Research Trends with Dr. Maria: Beta Cells, Botox, and More

Dr. Maria Muccioli holds degrees in Biochemistry and Molecular and Cell Biology and has over ten years of research experience in the immunology field. She is currently a professor of biology at Stratford University and a science writer at Diabetes Daily. Dr. Maria has been living well with type 1 diabetes since 2008 and is passionate about diabetes research and outreach.

In this recurring article series, Dr. Maria will present some snapshots of recent diabetes research, and especially exciting studies than may fly under the mainstream media radar.

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Even Very Slightly Elevated Blood Glucose May Impact Beta Cells

When diabetes first develops, a reduction in insulin production initially results in just a slight elevation of blood glucose. A just-published study by researchers at the Joslin Diabetes Center employed cell culture and mouse models to assess how very slight elevations in blood glucose levels might affect the beta cells. Interestingly, the scientists discovered that even slight perturbations in glycemia (*as little as “being only 11 mg/dL higher than controls) could result in gene expression changes in the beta cells. The major conclusion of the investigation was that “mild glucose elevations in the early stages of diabetes lead to phenotypic changes that adversely affect beta cell function, growth, and vulnerability.” Continuing to investigate exactly how the early stages of diabetes may affect disease progression may aid in the development of treatments aimed at slowing or halting disease progression by preserving or improving beta cell function. This study also underscores the importance of early diabetes detection and treatment.

Different Subtypes of Type 1 Diabetes Classed by Age at Diagnosis

The pathophysiology of type 1 diabetes is complex, although it is generally accepted that in most cases, a genetic predisposition and an environmental trigger result in disease onset. A research study that was recently published in the journal Diabetologia aimed to investigate different subsets (endotypes) of type 1 diabetes by evaluating the level of insulin production from recently-diagnosed patients. Interestingly, the authors report that in patients who were diagnosed prior to age 30, “there are distinct endotypes that correlate with age at diagnosis”. Specifically, the new research showed that those who were diagnosed at a very young age (before seven years old) exhibited more defective insulin processing as compared to those diagnosed at age 13 and older. The scientists believe that stratifying type 1 diabetes cases by endotype will prove useful in the most appropriate design of immunotherapies to treat the condition.

Male and Female Offspring May Be Differently Affected by Maternal Diabetes

Hyperglycemia during pregnancy can negatively affect the offspring. A study published in April 2020 in the journal Brain, Behavior, & Immunity – Health indicates that the effects of hyperglycemia on central nervous system development may affect male and female offspring differently. Notably, the authors concluded that while hyperglycemia could cause developmental defects in males in females, when it came to “impairments in recognition memory,” specifically, it was found that only the females were negatively affected. Although this research was performed in rodents, it offers valuable insights into how maternal diabetes may affect offspring development in a sex-specific way. Notably, it was also demonstrated that insulin administration to achieve strict glycemic control mitigated the negative effects, once again highlighting the importance of optimal glycemic management before and during pregnancy.

Botox Injection Plus High-Protein Diet for Obesity Treatment

Interestingly, the injection of botulinum toxin (Botox) has been shown effective in the treatment of obesity. A research study recently published in the journal Obesity Surgery evaluated the efficacy of botulinum toxin injections alongside a calorie-restricted, high-protein diet for weight loss. Participants were assigned to one of three groups: 1) botulinum toxin treatment only; 2) botulinum toxin treatment + calorie-restricted/high-protein diet; or 3) calorie-restricted/high-protein diet alone. Excitingly, the results showed that patients who received botulinum toxin treatment prior to initiating the diet protocol achieved faster weight loss and experienced more positive effects in improving comorbidities. The authors theorize that botulinum toxin treatment may help “facilitate adaptation to the new diet style”.

“Kitchen Intervention” in Type 2 Diabetes Education Helps Improve Outcomes

Several educational intervention programs aimed at improving glycemic management in patients with type 2 diabetes were compared in a recent initiative by the Milwaukie Family Medicine center in Oregon. A traditional diabetes education class was implemented for one group of patients, while a second group was assigned to the traditional education program, along with a “health-focused, budget-friendly cooking class” provided by the Providence Milwaukie Community Teaching Kitchen. Hemoglobin A1c measurements were acquired at baseline, and at several months post-intervention. The recently published results demonstrated that patients who participated in the cooking class intervention, lowered their A1c levels more, on average, than those who attended the traditional education program alone. Although this initiative was a small one and yields very preliminary results, the outcomes suggest that intervention programs focused on real-life applications (like budgeting and cooking) may afford better patient outcomes.

