the uncertain times caused by diabetes.

Bill Reese was spectacularly wrong.

By Cate's freshman year, she averaged 12.2 points and 8.3 rebounds on that championship team that featured five other Division I recruits. She averaged 20.8 points and 12.8 rebounds as a sophomore, the same year she joined the Texas Elite AAU team.

It was there that she impressed coach Joey Simmons.

"She's a bulldog," Simmons said. "She plays as hard as anybody I've coached. If the ball is loose, she is diving at it, jumping for it, pushing, shoving -- anything it takes. She never stops the whole game. She's a special player when it comes to being relentless."

You only get one life to live. I'm grateful I can still play. I'm still here.

Cate Reese

Simmons said Arizona, South Carolina and Texas A&M have been pushing hard to sign Reese. But Reese said she has yet to decide on favorites.

She is grateful, however, that her parents have been involved, accompanying her on unofficial visits to numerous colleges. Reese said she prefers a warm-weather school but is open to all possibilities. So far, she has visited Colorado, Washington, SMU, Texas Tech, Baylor, Texas Christian, Oklahoma State, Rice, Arizona, South Carolina, Texas A&M and George Washington, and she has scholarship offers from all those schools.

"She's a phenomenal athlete," Ali said of her sister, who is a senior on the Cypress Woods team. "She has a huge passion for the game that I don't see in other people."

Indeed, Cate's competitiveness is legendary among those who know her well.

"When I lose," Cate said, "it's not a fun car ride home."

Ali wants to study nursing but will not continue with basketball in college. Cate, who has more than 1,000 career rebounds and is less than 200 away from 2,000 points, wants to pick a school by September.

Both girls want to attend the same college, if possible. So wherever Ali goes ... Cate may follow.

Courtesy the Reese family

The one thing Cate Reese didn't want to share with her sister was diabetes.

The sisters have always been close, but the events of the last year have brought them even closer.

It was Ali who saw her sister overly thirsty last year and immediately tested Cate's blood sugar, forcing an urgent trip to the hospital and avoiding a situation that could have become dire if left unattended.

And it's Ali who has been there to answer Cate's questions, let her know what to expect and guide her in her new reality.

On the court, though, the sisters yelled at each other so much that Flores told them they would not play together if they couldn't find a way to get along.

"I get very passionate, and I yell at people," Cate said. "But I don't mean it like that -- I just get excited."

Cate is disappointed that Ali has chosen not to pursue college basketball.

"She has the skills to play at the next level," Cate said. "I love basketball so much that it's hard to believe when others don't love it as much as I do."

A couple of months ago, on senior night, tears flowed on the court as fans, friends and family watched the ceremony. And the sisters.

"Along the way," Cate said, "I've met a lot of teammates who have become like my sisters. But it's been great the past two years of high school and the past four years in AAU to play with my actual sister. It's hard to put into words how much she means to me. She's my biggest supporter and my best friend. I don't know what I would do without her."

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With a motor and a mentor, elite basketball recruit Cate Reese moves forward with diabetes - ESPN

Columbia University researchers have developed a personalized algorithm that predicts the impact of particular foods on an individual's blood sugar levels. The algorithm has been integrated into an app, Glucoracle, that will allow individuals with type 2 diabetes to keep a tighter rein on their glucose levels -- the key to preventing or controlling the major complications of a disease that affects 8 percent of Americans.

The findings were published online today in PLOS Computational Biology.

Medications are often prescribed to help patients with type 2 diabetes manage their blood sugar levels, but exercise and diet also play an important role.

"While we know the general effect of different types of food on blood glucose, the detailed effects can vary widely from one person to another and for the same person over time," said lead author David Albers, PhD, associate research scientist in Biomedical Informatics at Columbia University Medical Center (CUMC). "Even with expert guidance, it's difficult for people to understand the true impact of their dietary choices, particularly on a meal-to-meal basis. Our algorithm, integrated into an easy-to-use app, predicts the consequences of eating a specific meal before the food is eaten, allowing individuals to make better nutritional choices during mealtime."

The algorithm uses a technique called data assimilation, in which a mathematical model of a person's response to glucose is regularly updated with observational data -- blood sugar measurements and nutritional information -- to improve the model's predictions, explained co-study leader George Hripcsak, MD, MS, the Vivian Beaumont Allen Professor and chair of Biomedical Informatics at CUMC. Data assimilation is used in a variety of applications, notably weather forecasting.

"The data assimilator is continually updated with the user's food intake and blood glucose measurements, personalizing the model for that individual," said co-study leader Lena Mamykina, PhD, assistant professor of biomedical informatics at CUMC, whose team has designed and developed the Glucoracle app.

