Author: patienttalk

Posted on Diabetes

Research takes early step towards drug to treat common diabetes complication hypoglycaemia

Diabetes hypos | What does hypoglycaemia Feel Like? | Diabetes UK - YouTube

New research has taken an important step towards the goal for a treatment for the common diabetes complication hypoglycaemia, or low blood sugar.

In all forms of diabetes, blood sugars become too high as the body is either unable to produce insulin, or cannot make enough of it, or the insulin it produces is not effective. This means people with diabetes have to manage their blood sugar levels themselves, and these levels can commonly become dangerously high (hyperglycaemia) or low (hypoglycaemia).

Episodes of hypoglycaemia, also known as “hypos” often occur at night, disrupting sleep and sometimes causing seizures. Hypoglycaemia cause unpleasant symptoms such as anxiety, palpitations, sweating and hunger. If extreme, they can also cause dizziness, confusion, loss of consciousness and, if untreated, coma and even death.

Now, research published in Frontiers in Endocrinology led by the University of Exeter, working with Rigel Pharmaceuticals, found a way help to defend against hypoglycaemia by boosting hormonal defence systems. The team believes they have identified a promising target in the brain could be useful for future drug development to create an anti-hypoglycaemia drug.

The researchers, funded by JDRF and supported by Diabetes UK, conducted laboratory experiments using a pre-clinical test compound (R481), that acts a little like metformin, a widely used type 2 diabetes drug. However, R481 works differently because it enters the brain and switches on an important brain fuel gauge called AMPK (AMP-activated protein kinase).

Lead study author Dr Ana Cruz, of the University of Exeter, said: “Our work highlights the importance of better understanding the brain-pancreas communication to boost the body’s defences against hypoglycaemia. I see the daily emotional and physical impact hypoglycaemia can have and believe that these findings have taken us one step closer to finding targets within this brain-pancreas network to attenuate the impact of hypoglycaemia.” 

The researchers conducted experiments on specialised brain glucose-sensing neurons (GT1-7 cells) in petri dishes, and found that the compound works by activating this brain fuel gauge.

They then found that in healthy rats, the drug boosts the hormonal defence against hypoglycaemia, by increasing the release of a hormone called glucagon from the pancreas. The drug switched on a brain-pancreas link to defend against hypoglycaemia, yet did not change fasting blood sugar levels.

Senior study author Dr Craig Beall, of the University of Exeter, said: “Our findings suggest that switching on the brain fuel gauge we’ve identified could be useful for preventing hypoglycaemia. In the long term, our aim is to create a pill that could be swallowed before bed, to prevent night time hypos. This is just the first step in a long road, and we hope one day we may be able to give some peace of mind to people with diabetes and parents of children with diabetes that they won’t have a bad night time hypo.”

Dr Lucy Chambers, Head of Research Communications at Diabetes UK, which supported the study, said: “This early stage research, funded by Diabetes UK has uncovered important links between the brain and the pancreas, that could in future lead to new treatments to help people with diabetes avoid hypos, or bring back their ability to recognise signs of low blood sugars.

“Hypos and hypo unawareness can be dangerous and debilitating, and can have a huge impact on the daily lives of people living with all types of diabetes. New treatments for treating hypos, or hypo unawareness would make living with diabetes much easier – reducing anxieties and crucially protecting people from the serious consequences that hypos can have.”

Conor McKeever, Research Communications Manager at type 1 diabetes charity JDRF, said: “Hypoglycaemia is one of the things people with type 1 report fearing most about their condition, so a treatment to prevent hypos would go a long way to relieving some of the burden that comes with living with type 1.

“It could also help reduce the worry felt by family members, who tell us they regularly lose sleep for fear that their loved one will have a hypo in the night.

“We’re proud to have funded this research and are keen to see how it develops on the road towards a new treatment for the 400,000 people living with type 1 in the UK.”

Evidence suggests the 400,000 people with type 1 diabetes in the UK experience an average of two episodes of hypoglycaemia per week and one severe episode per year.  People with type 2 diabetes experience up to five episodes of hypoglycaemia per year. Although the frequency is lower in type 2 diabetes, the overall rate is higher, because the condition affects well over 4 million people in the UK.

The researchers have published the structure of the compounds in their paper, entitled ‘Brain permeable AMP-activated protein kinase activator R481 raises glycaemia by autonomic nervous system activation and amplifies the counter regulatory response to hypoglycaemia in rats’ It is published in Frontiers in Endocrinology.

