Rates of type 2 diabetes are higher in people with one of various common psychiatric disorders

Study shows minorities widely underrepresented in autism diagnoses


A new study published in Diabetologia (the journal of the European Association for the Study of Diabetes (EASD)) finds that the prevalence of type 2 diabetes (T2D) is elevated in people with a psychiatric disorder compared with the general population. The research was conducted by Nanna Lindekilde, Department of Psychology, University of Southern Denmark, Odense, Denmark, and colleagues.

Psychiatric disorders are common, impair the quality of life and are associated with increased mortality rates. This excess mortality is caused in part by more frequent suicides and accidents, but also by an elevated risk of developing physical conditions known to be linked to mental health problems such as cardiovascular and respiratory diseases. Diabetes is an increasingly common disease throughout the world and estimates suggest that 6% to 9% of the global general population are currently affected. Rates have been rising since 1990 onwards in a trend that is expected to continue for the next 20 years.

Previous research has found that the prevalence of T2D is higher in people with bipolar disorder, schizophrenia, and major depression compared to the general population. Despite this, no systematic overview of this research is currently available to examine the possible links between prevalence of T2D and psychiatric disorders in general.

The authors conducted an in-depth search of four electronic databases of scientific papers and found 32 systematic reviews based on 245 unique primary studies. There were 11 categories of disorders: schizophrenia, bipolar disorder, depression, substance use disorder, anxiety disorder, eating disorder, intellectual disability, psychosis, sleep disorder, dementia, and a ‘mixed’ group that comprised different types of psychiatric disorders.

The study found that people with a sleep disorder had the highest rates of T2D with 40% of subjects having the disease while its prevalence among individuals with other psychiatric disorders was 21% (binge eating disorder), 16% (substance use disorder), 14% (anxiety disorders), 11% (bipolar disorder), and 11% (psychosis). Prevalence of T2D was lowest among people with an intellectual disability with 8% of individuals having the disease. In each case these rates are as high or higher than the 6-9% level of T2D found in the general population.

The researchers explain that sleep disorders constitute a subgroup of psychiatric disorders and have high comorbidity with several other diseases. In the review, most of the primary studies were conducted among people with additional diseases such as chronic kidney disease. The authors say: “It is likely that this physical comorbidity contributes to the high T2D prevalence estimates in people with a sleep disorder. The link between T2D and sleep disorders is likely to be bidirectional with the sleep disorder raising the risk of developing diabetes, while diabetes, especially in combination with poor metabolic control, increasing the risk of developing sleep problems.”

While the authors found that people with any of the investigated psychiatric disorders are more likely to have T2D than the general population, they caution: “More refined comparisons should be made between prevalence estimates in the future to better account for differences in populations groups, study settings and the broad range of years as well as methods used to ascertain T2D.” For example, a study conducted in the United States might be expected to show higher rates of diabetes than the global average (including among people with a psychiatric disorder) simply due to differences in demographics and obesity rates between the US population and that of the world as a whole.

They conclude: “Increased prevalence of type 2 diabetes among individuals with a psychiatric disorder suggests that these conditions have a shared vulnerability to the development of the condition relative to the population at large. Better understanding of the observed differences in disease risk and the reasons behind them are still needed. Reliable information about prevalence and a better understanding of biological and behavioural factors driving increased prevalence of type 2 diabetes in people with a psychiatric disorder will be crucial to developing cost-effective strategies for the management of patients in this situation.”

Telehealth-delivered diet and exercise program eased pain and triggered weight loss

Participants report reduced pain and weight loss


Combined diet and exercise Telehealth program saw 80 per cent of participants experience reduced knee pain with an average weight loss of approximately 10.2 per cent. CREDIT PEAK Consulting

New research investigating the benefits of telehealth-delivered exercise and diet programs has found 80 per cent of participants experienced improvement in pain and an average of 10 per cent in loss of body weight, with one man shedding 39 kilograms. 

