Posted on Diabetes

Poor quality of sleep and falling asleep later are associated with poorer control of blood sugar after meals


A new study published in Diabetologia (the journal of the European Association for the Study of Diabetes [EASD]) finds that later bedtime routines and poor quality of sleep are associated with higher blood glucose levels and poorer control of blood sugar following meals.

The research was conducted by Neli Tsereteli, Lund University Diabetes Centre, Malmö, Sweden, and Professor Paul Franks of both Lund University Diabetes Centre, Malmö, Sweden and Harvard Chan School of Public Health, Boston, MA, USA, and colleagues.

The authors examined whether night-to-night fluctuations in sleep duration, efficiency, or timing affect postprandial (after meal) glucose response to breakfast the following day.

Diet, exercise, and sleep are fundamental components of a healthy lifestyle; however, the role that sleep plays in affecting the body’s control of blood sugar in people who are generally healthy has been subject to relatively little study so far. Sleep disorders often occur alongside other health problems, which allows them to act as a measure of general health.

Quality of sleep also has a direct causal effect on many life-threatening conditions such as cardiovascular disease, obesity, and type 2 diabetes (T2D); and disturbed sleep caused by conditions such as obstructive sleep apnoea is associated with both the prevalence of T2D and the risk of complications arising from the disease. This and other evidence suggest a strong link between both the quality and duration of sleep, and the ability of the body to properly regulate glucose levels.

The authors note: “While there have been numerous large prospective cohort studies focused on the relationship between self-reported sleep, disease and wellbeing, objective data on sleep and postprandial glucose metabolism typically comes from small studies conducted in tightly controlled settings and in specific population subgroups such as those suffering sleep disturbances owing to pregnancy, sleep apnoea, depression, obesity or diabetes…Because of this, there is a need for greater evidence of the effects of sleep on glucose metabolism in healthy individuals.”

The researchers looked at the relationship between sleep (duration, efficiency, and the midpoint between going to sleep and waking up) and postprandial glycaemic response (change in blood glucose levels after eating a meal) to breakfasts of varying macronutrient composition in a study group of 953 healthy adults from the UK and USA. Participants were enrolled into the ZOE Personalized REsponses to DIetary Composition Trial 1 (PREDICT1), the largest scientific nutrition studies of their kind in the world, which was conducted over 14 days and involved them consuming standardised test meals with a known content of carbohydrates, fat, protein, and dietary fibre. Blood sugar was monitored using a continuous glucose monitoring (CGM) device which took sample data every 15 minutes for the entire duration of the study, while sleep monitoring was performed by an actigraphy unit: a device worn on the wrist which measures the participant’s movements. 

The study found that while there was no statistically significant association between length of sleep period and postprandial glycaemic response, there was a significant interaction when the nutritional content of the breakfast meal was also considered. Longer sleep periods were associated with lower blood glucose following high-carbohydrate and high-fat breakfasts, indicating better control of blood sugar. Additionally, the researchers observed a within-person effect in which a study participant sleeping for longer than they typically would was likely to have with reduced postprandial blood glucose following a high-carbohydrate or high-fat breakfast the next day.

The authors also found a significant link between sleep efficiency (ratio of time asleep to total length of sleep period), which indicates disturbed sleep, and glycaemic control that was independent of the nutritional makeup of the following day’s breakfast. Participants with higher sleep efficiency were on average more likely to have lower postprandial blood glucose than those with lower sleep efficiency. When a participant slept more efficiently than they did normally, their postprandial blood glucose also tended to be lower than usual.

Timing of sleep had a significant effect with a later sleep midpoint being associated with higher blood glucose. This effect was primarily caused by changes to sleep onset (falling asleep later) rather than differences in sleep offset (waking later) and was observed to negatively impact glycaemic control both when comparisons were made between study participants, and when looking at variations in the sleep patterns of individual participants.

The authors say: “Our data suggest that sleep duration, efficiency and midpoint are important determinants of postprandial glycaemic control at a population level, while illustrating that to optimise sleep recommendations it is likely necessary to tailor these to the individual…These findings underscore the importance of sleep in regulating metabolic health, and a combination of both general and more personalised sleep guidelines is likely to be necessary to enable patients to minimise their risk of metabolic disease.”

They conclude: “This study’s findings may inform lifestyle strategies to improve postprandial blood glucose levels, focusing on earlier bedtime routines and maximising high-quality uninterrupted sleep. A combination of both generalised and more personalised sleep guidelines is likely required to ensure optimal metabolic health per se and maximise the effectiveness of guidelines for diabetes prevention.”