Posted on Multiple Sclerosis

Pilot study of exercise and cognition in progressive multiple sclerosis highlights need to assess outcomes of randomized controlled trials

Brian M. Sandroff, PhD


Dr. Sandroff is senior research scientist in the Center for Neuropsychology and Neuroscience at Kessler Foundation, and director of the Exercise Neurorehabilitation Research Laboratory. CREDIT Kessler Foundation

An international team ofmultiple sclerosis (MS) experts reported lack of association between cognition and physical activity and cardiorespiratory fitness in a large sample of individuals with progressive MS. These findings have important implications for studies involving exercise interventions aimed at treating the cognitive effects of MS. The article, titled, “Cardiorespiratory fitness and free-living physical activity are not associated with cognition in persons with progressive multiple sclerosis: Baseline analyses from the CogEx study,” was published in Multiple Sclerosis Journal on October 1, 2021, doi: 10.1177/13524585211048397. The authors represent Canada, the United States, Italy, the UK, Denmark, and Belgium.

Article link: https://pubmed.ncbi.nlm.nih.gov/34595972/

The effects of exercise interventions on cognition are a focus of rehabilitation research in conditions associated with deficits and decline in cognition. Cognitive benefits of aerobic exercise have been reported in relapsing-remitting (non-progressive) MS and in age-related cognitive decline. One small pilot study conducted in progressive MS found an association between aerobic ergometer exercise and cardiovascular fitness, alertness, and verbal memory.

To examine these associations, the authors analyzed baseline data from the CogEx study, a multi-national, multi-arm, randomized, blinded, sham-controlled trial looking at the effects of cognitive rehabilitation and aerobic exercise training on cognition and neuroimaging findings in 240 individuals with progressive MS. They measured cardiorespiratory fitness, free-living moderate-to-vigorous physical activity, and cognitive performance.

“Neither cardiorespiratory fitness nor free living physical activity correlated with cognitive performance in this study sample,” said lead author Brian Sandroff, PhD, senior research scientist in the Center for Neuropsychology and Neuroscience Research at Kessler Foundation. “This suggests that other mechanisms of action may mediate the potential effects of aerobic training on cognition in this population. The neuroimaging data collected in this trial may help clarify these underlying mechanisms.”  

The findings have important implications for randomized controlled trials in progressive MS. “It’s clear that we need to carefully assess the outcome measures for studies of exercise and cognition in this population,” added co-author John DeLuca, PhD, Senior Vice President for Research and Training at Kessler Foundation. “Improving cognition and brain health is essential to maintaining quality of life for people with progressive MS. To achieve that, we need to expand our investigation of how exercise affects brain function.”

Posted on Autism

Study finds few pediatric providers discuss transportation with their autistic patients Is this true for you?

BUS ART | Colourful Beautiful Bus | Indian Pakistani Decorated Bus - YouTube


A collaborative study from the Center for Injury Research and Prevention (CIRP) and the Center for Autism Research (CAR) at Children’s Hospital of Philadelphia (CHOP) found that only 8% of pediatric healthcare and behavioral service providers feel prepared to assess whether their autistic patients are ready to drive. These findings, recently published in the Journal of Autism and Developmental Disorders, suggest a critical need to develop resources that prepare providers and others who work with autistic youth to effectively facilitate independence and mobility as their patients become adults.

This study is part of a body of research that aims to understand the transportation needs of autistic adolescents. Prior studies have examined how individualized training, parental support, and driving patterns contribute to safe driving. Other studies have found that, whether autistic adolescents decide to drive or not, being able to get where they want to go on their own improves psychosocial, health and employment outcomes. While making decisions about transportation, families of both autistic and non-autistic youth seek guidance from their child’s pediatric healthcare and behavioral service providers. However, little is known about these conversations or how providers approach these topics with patients.

The researchers surveyed a total of 78 providers who care for both autistic and non-autistic patients in March and April of 2019. Most providers were attending pediatric physicians and psychologists located in Pennsylvania and New Jersey. Half reported they had general transportation-related discussions with their non-autistic patients, while only 1 in 5 had these conversations with their autistic patients. When discussing driving, 33% of providers believed they could assess if their non-autistic patients were ready to drive, while only 8% believed they could do so for their autistic patients.

“It was also surprising to learn that only 1 in 4 providers refer their patients, autistic or not, to other providers for driving-related issues,” says Emma Sartin, PhD, MPH, lead author and a postdoctoral fellow at CIRP. “Our next steps will be to start developing resources and tools so that families, and the professionals who support them, are not left largely on their own to make or guide important decisions about driving.”

