After a Stroke, Diabetes Could Worsen Brain Function

Having Type 2 diabetes could cause cognitive impairment in stroke survivors, according to new research that points out the need to aggressively treat prediabetes.

A new analysis of seven international studies found that three to six months after a stroke, the participants with diabetes functioned worse than those without diabetes on measures for memory, attention, mental flexibility, processing speed, language and other examples of cognitive function.

“That’s why Type 2 diabetes is another important target in the prevention of dementia, and the focus should be on early treatment for prediabetes to delay or prevent the progression to Type 2 diabetes,” Dr. Perminder Sachdev said in a news release. She is the study’s senior author and scientia professor at UNSW Sydney’s Centre for Healthy Brain Ageing in Kensington, Australia.

Previous research by Sachdev and colleagues determined that stroke patients with a diabetes history had worse brain function than those without the condition. But this new work, published Thursday in the American Heart Association’s journal Stroke, looked at whether that held true for people with prediabetes.

“This is important because prediabetes is very common, and individuals can have prediabetes for several years before progressing to Type 2 diabetes,” Sachdev said. “Early and aggressive treatment of prediabetes can delay or prevent Type 2 diabetes. If we target the treatment of prediabetes, could this prevent the development of dementia in some individuals?”

The analysis included data from 1,601 stroke patients in Australia, France, Korea, the Netherlands, Singapore and the United States. Their average age was 66 and almost all had clot-caused strokes. Overall, 70% were Asian, 26% white and 2.6% African American.

Fasting blood sugar levels measured at hospital admission and medical history were used to define Type 2 diabetes and prediabetes. But the study was limited by not having information about the duration and severity of diabetes and having only one blood sugar measurement.

After adjusting for age, sex and education, researchers found “significantly poorer” function in stroke survivors with diabetes – but not in those with prediabetes. The findings held up even after researchers adjusted for additional factors such as ethnicity, high blood pressure, smoking, body mass index, abnormal heart rhythm and previous stroke.

“The deficits we found in all areas of cognitive function highlight the importance of assessing the capacity for self-care in patients with Type 2 diabetes following a stroke,” Jess Lo, lead author of the study, said in a news release. She is a research associate at UNSW Sydney’s Centre for Healthy Brain Ageing.

Health care providers should ensure stroke survivors have the mental competency to fulfill the complex tasks needed to manage diabetes, Lo said.

That “can include measuring glucose levels multiple times a day, managing glucose monitoring devices, adjusting medication doses, self-administering insulin or other medications, and understanding food labels and portion sizes to adjust what is eaten at each meal or snack.”

Source: American Heart Association

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The Complex Connection Between Depression and Our Bodies

Kristen Fuller wrote . . . . . . . . .

Major depressive disorder is a mood disorder that affects more than 15 million adults in the United States. Individuals with depression may not even report depressive signs and symptoms and instead present to their physician for somatic or physical symptoms such as headaches, abdominal pain, muscle pain, and fatigue. Individuals may also complain of irritability or problems concentrating. Adolescents with major depressive disorder may present with a decline in school performance, substance abuse, irritability or social withdrawal and elderly individuals often present with confusion or a decline in general functioning. This disorder may be difficult to initially diagnose, as many individuals may not show the clear-cut signs and symptoms of depression. According to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-V), at least five of the following symptoms must be present within a two-week period with at least one of the symptoms being depressed mood. Additionally, these symptoms must cause apparent distress in social and occupational functioning.

  • Sleep disturbance
  • Loss of interest in activities
  • Feelings of guilt
  • Loss of energy
  • Difficulty concentrating
  • Change in appetite
  • Psychomotor agitation
  • Sadness
  • Suicide ideations

Although depression is considered a mental health disorder, it is tightly intertwined with our physical health and often commonly co-occurs with other mental health disorders.

The link between diabetes and depression

Diabetes is often a lifelong disorder that is either diagnosed in childhood or adulthood and can have chronic effects on many of the body’s organs. Diabetes, when not controlled affects the brain, eyes, feet, digestive tract, and is also known to cause delayed wound healing. Diabetes is also tightly linked to depression. Individuals with diabetes are two to three times more likely to have depression than people without diabetes, according to the U.S. Centers for Disease Control and Prevention.