Posted on Multiple Sclerosis

In children with multiple sclerosis, teriflunomide tempers lesion growth

Sanofi Launches 'Once Daily' Oral, Teriflunomide 14 mg Tablet 'Aubagio®'- for Treatment of Multiple Sclerosis in India

There are few treatment options for children with multiple sclerosis—a condition in which the immune system attacks the protective covering of nerves in the brain and spinal cord—and most therapies for the disease have not been tested in children. An international team of investigators, including researchers at Massachusetts General Hospital (MGH), has conducted a phase 3, randomized, double-blind clinical trial to examine the safety and efficacy of teriflunomide, an oral immunomodulatory drug approved in more than 80 countries for the treatment of adults with relapsing forms of multiple sclerosis. Based on the trial’s results, which appear in Lancet Neurology, teriflunomide was recently approved by the European Commission for children aged 10–17 years with a diagnosis of relapsing remitting multiple sclerosis.

In the trial, called TERIKIDS, 109 children were randomized to receive teriflunomide and 57 were randomized to receive placebo for up to 96 weeks (nearly two years). Early entry in an open-label extension phase (where patients were guaranteed to receive teriflunomide) was possible before the end of the double-blind period for patients who experienced a relapse or demonstrated high disease activity on MRI imaging tests.Importantly, more patients in the placebo group entered the open-label extension phase (because of high MRI activity) than anticipated, with 26% of patients switching from placebo to teriflunomide before 96 weeks.

After 96 weeks, there was no difference in time to first clinical relapse of multiple sclerosis with teriflunomide compared with placebo. Teriflunomide was well tolerated—serious adverse events occurred in 11% of patients in the teriflunomide group and 11% of patients in the placebo group. Nasal inflammation, upper-respiratory-tract infection, hair loss, tingling sensations, abdominal pain, and increased blood creatine phosphokinase (a marker of muscle damage) were more frequent with teriflunomide than with placebo.

“The trial did not meet its primary endpoint—delaying time to the next clinical relapse—possibly because of more frequent switches to the open-label arm due to high MRI activity. However, the study did meet several key secondary endpoints related to teriflunomide’s ability to reduce the number of new or enlarged lesions that are detected through MRI, suggesting that the medication might have beneficial effects in children with relapsing forms of multiple sclerosis,” says lead author Tanuja Chitnis, MD, director of the MGB Pediatric Multiple Sclerosis Center at MGH.

Chitnis notes that an ongoing open-label treatment extension study is continuing to evaluate the long-term effects of teriflunomide in young patients.

Chitnis is also director of the Translational Neuroimmunology Research Center at Brigham and Women’s Hospital and a professor of neurology at Harvard Medical School.

This work was supported by Sanofi.

Posted on Mental health

How to cope with anxiety

How To COPE With ANXIETY - Olivia Remes Motivational Video 2020 - YouTube


Anxiety is one of most prevalent mental health disorders, with 1 out of 14 people around the world being likely affected. Leading up to conditions such as depression, increased risk for suicide, disability and requirement of high health services, very few people who often need treatment actually receive it. In her talk “How to cope with anxiety”, Olivia Remes of the University of Cambridge will share her vision on anxiety and will unravel ways to treat and manage this health disorder.


Arguing that treatments such as psychotherapy and medication exist and often result in poor outcome and high rates of relapses, she will emphasise the importance of harnessing strength in ourselves as we modify our problem-coping mechanisms. Olivia will stress that by allowing ourselves to believe that what happens in life is comprehensive, meaningful, and manageable, one can significantly improve their risk of developing anxiety disorders.

Posted on Autism

The Best Ways That You Can Look After an Autistic Child and Help Them Thrive

Looking after a child who has autism can be challenging, but there are many different means available that you can look after them in a way that keeps them safe, happy and encourages them to thrive. While doing all of this, you need to make sure that you are taking care of yourself throughout and being as emotionally strong as possible. This article will break down some of the best ways that you can look after your child if they have autism and keep encouraging them to thrive.

Create a Home Safety Zone

A home safety zone for a lot of parents will mean an area where you should keep safety supplies. This is an important zone to have in case your child ends up hurting themselves, so be sure to leave in one area some first aid supplies from a site such as MFASCO, as well as some information on treating common injuries.