Glucoracle allows the user to upload fingerstick blood measurements and a photo of a particular meal to the app, along with a rough estimate of the nutritional content of the meal. This estimate provides the user with an immediate prediction of post-meal blood sugar levels. The estimate and forecast are then adjusted for accuracy. The app begins generating predictions after it has been used for a week, allowing the data assimilator has learned how the user responds to different foods.

The researchers initially tested the data assimilator on five individuals using the app, including three with type 2 diabetes and two without the disease. The app's predictions were compared with actual post-meal blood glucose measurements and with the predictions of certified diabetes educators.

For the two non-diabetic individuals, the app's predictions were comparable to the actual glucose measurements. For the three subjects with diabetes, the app's forecasts were slightly less accurate, possibly due to fluctuations in the physiology of patients with diabetes or parameter error, but were still comparable to the predictions of the diabetes educators.

"There's certainly room for improvement," said Dr. Albers. "This evaluation was designed to prove that it's possible, using routine self-monitoring data, to generate real-time glucose forecasts that people could use to make better nutritional choices. We have been able to make an aspect of diabetes self-management that has been nearly impossible for people with type 2 diabetes more manageable. Now our task is to make the data assimilation tool powering the app even better."

Encouraged by these early results, the research team is preparing for a larger clinical trial. The researchers estimate that the app could be ready for widespread use within two years.

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Diabetes app forecasts blood sugar levels - Science Daily

A new study led by researchers at Brigham and Women's Hospital has found that a single measurement of plasma glycated CD59 (GCD59), a novel biomarker for diabetes, at weeks 24-28 of gestation identified, with high sensitivity and specificity, women who failed the glucose challenge test as well as women with gestational diabetes. Plasma levels of GCD59 were also associated with the probability of delivering a large-for-gestational-age newborn. These findings are published in Diabetes Care.

Gestational diabetes is a type of diabetes that occurs during a woman's pregnancy, increasing the mother's risk of delivering a large-for-gestational-age baby, which can lead to pre-term birth, fetal injury, perinatal mortality and cesarean delivery. Gestational diabetes is also a risk factor for preeclampsia and gestational hypertension. Since treatment of gestational diabetes can lessen the risk of adverse pregnancy outcomes, practice guidelines recommend screening all non-diabetic, pregnant women for the disease. The current standard of care to both screen and diagnose gestational diabetes predominantly involves a two-step approach. The first step, known as the glucose challenge test, includes administration of a sugary drink followed by a blood sugar measurement one hour later. Women who fail this screening are then sent for a longer test, called the oral glucose tolerance test, which requires fasting overnight, drinking a more concentrated sugar solution and undergoing baseline and hourly blood draws for three hours. These glucose tests, or variations thereof, are currently the only methods used to screen pregnant women for or diagnose gestational diabetes. They are time consuming, cumbersome, uncomfortable for mothers and have poor reported reproducibility.

The research team's primary goal was to assess the accuracy of the diabetes biomarker, GCD59, in predicting the results of the standard of care glucose challenge test used to screen for gestational diabetes. The team conducted a case-control study of 1,000 pregnant women who were receiving standard prenatal care at BWH: 500 women who had a normal glucose challenge test (control subjects) and 500 women who failed the glucose challenge test and required a subsequent oral glucose tolerance test (case patients). Researchers found that, when compared with the control subjects, the median plasma GCD59 value was 8.5-fold higher in the patients who failed the glucose challenge test and 10-fold higher in the subset of these patients who met diagnostic criteria for gestational diabetes in the subsequent oral glucose tolerance test.

"This is the first study to demonstrate that a single measurement of plasma GCD59 can be used as a simplified method to identify women who are at risk for failing the glucose challenge test and are at higher risk for developing gestational diabetes," says Jose Halperin, MD, a physician and researcher, Director of the Hematology Laboratory for Translational Research at BWH and senior author of the publication.

The researchers also found that higher plasma GCD59 levels at gestational week 24-28 were associated with higher prevalence of large-for-gestational-age newborns, with the higher the level, the higher the risk (4 percent higher risk for patients in the lowest quartile of GCD59 plasma levels, and 14 percent in the highest quartile). Out of the 58 large-for-gestational-age babies born to mothers that failed the glucose challenge test in this study, 80 percent were born to mothers who did not meet oral glucose tolerance test criteria for gestational diabetes, but had median plasma GCD59 levels 7-fold higher than control women with a normal glucose challenge test. These findings are consistent with other studies showing that women who fail the glucose challenge test, but do not meet criteria for gestational diabetes, are still at a higher risk of abnormal pregnancy outcomes, including delivering large for gestational age babies. Currently there are no practice guidelines for the management of women who fall between normal and abnormal glucose tolerance levels, and, therefore, their management is the same as that for women with a normal glucose challenge test results.