“The incidence of major depressive disorder amongst individuals with diabetes is significantly greater than the general population,” said the study’s corresponding author, Vincent Chin-Hung Chen, Professor, of Chiayi Chang Gung Memorial Hospital and Chang Gung University in Puzi, Taiwan. “Diabetes and depression each independently contribute to increasing total mortality.”

Diabetes can be a complicated disease and individuals with this disorder must strictly control their blood sugar through insulin and/or oral hypoglycemic medications while adopting a strict diet. This results in a drastic lifestyle change and can lead to long-term stress and a decreased quality of life, which can lead to depression.

Alternatively, individuals who have been diagnosed with depression, often have higher levels of the stress hormone cortisone, which can cause problems with glucose metabolism in the body thereby increasing insulin resistance and the accumulation of belly fat; all risk factors for the development of diabetes.

When individuals have both depression and diabetes simultaneously it also becomes a problem as so much of the treatment for diabetes is self-care and individuals who have depression may not take good care of themselves. These individuals may have a hard time exercising, following a strict diet, taking their blood sugar and administering their medication. As a result, each illness can worsen without paying proper attention to the emotional and physical aspect of diabetes.

If an individual’s diabetes is uncontrolled, even if they are strict with their diet and insulin regimen, they may be struggling with depression. It is extremely important to address the emotional and mental side of diabetes; in other words to adopt a “whole person” approach.

The link between chronic pain and depression

Chronic pain is a persistent, agonizing sensation that can last for weeks, months or even years and by definition, is pain that has been present for at least 12 weeks in duration. Chronic pain can present in many different forms such as stabbing, throbbing or aching in nature and can be intermittent, persistent; mild, or intense. It can sometimes begin as a result of an injury or illness, but oftentimes it arises without a clear etiology. Chronic pain, unlike more acute pain that resolves within days or weeks, tends to cause more emotional and lifestyle challenges because of its duration and its unpredictability. According to statistics, there are 100 million Americans who suffer from chronic pain and over 1.5 billion individuals suffer from chronic pain worldwide. Low back pain is the most common form of chronic pain and chronic pain is the number one cause of disability in the United States. Chronic pain, as a stress state, is one of the critical factors for determining depression, and their coexistence tends to further aggravate the severity of both disorders. Clinical studies have revealed that chronic pain, as a stress state, often induces depression and that up to 85% of individuals with chronic pain are affected by severe depression. Unfortunately, to date, neither the corresponding pathophysiological mechanisms of chronic pain and depression nor their mutual correlation has been identified, which poses a huge challenge for the treatment of pain accompanied by depression. Lifestyle modifications such as yoga, modified exercise, and physical therapy can help manage chronic pain while also helping with depression. Although opioids are the first-line for certain types of pain, specifically cancer-related pain, the potential of opioid addiction is tremendous and unfortunately, opioid addiction is highly linked to depression. As a result, it may be wise to look at other treatment options for individuals who are struggling with chronic non-cancer pain as they are at an increased risk for developing depression. Tricyclic antidepressant drugs are traditional antidepressant drugs, commonly including amitriptyline, imipramine, nortriptyline, and desipramine. These antidepressants are also known to help with chronic pain, in particular, neuropathic pain.

As stated above, depression itself can also present with chronic pain, in particular headaches, abdominal pain and joint pain and therefore depression should be considered in individuals who have vague pain without a clear underlying reason.

The link between eating disorders and depression

Depression occurs in approximately half of women who meet the criteria for anorexia nervosa. Eating disorders can result in a severely malnourished state, which can lead to physiological consequences such as poor mood states or feelings of worthlessness, which can lead to depression. Alternatively, depression itself can result in eating disorders such as anorexia nervosa, binge eating disorder, and bulimia nervosa.

Eating disorders are triggered by severe underlying stress and many individuals use disordered eating behaviors such as binging and self-induced purging as ways to self-treat their depression, however, these poor coping behaviors are known to worsen the depression while causing extreme harm to the body. For example, life stressors, like the demands of puberty, the death of a loved one, a divorce, and physical or sexual abuse, can lead to depression. For many individuals, eating disorders are a way to exercise control over a life that’s become unmanageable. Ritualistic eating patterns and extreme weight loss can become a poor coping mechanism to suppress overwhelming emotional pain associated with depression.

