Posted on Diabetes

At risk for diabetes? Cut the carbs, says new study

At risk for diabetes? Cut the carbs, says new study
At risk for diabetes? Cut the carbs, says new study


While low-carb diets are often recommended for those being treated for diabetes, little evidence exists on whether eating fewer carbs can impact the blood sugar of those with diabetes or prediabetes who aren’t treated by medications.

Now, according to new research from Tulane University, a low-carb diet can help those with unmedicated diabetes — and those at risk for diabetes — lower their blood sugar.

The study, published in the journal JAMA Network Open, compared two groups: one assigned to a low-carb diet and another that continued with their usual diet. After six months, the low-carb diet group had greater drops in hemoglobin A1c, a marker for blood sugar levels, when compared with the group who ate their usual diet. The low-carbohydrate diet group also lost weight and had lower fasting glucose levels.

“The key message is that a low-carbohydrate diet, if maintained, might be a useful approach for preventing and treating Type 2 diabetes, though more research is needed,” said lead author Kirsten Dorans, assistant professor of epidemiology at Tulane University School of Public Health and Tropical Medicine.

Approximately 37 million Americans have diabetes, a condition that occurs when the body doesn’t use insulin properly and can’t regulate blood sugar levels.Type 2 diabetes comprises more than 90% of those cases, according to the Centers for Disease Control and Prevention (CDC). Type 2 diabetes can severely impact quality of life with symptoms such as blurred vision, numb hands and feet, and overall tiredness and can cause other serious health problems like heart disease, vision loss and kidney disease.

The study’s findings are especially important for those with prediabetes whose A1c levels are higher than normal but below levels that would be classified as diabetes. Approximately 96 million Americans have prediabetes and more than 80% of those with prediabetes are unaware, according to the CDC. Those with prediabetes are at increased risk for Type 2 diabetes, heart attacks or strokes and are usually not taking medications to lower blood sugar levels, making a healthy diet more crucial. 

The study involved participants whose blood sugar ranged from prediabetic to diabetic levels and who were not on diabetes medication. Those in the low-carb group saw A1c levels drop 0.23% more than the usual diet group, an amount Dorans called “modest but clinically relevant.” Importantly, fats made up around half of the calories eaten by those in the low-carb group, but the fats were mostly healthy monounsaturated and polyunsaturated fats found in foods like olive oil and nuts.

Dorans said the study doesn’t prove that a low-carb diet prevents diabetes. But it does open the door to further research about how to mitigate health risks of those with prediabetes and diabetes not treated by medication. 

“We already know that a low-carbohydrate diet is one dietary approach used among people who have Type 2 diabetes, but there is not as much evidence on effects of this diet on blood sugar in people with prediabetes,” Dorans said. “Future work could be done to see if this dietary approach may be an alternative approach for Type 2 diabetes prevention.” 

Posted on Autism

Autistic women have increased risk of mental illness 

Autistic young men and women are more affected by psychiatric conditions and have an increased risk of being hospitalized as a result of their mental illness compared with non-autistic people. Autistic women are particularly vulnerable. This is shown by researchers from Karolinska Institutet in a study published in JAMA Psychiatry.   

Autistic people have an increased risk of suffering from mental illness. Current data indicates that autistic women are more vulnerable than autistic men, but few studies have been able to establish that there are sex differences.   

Researchers from Karolinska Institutet have now conducted a register-based cohort study with more than 1.3 million people in Sweden who were followed from the age of 16 to 24 between 2001 and 2013. Just over 20,000 of these individuals were diagnosed with autism.   

The researchers found that by age 25, 77 out of 100 autistic women, compared with 62 out of 100 autistic men, had received at least one psychiatric diagnosis.  

“We saw an increased risk of eleven different psychiatric conditions, including depression, anxiety disorders, self-harm and difficulty sleeping,” says Miriam Martini, a doctoral student in psychiatric epidemiology at the Department of Medical Epidemiology and Biostatistics at Karolinska Institutet and first author of the study. 


  

Something that Miriam Martini finds particularly worrying is that 32 out of 100 autistic women had been hospitalized as a result of their mental illness, compared with 19 out of 100 autistic men. For non-autistic people, the corresponding figure was less than five out of 100.    

The study focuses on young adults who are at a crucial time in their life when many mental health problems increase, while the transition to adulthood often means poorer access to care, says Miriam Martini.    