More than 400 individuals with knee osteoarthritis participated in the Better Knee, Better Me trial, developed by the University of Melbourne in partnership with Medibank and Austin Health.

Published in the Annals of Internal Medicine today, the study shows researchers evaluated two six-month telehealth-delivered exercise programs, one with and one without a weight-loss dietary program, compared with an information-only control group.

During the trial, participants in the intervention groups were provided support from physiotherapists and dietitians via Zoom and a suite of resources. Those in the exercise plus diet group also received meal replacements so they could undertake a ketogenic low energy diet.

Compared to the group that only received information, both intervention programs resulted in benefits for pain, function and quality of life. Compared to the exercise-only program, the combined exercise and diet program led to additional benefits – including a greater reduction in pain, greater improvements in physical function, lower use of pain medications, and significant weight loss. After both programs, participants were also less willing to undergo knee joint replacement surgery.

Lead researcher and Director of the Centre for Health, Exercise and Sports Medicine at the University of Melbourne Professor Kim Bennell, said participants lost on average 10.2 kilograms over a six-month period with four out of five participants achieving significant improvement in pain. She said 30 per cent of participants lived in regional and rural Australia.

“We are proud to have developed a program that has a strong regional and rural representation and is based on a trial which made a real difference in the lives of participants. Particularly during these times of pandemic-related travel restrictions, it is crucial Australians are able to access home-based treatments to manage their osteoarthritis symptoms, no matter where they live or what COVID restrictions are in place.”

Participant Matthew Boyd, from Toowoomba in Queensland, said his knee pain had become unbearable and was struggling to do the things he enjoyed, leading to a decline in physical activity and an increase in his weight.

“Since taking part in Better Knee, Better Me, I feel amazing. I have lost 16kg which has decreased the weight load on my knees, and my pain. I no longer take any pain relief for my knee pain, which has meant I have been able to return to all the physical activities I wasn’t able to do over the past five years. The pain in my knees no longer dictates my daily routine and I am back moving in a way I haven’t done in years,” Mr Boyd said.

Around 2.1 million Australians are currently living with osteoarthritis. The prevalence of osteoarthritis is expected to increase by 58 per cent by 2032 due to an ageing population and rising obesity rates.

Medibank Head of Member Health Service and Design Catherine Keating said Medibank wants to provide its customers with healthcare that gives them more choice and control in how they receive their care. 

“It’s part of our focus on taking the lead on driving preventative health because we know our customers want personalised support to improve their health and wellbeing.”

Scientists discover biological mechanisms in high-risk autism gene

ACTIN


Actin (yellow) and tubulin (red) distribution in young mouse cortical neurons deficient in giant ankyrin-B CREDIT Lorenzo Lab, UNC SOM

Scientists at the University of North Carolina at Chapel Hill School of Medicine and colleagues have demonstrated that rare variants in the ANK2 gene, consistently found in individuals with autism spectrum disorder (ASD), can alter architecture and organization of neurons, potentially contributing to autism and neurodevelopmental comorbidities.

The discovery, published in the journal eLife, was led by Damaris Lorenzo, PhD, an assistant professor in the UNC Department of Cell Biology and Physiology and member of the UNC Neuroscience Center and the UNC Intellectual and Developmental Disabilities Research Center.

ANK2 instructs neurons and other cell types how to make ankyrin-B, a protein with multiple functions in the nervous system. ANK2 encodes for various versions (isoforms) of ankyrin-B through a process known as alternatively splicing, whereby portions of the protein are excluded in the final molecules.

Mammals, such as mice and humans, express the full-size (giant) ankyrin-B isoform only in neurons; another highly abundant isoform half its size is found in virtually every type of cell and organ. Multiple genetic studies have consistently identified rare variants in ANK2 in individuals with ASD, making it one of the high-confidence risk genes associated with the condition. Depending on their type and location in the gene, ANK2 variants can affect giant ankyrin-B exclusively or both isoforms simultaneously.