A lack of guidance for families on how to navigate transportation decisions could be critical, as previous CHOP research found that two-thirds of 15- to 18-year-old autistic adolescents without intellectual disability are currently driving or planning to drive, and 1 in 3 autistic individuals without intellectual disability get licensed by age 21. Other recent research conducted at CHOP found that newly licensed young autistic drivers have similar to lower crash rates than their non-autistic peers, suggesting those who do become licensed are generally safe drivers. Additionally, young autistic drivers are much less likely to have their license suspended or to receive a traffic violation than their non-autistic peers.

“One important way that providers can help autistic teens and their families is to start talking about driving and transportation before they get to high school,” says Benjamin E. Yerys, PhD, study author and a clinical psychologist at CAR. “We know this seems early, but it provides more time for them to benefit from supports, including those services that come from outside of healthcare, including tailored instruction from a driving rehabilitation specialist.”

Resources for families to help their autistic teens transition to adulthood are available at the Center for Autism Research at CHOP and TeenDriverSource.org.

This research was supported by the Eunice Kennedy Shriver National Institute of Child Health and Human Development at the National Institutes of Health Awards R01HD079398 and R01HD096221.

Sartin et al, “Brief Report: Healthcare Providers’ Discussions Regarding Transportation and Driving with Autistic and Non-autistic Patients.” J Autism Dev Disord. Online December 1, 2021.DOI: 10.1007/s10803-021-05372-3

Posted on Autism

Racial and ethnic health disparities persist for individuals with autism

Data graph - adult autistic Medicaid beneficiaries


Using Medicaid data, researchers from the A.J. Drexel Autism Institute identified health conditions that varied in prevalence. They found a higher prevalence of heart disease, hypertension, diabetes and obesity by race. CREDIT A.J. Drexel Autism Institute

Often autistic adults can have several co-occurring physical and mental health conditions and, like in non-autistic adults, these may differ by racial and/or ethnic group. Researchers from Drexel University’s A.J. Drexel Autism Institute recently published research showing autistic adults on Medicaid have increased odds of some health, nutrition and psychiatric conditions, compared to the general Medicaid population.

The research also showed that many of the same health disparities by racial/ethnic group in the general population persist among the autistic adult Medicaid population. For example, Black, Hispanic and Asian autistic adults on Medicaid have higher odds of diabetes, and Black and Hispanic autistic adults have higher odds of obesity and nutrition conditions, compared to white autistic adults on Medicaid.

The research team examined Medicaid claims data from 2008–2012 to examine adults ages 18-64, including the full population of adults with autism and created a comparison group from a random sample of beneficiaries without an autism diagnosis. They identified prevalence of co-occurring physical and mental health conditions for these groups and were able to estimate the association of autism diagnosis with those conditions. Finally, using only the population with an autism diagnosis, they estimated the association of racial/ethnic category with each physical and mental health diagnosis.

These findings suggest that, as a whole, autistic adults on Medicaid are not at higher risk of certain severe physical health conditions, such as stroke and cardiovascular disease compared to other Medicaid beneficiaries. However, they are at higher risk of some important health conditions – including conditions such as epilepsy, seizures, Parkinson’s disease and nutrition conditions. Moreover, researchers found important racial disparities in physical health conditions, with Black, Hispanic and Asian autistic adults on Medicaid having higher odds of conditions like diabetes, hypertension and stroke.

“We need to consider ways to reach families with autistic members to ensure they receive preventive health measures and screenings for these conditions,” said Whitney Schott, PhD, a research scientist at the Autism Institute and lead author on the study. “For example, clinicians and public health programs can reach out to patients and families with public health messages and reminders or explore ways of communicating more frequently with patients.”

Autistic adults enrolled in Medicaid have higher odds of mental health diagnoses, including anxiety disorder, attention deficit hyperactivity disorder (ADHD), bipolar and obsessive-compulsive disorder, compared to the general Medicaid population. However, analysis by racial/ethnic group suggests that these diagnoses are less common among Asian, Black and Hispanic autistic adults on Medicaid.

“New and different strategies to ensure access to preventive care, screening and regular monitoring are needed to address health inequities among autistic adults,” said Lindsay Shea, DrPH, director of the Policy and Analytics Center and interim leader of the Life Course Outcomes Research Program at the Autism Institute, an associate professor and co-author of the report. “We need to support autistic individuals, their families, and clinicians to understand and address the needs of Asian, Black and Hispanic groups within Medicaid since it is an important insurer across the lifespan.”