“Healthcare for young adults needs to be expanded, especially for autistic women, so that mental illness can be detected in time to avoid worsening of symptoms resulting in hospitalization,” says Miriam Martini.   

The reason why autistic women are more affected by mental illness than autistic men is not clear, but in the study, the researchers point to several possible factors. Previous research has shown that autistic women to a greater extent use compensatory behaviours to camouflage their autism, which may be due to the fact that women generally tend to adapt to the expectations of those around them. This delays diagnosis and the provision of assistance, which can negatively affect their mental health.   

Another possible explanation may be that it could be difficult to detect autism in women using diagnostic criteria.    

“It may be that autism manifests differently in women than in men, which means that women are not detected using today’s diagnostic criteria. This is something we need to do more research on,” says Miriam Martini.   

The study was funded by MQ Mental Health Research. Some of the study authors have received compensation from industrial companies outside the scope of the current study.    

Posted on Autism

Developmental-behavioural paediatricians can diagnose most autism cases in young children without ADOS testing, finds study.

The Autism Diagnostic Observation Schedule (ADOS) did not change the diagnosis in 90% of cases; study findings could reduce wait times for diagnosis and care


Trained developmental-behavioral pediatricians can generally diagnose autism spectrum disorder (ASD) in young children without the need for additional Autism Diagnostic Observation Schedule (ADOS) testing, finds a prospective multicenter study. The study, conducted through the Developmental Behavioral Pediatrics Research Network (DBPNet) and led by Boston Children’s Hospital, was published October 17 in the journal JAMA Pediatrics.

The ADOS was originally developed as a research tool. Through semi-structured observations, specially trained evaluators assess children’s communication skills, social interaction, and imaginative use of materials.

“The ADOS was never designed to be used in the clinic,” says William Barbaresi, MD, the study’s principal investigator and chief of the Division of Developmental Medicine at Boston Children’s. “But currently, ADOS testing is often required for young children to receive an ASD diagnosis that is accepted by early intervention agencies, schools, and insurers. This study shows that in the majority of cases, young children may be able to have a diagnostic evaluation for ASD by a developmental-behavioral pediatrician without using the ADOS.”

ADOS administration is time consuming, adds additional cost to the diagnostic process, and  there are not enough people trained to administer it. “The requirement for ADOS testing has become a barrier to timely diagnosis and initiation of treatment,” Barbaresi says. “Young children can wait months or even years for an assessment, making it difficult for them to access intensive early intervention services when they are most effective — ideally starting at around 24 months of age.”

The study involved 349 children aged 18 months to 5 years who were evaluated at nine academic pediatric centers. Developmental-behavioral pediatricians (DBPs) first made a diagnosis based on their clinical assessment. A specially trained clinician then administered the ADOS, the results of which were shared with the DBP, who then could revise their diagnosis.

In 90 percent of cases, the diagnosis including the ADOS was consistent with the original clinical diagnoses. Consistency was most likely when the clinician felt highly certain of their original diagnosis.

“Overall, this study is good news,” says Barbaresi. “We believe it has the potential to change current practice by reducing wait times for diagnostic evaluations so that children can receive early, intensive treatment for ASD.” The other participating centers were the Children’s Hospital of Philadelphia, Children’s Hospital Colorado, University of Arkansas for Medical Sciences, University of California-Davis, Children’s Hospital Los Angeles, Hospital of St. John of God (Linz, Austria), Rainbow Babies and Children’s Hospital (Cleveland, Ohio); and the Children’s Hospital at Montefiore (Bronx, NY).

Posted on Fibromyalgia

Green eyeglasses reduce pain-related anxiety in fibromyalgia patients, study shows

Green eyeglasses reduce pain-related anxiety in fibromyalgia patients
Green eyeglasses reduce pain-related anxiety in fibromyalgia patients


Wearing special green eyeglasses for several hours a day reduces pain-related anxiety and may help decrease the need for opioids to manage severe pain in fibromyalgia patients and possibly others who experience chronic pain, according to a study being presented at the ANESTHESIOLOGY® 2022 annual meeting.