“Together with its high prevalence and striking clinical presentation, ASD’s uncertain cause is a major limiting step in advancing therapeutic options,” Lorenzo said. “The evidence of ASD’s genetic origin is strong but also complex, with at least 100 other high-risk genes linked to the disorder.”

Revealing the cause of ASD is made even more complicated because single genes such as ANK2 and the isoforms they encode can have multiple cellular functions. However, based on how subgroups of these genes overlap functionally, or work together to enact biological pathways, scientists have proposed convergent mechanisms that may be predominantly affected in individuals with ASD. One of these common mechanisms is neuron communication, which is determined in part by alterations in axons – the long extensions that carry signals from neurons to other neurons. Underlying these processes within a single neuron is the axonal cytoskeleton, a complex network of filament-like proteins that plays pivotal roles in each neuron’s growth, shape, and plasticity. The axonal cytoskeleton is thought to be another major functional axis affected in ASD.

Previous work by Lorenzo published in JCB showed that simultaneous loss of both major isoforms of ankyrin-B in the brain of mice resulted in profound anatomical defects involving axonal wiring, underscoring the importance of ankyrin-B in brain architecture and function. In a later study published in PNAS, Lorenzo and colleagues from Duke University observed that eliminating only the giant ankyrin-B isoform in neurons cultured in the lab resulted in more axon branches, which implicated deficits in the dynamics of microtubules, an essential cytoskeleton component.

In this new study, the Lorenzo lab showed that selective loss of the giant ankyrin-B isoform leads to more axon branches in mouse brains and volumetric increases of multiple axonal bundles including the corpus callosum. In collaboration with Eva Anton, PhD, at the UNC Neuroscience Center and co-author of the eLife paper, they found that the giant ankyrin-B isoform is required to maintain the topographic order of callosal axons arising from the somatosensory cortex during brain development and to ensure the specific targeting and refinement of callosal projections on the opposite side of the brain. The team did not observe increases in axon branches in a novel mouse model they engineered that only lacks the shorter ankyrin-B isoform.

“These findings confirm divergent roles of ankyrin-B isoforms and support critical and specialized roles of giant ankyrin-B in axon collateral branch formation, targeting, and refinement,” Lorenzo said. 

In collaboration with a team led by Meng Meng Fu, PhD, at the National Institute of Neurological Disorders and Stroke and co-authors of the eLife paper, the researchers verified that the observed corpus callosum abnormalities did not involve changes in myelination and in the number and maturation of oligodendrocytes, a non-neuronal brain cell type implicated in similar pathologies.

“Brain cortical regions have been the most directly linked to ASD pathology. The changes we observed in cortical structural connectivity likely result from combined defects in axon branch initiation, guidance, and pruning of misdirected or overabundant projections during development due to giant ankyrin-B deficiency,” Lorenzo said.

Cues outside of cells modulate these processes to trigger changes in neurons through attractive and repulsive effects. Lorenzo’s research team showed that cortical neurons require the giant ankyrin-B isoform to make possible the repulsive effects of semaphorin 3A, a molecule that interacts with and collapses the tips of axons and their branches. The team also showed that ANK2 variants exclusively affecting giant ankyrin-B have similar loss of response to the Semaphorin 3A molecule, revealing a possible mechanistic contribution to ASD.

“Our new insights together with our tools and methods will help us assign pathogenicity to other ANK2 variants. We are certain there is undiscovered biology relevant to brain function and ASD involving this gene and we are pursuing it,” Lorenzo said. “Our bottom-up approach of discovery and functional validation contributes to the underdeveloped knowledge database of ASD functional etiology. This is critical because this heterogeneous and complex disorder likely requires personalized strategies for clinical intervention.”

7 ways to cope with chronic illness during the holidays

7 ways to cope with chronic illness during the holidays - YouTube


Holidays are meaningful, fun, and enjoyable for many people. Yet, it’s easy to make a big production out of them when we try and accomplish too many holiday “to-dos.” Cue the cooking marathon, never-ending errands, perfectly orchestrated family pictures, Instagram-worthy homemade meals, … should I say more? Planning out the “perfect” holiday season while navigating chronic illness can become overwhelming. In fact, chronic illness is emotionally and physically taxing any day of the year, so adding to it the pressure of checking off every holiday “must-do” can lead to undue pain, fatigue, and symptoms flare. Below are 7 ideas and tips to reclaim the fun of this holiday season and alleviate some of the stress.