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Please share your thoughts with us and stay tuned for more recent research updates!

Source: diabetesdaily.com

Another CGM Approved in Europe for Pregnancy: Dexcom G6 Joins Freestyle Libre

This content originally appeared on diaTribe. Republished with permission.

By Divya Gopisetty

In Europe, the Dexcom G6 CGM received approval for pregnant women with diabetes

Dexcom’s G6 continuous glucose monitor (CGMreceived European approval (“CE Mark”) to be used by women with diabetes during pregnancy. This official label is set to launch in spring of 2020 and will apply to women with type 1, type 2, or gestational diabetes. The Dexcom G6 is already approved for people with diabetes over the age of two.

CGM can help provide awareness of blood glucose trends, which is especially important for pregnant women and their babies. The 2019 ADA Standards of Care recommend that pregnant women with gestational, type 1, or type 2 diabetes spend the majority of the day in the tighter blood sugar range of 63-140 mg/dl. CGM can allow people with diabetes to work with their healthcare team to better understand their time in range and improve their diabetes management by reducing hyperglycemia and hypoglycemia.

During pregnancy, insulin (the hormone that helps the body use glucose for energy and lowers blood sugar) may not be able to perform its typical role due to interference from other hormones produced by the developing baby. With gestational diabetes, the body’s insulin can’t keep blood sugar levels in the target range. This leads to higher blood sugar levels that can cause health risks for both the mother and baby.

You can learn more about diabetes during pregnancy here. The late gestational diabetes guru Dr. Lois Jovanovic also shared a few pieces of advice for pregnant women with diabetes. We encourage you to consider these tips as you communicate with your support system and healthcare professional.

Source: diabetesdaily.com

Pregnancy, Delivery, and Postpartum Care During the COVID-19 Pandemic

Almost any pregnancy is full of excitement but can be stressful at times. Add in having diabetes and living through a global pandemic, and it can be quite anxiety-provoking. This article summarizes how recent policy changes due to COVID-19 may be affecting women with diabetes who are currently pregnant or have recently given birth.

A High-Risk Pregnancy

For women with diabetes, pregnancy is automatically classed as a high-risk affair. Although a healthy pregnancy is very possible with any type of diabetes, a lot of emphasis is placed on optimizing glycemic management, and women are closely followed with extra appointments and ultrasound scans throughout the pregnancy, and in particular, during the third trimester.

Telemedicine and In-Person Appointments

For those who are going through pregnancy during the COVID-19 pandemic, certain appointments may be possible to achieve via telemedicine. For example, if you’re working with an endocrinologist to manage your blood sugar levels, odds are, that can be achieved largely through telemedicine (or email). However, certain other checks (like ultrasounds), or if a woman is experiencing concerns or complications, there is no substitute for an in-person healthcare provider or even a hospital visit.

Ask your provider(s) which in-person appointments they expect you to keep and why. Also, keep in mind that there will likely be additional precautions, like waiting in your vehicle, instead of the waiting room, for example.

To curtail the spread of the novel coronavirus, most doctors’ offices and hospitals have now implemented strict policies concerning the number of visitors who are allowed at appointments. Most will find that for all (or almost all) appointments, women will be asked to come to their appointment without any additional visitors.

Of course, these new policies, while important, also can bring up considerable emotional issues. Pregnancy is supposed to be an exciting time, most often shared with loved ones, like your partner and family. Milestone appointments, attended alone, may feel bittersweet.

To help increase support during these times, ask your healthcare providers what their specific policies are and inquire whether it is possible to have your support person or people attend with you virtually. For instance, you may find that your practice will allow your partner to phone in via videochat to virtually experience a milestone ultrasound, and will give them an opportunity to ask any questions that they might have. While not the same as under normal circumstances, this can offer women more emotional support during these exciting (and challenging) times.