“Our research found that certain wavelengths of green light stimulate the pathways in the brain that help manage pain,” said Padma Gulur, M.D., lead author of the study and executive vice chair of Duke Anesthesiology and Duke Health, Chapel Hill, North Carolina. “There is an urgent need for additional treatments to reduce the use of opioids among patients with fibromyalgia and other types of chronic pain, and green eyeglasses could provide an easy-to-use, non-drug option.”

Few alternatives to opioids — especially non-drug options — exist for patients with severe and chronic pain conditions such as fibromyalgia, which causes pain all over the body. Fibromyalgia affects about 4 million U.S. adults, according to the Centers for Disease Control and Prevention.

Pain and anxiety share similar biological mechanisms. Additionally, fear of pain exacerbates anxiety, often leading to increased opioid use, said Dr. Gulur.

The researchers studied 34 fibromyalgia patients who were randomized to wear various shades of eyeglasses four hours a day for two weeks: 10 patients wore blue eyeglasses, 12 wore clear eyeglasses and 12 wore green eyeglasses. Patients who wore green eyeglasses were four times more likely to have reduced anxiety than those in the other groups, which saw no reduction in anxiety.

“We found that although their pain scores remained the same, those who wore the green eyeglasses used fewer opioids, demonstrating that their pain was adequately controlled,” said Dr. Gulur. “We would recommend the green eyeglasses treatment for those with fibromyalgia and are studying patients with other chronic pain conditions to determine if it would be beneficial.”

The eyeglasses are specially formulated to filter a specific wavelength on the green light spectrum, said Dr. Gulur. She noted that most patients who wore the green eyeglasses reported feeling better and asked to keep wearing them.

Posted on Lupus

New for Lupus Research in Children

Dr. Virginia Pascual

Dr. Virginia Pascual CREDIT John Abbott

A multi-institutional team of scientists, led by researchers at Weill Cornell Medicine’s Gale and Ira Drukier Institute for Children’s Health, have received a five-year $8.297 grant to continue funding a Center for Lupus Research. The grant, awarded by the National Institute of Arthritis and Musculoskeletal and Skin Diseases of the National Institutes of Health, will allow researchers to explore the underlying mechanisms of systemic lupus erythematosus (SLE) in children with the goal of better tailoring treatment.

“Pediatric lupus is often underrecognized, but up to a quarter of people with the illness have disease that starts in childhood,” said Dr. Virginia Pascual, program director of the Center for Lupus Research and the Drukier Director of the Drukier Institute for Children’s Health at Weill Cornell Medicine.

SLE, a chronic immune disease, tends to be more aggressive in children than in adults. Symptoms can include joint pain, rash, fatigue, fever and sensitivity to light. “There is a tremendous need to understand the complexity of pediatric lupus,” said Dr. Pascual, who is also the Ronay Menschel Professor of Pediatrics at Weill Cornell Medicine.

Dr. Pascual and her colleagues received funding based on their prior research. They discovered that children with lupus have red blood cells that are a rich and unusual source of nucleic acids that activate other cells to cause inflammation. These cells, called macrophages, produce cytokines, or molecules that activate the immune system, creating an inflammatory response. The research team wants to better understand the underlying mechanisms of this inflammatory process.

They also want to determine why up to a third of children with lupus do not respond to standard of care, which consists of high doses of steroids and immunosuppressive medications.

“We want to apply all of the molecular techniques we have developed for studying this disease to understanding what’s going on in these patients at the time of diagnosis and through flares and remissions,” said Dr. Pascual.

The researchers will compare this data to information collected from children who do respond to treatment. The goal is to identify biomarkers of drug resistance and to develop new approaches to care.

Dr. Pascual’s research colleagues include Dr. Patrick Wilson, who was recruited as a professor of pediatrics and member of the Drukier Institute at Weill Cornell Medicine and a principal investigator at the Center for Lupus Research; Dr. Simone Caielli, assistant professor of immunology research in pediatrics and a junior investigator at the center. Other members include Dr. Duygu Ucar, associate professor at the Jackson Laboratory and the center’s administrative core associate director and co-investigator; Dr. Tracey Wright, chief of the Division of Pediatric Rheumatology at UT Southwestern Medical Center and principal investigator for the center’s clinical sample core; and several pediatric rheumatologists from Nationwide Children’s Hospital, who will contribute patients for the study.

“I am very fortunate to have received this award and to work with this amazing group of colleagues,” Dr. Pascual said. “Together, we have already generated some interesting data, and we hope to continue advancing the field.”