1. Set boundaries

Setting boundaries can be as easy as saying NO! “I appreciate the invitation but I won’t be able to attend”, “I love that you’re hosting this event, I’ll pass this year. Hope you have a fun time!” And give yourself permission to turn down invitations without justifying yourself if you don’t want to. Limit the number of events that you will attend. Identify the ones you really want to be part of, whether you’re hosting or attending, and RSVP no to the other ones. And before attending a party, it can be helpful to have an idea of how much time you plan on spending there. Know your limits! If you know from experience that you become fatigued and your pain increases significantly after one hour of mingling, standing, or being in a loud environment, give yourself permission to leave at the 55-minute mark. It can also help to share a “code word” with your partner or a friend giving you a ride. This way, they know that when you say “blue cheese” it’s time to leave!

2. Prioritize the things that bring you most joy and meaning

Be wise about how you spend your time, energy (and even money)! Prioritize activities, events, experiences that bring you joy or meaning. Ditch those that you don’t particularly care about. It’s okay if your list of “must-do holiday things” looks different from that of your next-door neighbor or even from your list from the previous year.

3. Simplify your life as much as possible

Some holiday experiences or items may be important to you, yet you’d rather not be in charge of planning or executing them. For instance, you may enjoy nicely wrapped gifts but wrapping gifts for hours increases your pain. You enjoy eating a traditional thanksgiving meal but can’t stand for hours cooking in the kitchen. Delegate! Find support to make the holiday season meaningful without having to be the one in charge of all the logistics. And allow yourself to take off your list all the activities and items that you’ve been doing but that don’t really bring you or your family much joy or meaning. It’s not rare that we find ourselves doing things out of habit only to realize that it’s not something that speaks to our values.

4. Self-care

Now is the time to double-up on self-care! The holiday season is without an ounce of a doubt one of the most stressful and busy time of year. Holidays are physically, emotionally, financially taxing. It’s important to be even more intentional about making time for your needs and prioritize your body and mind. And if you don’t enjoy the holidays, it can also be difficult to go through this season. So taking care of yourself and reaching out for support might be much needed.

5. Pace yourself

Pacing is an important aspect of living with chronic illness. The holidays should be no exception. While your schedule might be more packed than usual and your to-do list might run longer, try as much as possible to plan errands and events in a way that allows for resting and recovery. The key word here is to plan!

6. Keep up with your routine

Make a list of your non-negotiable health routines and plug them into your schedule before planning anything else. Then, you can schedule other events and errands around your routines, as much as possible.

7. Create traditions that are meaningful to you and your family

Creating fun traditions that are meaningful for you and your family AND respect your health needs is especially important. One family for instance started a new tradition for Thanksgiving, when each family member would order in their favorite food, and they would then share a meal in bed, picnic style, and it made for great memories! You can also plan on having a virtual Friendsgiving, which allows you to rest as needed and turn down the volume when you need to take a break. As we enter this holiday season, take some time to reflect on what you want this season to look like and how you can focus on the most meaningful experiences without adding too much physical and emotional stress


Holidays Can Be A Big Adjustment For (Autism And Christmas)

autistic girl | The Aspie World

Holidays and Christmas are a big adjustment for children with autism.

The COVID-19 pandemic and the holiday season may create increased stresses for children on the autism spectrum.

Think about creating a visual calendar with what activities will happen when; clearly communicating the challenges the person with autism is facing to family and friends so things do not get worse; and a gradual decorating of the house.

This time of year can be stressful for children with autism as it is, let alone a global pandemic.

Change is a usual thing that happens at this time of year with Christmas and everything but due to the COVID-19 pandemic there are larger changes that are difficult for children with autism.