Labor and Delivery

One fear that many women are expressing these days (and rightfully so!) is one of having to labor and deliver their babies without a support person. While formal “birth plans” are notorious for falling apart (at least somewhat, as no birth is predictable), this is perhaps the first time in our recent history that women have to worry about not being able to have their emotional support system in place for the big event.

It appears that most hospitals are balancing the need for limiting viral spread with the importance of emotional support for patients during this critical time. Most likely, your hospital will allow one support person to attend your labor and delivery (although this may not be the case everywhere, especially in COVID-19 disease epicenters). However, be prepared that they may not be able to accompany you during the postpartum hospital stay. Ask your hospital ahead of time what the policy is (also for vaginal delivery vs. c-section) so you can be prepared. Also, you may find that (if deemed appropriate) your discharge from the hospital may happen sooner than what is typical.

Diabetes online community member, Shannon M. (who has type 1 diabetes) described to us her challenging experience with delivering her baby boy amid the COVID-19 outbreak:

“I planned on being induced at 39 weeks but was induced the day I hit 38 weeks due to the doctors personal concern about the virus. The hospital was also thinking of starting to allow no help in the delivery room and they wanted to make sure I had someone there with me, as well as to get in and out of the hospital before the virus spread got even worse. My biggest concern the entire time ended up being for the virus rather than health of the baby in general.

While I was in labor, they decided I needed an emergency c-section and took me into another room. I was concerned about going into so many different rooms because that increased my chances of getting the virus rather than being afraid of the c-section itself.

After everything, my baby was taken to NICU for low blood sugars. As I had expected this, I wasn’t too worried, but again, worried about his extended stay in the hospital because of the virus. This also meant I had to visit him daily in the hospital, which concerned me, trying to not get the virus myself and transfer it to him or the rest of my family.

They only let me recover one day in the hospital from the c-section, when it’s usually three days. The social worker admitted to me the cases were getting bad in our hospital and just wanted everyone who didn’t absolutely have to be there, out. Everyone had to wear masks and gloves throughout the hospital. One of my nurses continued to not wear her mask around me and it made me very paranoid.

My baby is still in the NICU. It has now been 13 days and I still have anxiety visiting him. I don’t leave his room to eat or use the restroom unless I absolutely have to. It’s been a horrible experience and cannot wait to get him home. I also live in Essex county NJ, which is the second-worst infected county in the second-most infected state, as we are 20 minutes from NYC.”

Postpartum Care

In addition to possibly leaving the hospital earlier than expected, women are likely going to experience more isolation than they normally would. Importantly, this can affect the rates of postpartum depression, which is of great concern.

Taking time every day for essential self-care and human connection is important for all new moms and is perhaps even more critical during these tough times. Having a support system in place, even if you’re only able to communicate remotely, can help women feel more supported.

Photo credit: smpratt90 (Pixabay)

While many women will probably attend their 6-week postpartum check-up (especially for birth control, like an IUD), this may not be the case for those who don’t have any upcoming procedures, questions or concerns (I actually cancelled my own 6-week postpartum check-up that was supposed to take place mid-March). Be sure to bring up any physical or mental health concerns to your doctor right away. Don’t forget that many issues can be addressed via telemedicine (e.g., mental health appointments), so you can safely stay at home with your baby.

Also, don’t forget to check in with your pediatrician’s office about what their policies are. Most likely, only one parent will be able to attend the child’s well-visit appointments. Some appointments may even be postponed, depending on the specific circumstances.

Jennifer A., who delivered her son at the end of March, describes:

“My son has only had one appointment over a phone chat. It was OK. I prefer to keep him safe but I also want to make sure my son is healthy and growing right and that is hard to tell over a phone.”

Conclusions

Going through pregnancy, labor and delivery, and the postpartum period, while also managing diabetes, is difficult enough but can feel overwhelming during a global virus pandemic. Understanding that the inconvenient policies are there to help protect you and your baby, and getting the mental health and emotional support you need during and after pregnancy is key to keeping the big picture in mind and being able to enjoy this very special time.

Are you currently pregnant or have recently had a baby during this crisis? We’d love to hear about your thoughts and experiences.

Source: diabetesdaily.com

Joslin Diabetes Center: A Global Leader in Research and Care

Learn about the mission and diabetes advocacy efforts of the Joslin Diabetes Center. Check out this summary to learn more about who they are, what they do, and more.
Source: diabetesdaily.com

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