Anorexia nervosa and depression are known to certain neurological factors, which include the following:

  • High levels of cortisol, a hormone that the body produces in stressful situations
  • Low levels of serotonin, a hormone that’s responsible for mood regulation
  • Low levels of norepinephrine, a neurotransmitter that plays a role in emotions and moods
  • High levels of vasopressin, which has also been linked with obsessive-compulsive disorder

Living a healthy life with depression

Depression, although is a mood disorder, can have multiple long-lasting effects on the body and physical ailments such as heart disease, diabetes, an autoimmune disorder, and cancer can also lead to depression as these medical disorders require major lifestyle modifications. Depression is also highly linked to substance abuse disorders and eating disorders. Depression a “whole person” disorder as it can potentially affect every organ system and as a result practicing the correct self-care tips, attending therapy and taking antidepressants are incredibly important to live a full happy life, even if you have been diagnosed with depression. Living with depression is possible.

Source: Psychology Today

Breastfeeding May Help Guard Against Diabetes

Breastfeeding is good for more than babies: New research suggests it may protect new mothers from developing diabetes for years after they give birth.

The study included 85 women who breastfed and 99 who did not. They were assessed two months after giving birth and each year after that for at least three years.

Compared to those who didn’t breastfeed, mothers who breastfed had improved pancreatic beta cell mass and function and lower blood glucose (sugar) levels, reducing their risk of diabetes, the investigators found.

These benefits continued after women stopped breastfeeding, lasting for more than three years after they gave birth, according to the study published recently in the journal Science Translational Medicine.

The South Korean researchers said the milk-secreting hormone “prolactin” in breastfeeding mothers not only promotes milk production, but also stimulates insulin-secreting pancreatic beta cells that regulate blood glucose.

The researchers also found that “serotonin” — a chemical that contributes to well-being and happiness — is produced in pancreatic beta cells during breastfeeding. Serotonin in pancreatic beta cells act as an antioxidant and reduce oxidative stress, making mothers’ beta cells healthier.

Serotonin also induces the proliferation of beta cells, thereby increasing the beta cell mass and helping maintain proper glucose levels, according to the researchers at the Korea Advanced Institute of Science and Technology.

Because pregnancy causes weight gain and increased insulin resistance, it can increase the risk of diabetes. Other factors — such as a history of gestational diabetes, age and obesity — also affect a pregnant woman’s risk of developing diabetes after giving birth.

The risk of diabetes after delivery is highest among women who’ve had gestational diabetes and/or repeated deliveries, the study authors noted.

“We are happy to prove that lactation benefits female metabolic health by improving beta cell mass and function as well as glycemic control,” said Hail Kim, a professor in the institute’s Graduate School of Medical Science and Engineering.

“Our future studies … may lead to new therapeutics to help prevent mothers from developing metabolic disorders,” Kim added in an institute news release.

Source: HealthDay

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Obesity is a Critical Risk Factor for Type 2 Diabetes, Regardless of Genetics

Obesity increases the risk of developing type 2 diabetes by at least 6 times, regardless of genetic predisposition to the disease, concludes research published in Diabetologia (the journal of the European Association for the Study of Diabetes [EASD]). The study is by Dr Theresia Schnurr and Hermina Jakupović, Novo Nordisk Foundation Center for Basic Metabolic Research, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark, and colleagues.

Using data from a case-cohort study nested within the Diet, Cancer and Health cohort in Denmark, the authors examined the joint association of obesity, genetic predisposition, and unfavourable lifestyle with incident type 2 diabetes (T2D). The study sample included 4729 individuals who developed type 2 diabetes during a median 14.7 years of follow-up, and a randomly selected cohort sample of 5402 individuals (the control group).

The mean age of all participants was 56.1 years (range 50-65) and 49.6% were women. Overall, 21.8% of all participants were classified as obese, 43.0% as overweight and 35.2% as having normal weight; and 40.0% of the participants had a favourable lifestyle, 34.6% had an intermediate lifestyle and 25.4% had an unfavourable lifestyle.