"These results suggest that a single measurement of plasma GCD59 during weeks 24-28 may also help stratify the risk for delivering larger infants among women with gestational glucose intolerance." says Halperin. "Our studies opened an avenue for larger multicenter studies to further assess the clinical utility of plasma GCD59 for screening and diagnosis of gestational diabetes among the general population of the United States. If our results are confirmed, we're hopeful that the GCD59 test could be available in clinical practices within the next few years."

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New blood test may better predict gestational diabetes - Science Daily

Imagine taking out your smartphone and asking, Can you control my blood sugar now? Ideally, you wouldnt even have to askif the smartphone were part of a loop that wirelessly connected your glucometer and an implanted population of cells engineered to secrete insulin on demand.

Such a setup, assembled by scientists based at the Shanghai Key Laboratory of Regulatory Biology, was recently shown to keep blood sugar levels within normal limits in diabetic mice. Details of this work, a synthetic biology tour de force, appeared April 26 in the journal Science Translational Medicine, in an article entitled Smartphone-Controlled Optogenetically Engineered Cells Enable Semiautomatic Glucose Homeostasis in Diabetic Mice.

Using a multidisciplinary design principle coupling electrical engineering, software development, and synthetic biology, we have engineered a technological infrastructure enabling the smartphone-assisted semiautomatic treatment of diabetes in mice, wrote the articles authors. A custom-designed home server SmartController was programmed to process wireless signals, enabling a smartphone to regulate hormone production by optically engineered cells implanted in diabetic mice via a far-red light (FRL)responsive optogenetic interface.

Essentially, the researchers added the cells to a soft biocompatible sheath that also contained wirelessly powered red LED lights to create HydrogeLEDs that could be turned on and off by an external electromagnetic field. Implanting the HydrogeLEDs into the skin of diabetic mice allowed the researchers to administer insulin doses remotely through a smartphone application. When the cells in the hydrogel were stimulated by the red LED lights, they produced a short variant of human glucagon-like peptide 1 (shGLP-1) or mouse insulin.

The scientists, led by Haifeng Ye, Ph.D., not only custom-coded the smartphone control algorithms, but also designed the engineered cells to produce insulin without any "cross-talk" between normal cellular signaling processes. The scientists went on to pair the system with a Bluetooth-enabled blood glucose meter, creating instant feedback between the therapeutic cells and the diagnostic device that helped diabetic animals rapidly achieve and maintain stable blood glucose levels in a small pilot experiment over a period of several weeks.

In vivo production of shGLP-1 or mouse insulin by the engineered cells in the hydrogel could be remotely controlled by smartphone programs or a custom-engineered Bluetooth-active glucometer in a semiautomatic, glucose-dependent manner, the authors continued. By combining electronic devicegenerated digital signals with optogenetically engineered cells, this study provides a step toward translating cell-based therapies into the clinic."

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Smartphone App Enables Wireless Control of Diabetes - Genetic Engineering & Biotechnology News

A local organization recently got a grant to help area residents who have diabetes. (Photo: Contributed)

A local nonprofit just landed a $35,000 grant to create a nutrition and wellness program that will help people with diabetes who don't have access to health insurance.

Volunteers in Medicine Chattanooga, a free clinic thatprovides primary and preventive health care to financially eligible individuals and families who don't have insurance,was one of 33 organizations across the country to be awarded a CVS Health Foundation Grant.

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The organization serves people between the ages of 19 and 64 who are at or below 200 percent of the federal poverty level.

Services are provided by licensed medical professionals who donate their time without charge to Volunteers in Medicine Chattanoogapatients.

For more information about how to start the program, click here, call 423-855-8220 or go by the clinic, which is located at 5705 Marlin Road, Suite 1400.

"We are thrilled to be recognized by the CVS Health Foundation as a recipient of a CVS Health Foundation Grant," Executive Director Ashley Evans said. "The foundations support makes it possible for our organization to continue helping our diabetic patients manage this chronic disease."

If left untreated, diabetes can cause the loss of limbs, blindness and kidney failure, she said.

But many of the organization's patients ignore chronic conditions because they don't have the resources to make it to appointments.

In 2016, the organization treated more than 100 patients with diabetes through medication oversight, diet plans and quarterly education talks.

Of those patients, about 70 percent maintained or reduced their blood sugar to normal levels.

The grant will be used to develop, implement and evaluate a lifestyle education program specifically to help patients prevent, reverse and manage diabetes.

It will allow the organization to work with 60 patients and do a 21-day food program in which the participants stay on a plant-based diet. The organization will provide lunch and dinner to participants for the 21 days. That will be coupled with weight loss and nutrition classes, as well as health screenings.

"I don't expect a lot of people will stick with being completely vegan after this, but ... [we're hoping] that when people see they've lost weight and their diabetes might be completely under control that will make an impact on them," Evans said.

The program is set to start in May.

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Local nonprofit gets grant to help uninsured diabetes patients - Nooga.com