The researchers explained it is important to examine whether the lower odds of diagnosis with various mental health conditions among Asian, Black and Hispanic beneficiaries is a true difference, or whether there is a lack of access to diagnostic and mental health services for these groups.

“The call to action to address health inequities across groups of autistic adults is urgent since the care they need cannot and should not wait. We need medical and public health solutions to engage these groups directly and work together to create change in how they can access the health care they need all along the way,” said Shea. “We should not be waiting until a person has a serious medical condition to serve them. We have opportunities to deliver preventive care that can improve health and well-being now, but we must restructure our approaches to make it a reality.”

The study, “Co-Occurring Conditions and Racial-Ethnic Disparities: Medicaid Enrolled Adults on the Autism Spectrum,” was recently published in Autism Research.

Posted on Rheumatoid arthritis

Black Patients with RA Less Likely to Receive a Biologic, More Likely to Be Treated with Glucocorticoids Than Whites

Black Patients with RA Less Likely to Receive a Biologic, More Likely to Be Treated with Glucocorticoids Than Whites
Black Patients with RA Less Likely to Receive a Biologic, More Likely to Be Treated with Glucocorticoids Than Whites


A new study reveals that Black patients with rheumatoid arthritis (RA) were less likely to be prescribed a biologic treatment and more likely to use glucocorticoids, which carry a risk of serious long-term side effects. This study highlights ongoing racial disparities in the care of patients with rheumatic disease. Details of the study was shared at ACR Convergence, the ACR’s annual meeting (abstract #0044).

RA is the most common type of autoimmune arthritis. It is caused when the immune system (the body’s defense system) is not working properly. RA may cause pain and swelling in the joints as well as affect multiple organ systems such as the lung and eye. RA is treated with disease modifying anti rheumatic drugs, including biologics, to help stop joint pain and swelling, and also prevent joint damage. “

Racial disparities in access to care and effective treatment regimens are poorly understood in the RA population, but past research shows that non-white RA patients have a lower frequency of biologic use versus white patients, even when accounting for comparable disease activity and access to treatment. This new study looked at racial disparities in RA treatment and emergency department use in patients with RA at a single, tertiary academic center in Pennsylvania.

“With the explosion of effective therapies for rheumatoid arthritis, it is particularly important to make sure that we are treating patients in the best way possible,” says the study’s co-author, Michael George, MD, MSCE, Assistant Professor of Medicine at the Hospital of the University of Pennsylvania. “Variability in practice, and disparities in treatment, suggest that there is room for significant improvement. We hope that this study will add to the existing literature about disparities in rheumatoid arthritis care–understanding why they exist and finding ways to address them are key to improving the health of patients with RA.”

The study used electronic health record data from 1,831 patients with RA from 2010 to 2018. Patients had at least two RA diagnoses from a rheumatology outpatient encounter and at least one prescription of a disease-modifying antirheumatic drug (DMARD) during the follow-up period, or from their first to their last clinic visit. The researchers also measured patient demographic information, medication use and comorbidities at the baseline visit and at any point during the follow-up period.

The researchers then compared the differences in patient characteristics and visits between Black and white patients. Of the 1,831 patients in the study, 82% were female, 35% were Black, 54% were white and the mean age was 55. The average follow-up period for all patients was 6.97 years. Black patients were more likely to be older, have a higher body-mass index (BMI), were former or current smokers and had higher rates of cardiovascular disease and diabetes.

The researchers found racial disparities in how RA was treated with prednisone and conventional synthetic DMARD treatments used significantly more often in Black patients than whites: 79.3% of Black patients used prednisone compared to 69.1% of whites, and 96.7% of Black patients used a conventional DMARD compared to 93.5% of whites.

Additionally, white patients in the study were significantly more likely to use a biologic, a more advanced, expensive, and effective treatment for controlling RA disease activity and preventing joint damage. According to the data, 74% of whites and 67% of Blacks were prescribed a biologic drug. Black patients also had significantly more visits to the hospital emergency department (ED) over the eight-year period.

“This project supports prior work showing reduced use of biologics and a greater use of prednisone in patients who were Black – which could potentially mean worse outcomes or increased steroid side effects in this group,” says Dr. George. “A key next step that many are working on is understanding the key drivers of these disparities – understanding why they exist (e.g., access to medications, insurance, patient-provider communication, health beliefs, etc.) is important so we know how to address these disparities.”