Genetic predisposition was quantified using a genetic risk score (GRS) comprising 193 known type 2 diabetes-associated genetic variants and divided into 5 risk groups of 20% each (quintiles), from lowest (quintile 1) to highest (quintile 5) genetic risk. Lifestyle was assessed by a lifestyle score composed of smoking, alcohol consumption, physical activity and diet. Statistical modelling was used to calculate the individual and combined associations of the GRS, obesity and lifestyle score with developing T2D.

Compared with people of normal weight, those with obesity were almost six times more likely to develop T2D, while people who were overweight had a 2.4 times increased risk. For genetic risk, those with the highest GRS were twice as likely to develop T2D as those with the lowest, while those with the unhealthiest lifestyle were 18% more likely to develop T2D than those with the healthiest.

Individuals who ranked high for all three risk factors, with obesity, high GRS and unfavourable lifestyle, had a 14.5 times increased risk of developing T2D, compared with individuals who had a normal body weight, low GRS and favourable lifestyle. Notably, even among individuals with a low GRS and favourable lifestyle, obesity was associated with 8.4 times increased risk of T2D compared with normal weight individuals in the same genetic and lifestyle risk group.

The authors conclude: “The results suggest that type 2 diabetes prevention by weight management and healthy lifestyle is critical across all genetic risk groups. Furthermore, we found that the effect of obesity on type 2 diabetes risk is dominant over other risk factors, highlighting the importance of weight management in type 2 diabetes prevention.”

Source: Diabetologia

A Non-invasive Way of Monitoring Diabetes

Saliva could be used instead of blood to monitor diabetes in a method proposed in research involving the University of Strathclyde.

The test has been developed as an alternative to the current prevalent practice of monitoring blood glucose, which can be invasive, painful and costly.

Lab tests of the saliva process had an accuracy rate of 95.2%. The research shows promising results for monitoring diabetes, which affects an estimated 425 million people worldwide – around half of them undiagnosed.

The research has been published in the journal PLOS One. It also involved partners at the Federal University of Uberlandia in Minas Gerais, Brazil, the University of Vale do Paraíba in Sao Paolo, Brazil and the University of Saskatchewan in Canada.

Dr Matthew Baker, a Reader in Strathclyde’s Department of Pure and Applied Chemistry and lead researcher in the project, said: “Frequent monitoring of diabetes is essential for improved glucose control and to delay clinical complications related to the condition. Early screening is also paramount in reducing these complications worldwide.

“Blood analysis for screening, monitoring and diagnosing diabetes is widely practised but is quite invasive and painful. The constant need of piercing the fingers several times daily for most patients may lead to the development of finger calluses, as well as difficulty in obtaining blood samples; furthermore, not everyone would want to give blood and there are circumstances in which it could be dangerous.

Saliva reflects several physiological functions of the body, such as emotional, hormonal, nutritional and metabolic, and so its biomarkers could be an alternative to blood for robust early detection and monitoring. It is easy to collect, non-invasive, convenient to store and requires less handling than blood during clinical procedures, while also being environmentally efficient. It also contains analytes with real-time monitoring value which can be used to check a person’s condition.”

Dr Robinson Sabino-Silva, an associate professor at Federal University of Uberlandia (UFU) and a partner in the research, said: “The present protocol used in the infrared platform is able to detect spectral biomarkers without reagents. The combination of a non-invasive salivary collection and a reagent-free analysis permit us to monitor diabetes with a sustainable platform classified as green technology.“

The lab tests used a scientific system known as Attenuated total reflectance Fourier transform infrared (ATR-FTIR) spectroscopy. This has been used in the diagnosis of several diseases, although its applications in the monitoring of diabetic treatment have begun to emerge only recently. Samples were assessed in three categories – diabetic, non-diabetic and insulin-treated diabetic – and two potential diagnostic biomarkers were identified.

The researchers are hopeful that the process they have developed could be used for both Type 1 and Type 2 diabetes, although further study will be required to confirm this.

Source: The University of Strathclyde

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