While this is relevant, a home safety zone for a child with autism can be something else too. This essentially means creating an area in a space that is private (or at least offers some privacy) where your child is able to relax and feel as safe and secure as possible. This is good as it means you can set your child some boundaries that they will be able to understand.

Be Consistent Within Your Child’s Environment

The symptoms of autism can manage themselves differently in some people over others; however, one of the most common instances is that they find it difficult to apply something they have learned in one environment to another. For instance, if they learn something at home, then they might struggle to carry out such an action in a classroom environment. As such, it is important that you keep a level of consistency within your child’s life. In order to make it so your child can apply lessons to different environments, you should ask if lessons and therapy sessions can take place in multiple locations as this will help with their development.

Be Sure to Practice Positive Reinforcement by Rewarding Good Behaviour

Positive reinforcement can go a long way when it comes to teaching your child and encouraging them to thrive. As such, whenever you catch your child doing something good or they excel in school or therapy at something, be sure to make a big deal out of it and reward them. You should make sure your rewards come with variety, too, as this will encourage your child to keep acting in such a positive manner in order to see what their reward will be.

Conclusion

Looking after a child comes with an array of challenges regardless of whether they are born with autism or not. That being said, there is no getting around the fact that when you have a child with autism, this can present other challenges. In order to take care of them and encourage them to thrive, you should assign your home with a safety area, reward positive behavior and be consistent with the way you educate your child.

Posted on Fibromyalgia, Pain Management

Gut bacteria associated with chronic pain

People with fibromyalgia show variations in microbiome composition

Bacterial Species Composition

Bacterial species which were found in greater quantities in individuals with fibromyalgia (left) versus species which were found in greater quantities in healthy individuals (right).CREDIT Dr. Amir Minerbi

Scientists have found a correlation between a disease involving chronic pain and alterations in the gut microbiome.

Fibromyalgia affects 2-4 percent of the population and has no known cure. Symptoms include fatigue, impaired sleep and cognitive difficulties, but the disease is most clearly characterized by widespread chronic pain. In a paper published today in the journal Pain, a Montreal-based research team has shown, for the first time, that there are alterations in the bacteria in the gastrointestinal tracts of people with fibromyalgia. Approximately 20 different species of bacteria were found in either greater or are lesser quantities in the microbiomes of participants suffering from the disease than in the healthy control group.

Greater presence or absence of certain species of bacteria

Human Gut Microbiome Composition

Human gut microbiome composition shows an enormous richness. Each circle represents a bacterial species, while the different colours mark different bacterial phyla. CREDIT Dr. Amir Minerbi

“We used a range of techniques, including Artificial Intelligence, to confirm that the changes we saw in the microbiomes of fibromyalgia patients were not caused by factors such as diet, medication, physical activity, age, and so on, which are known to affect the microbiome,” says Dr. Amir Minerbi, from the Alan Edwards Pain Management Unit at the McGill University Health Centre (MUHC), and first author on the paper. The team also included researchers from McGill University and Université de Montréal as well as others from the Research Institute of the MUHC.

Dr. Minerbi adds, “We found that fibromyalgia and the symptoms of fibromyalgia – pain, fatigue and cognitive difficulties – contribute more than any of the other factors to the variations we see in the microbiomes of those with the disease. We also saw that the severity of a patient’s symptoms was directly correlated with an increased presence or a more pronounced absence of certain bacteria – something which has never been reported before.”

Are bacteria simply the markers of the disease?

At this point, it’s not clear whether the changes in gut bacteria seen in patients with fibromyalgia are simply markers of the disease or whether they play a role in causing it. Because the disease involves a cluster of symptoms, and not simply pain, the next step in the research will be to investigate whether there are similar changes in the gut microbiome in other conditions involving chronic pain, such as lower back pain, headaches and neuropathic pain.

The researchers are also interested in exploring whether bacteria play a causal role in the development of pain and fibromyalgia. And whether their presence could, eventually, help in finding a cure, as well as speed up the process of diagnosis.

Confirming a diagnosis and next steps towards finding a cure

Fibromyalgia is a disease that has proved difficult to diagnose. Patients can wait as long as 4 to 5 years to get a final diagnosis. But this may be about to change.

“We sorted through large amounts of data, identifying 19 species that were either increased or decreased in individuals with fibromyalgia,” says Emmanuel Gonzalez, from the Canadian Center for Computational Genomics and the Department of Human Genetics at McGill University. “By using machine learning, our computer was able to make a diagnosis of fibromyalgia, based only on the composition of the microbiome, with an accuracy of 87 per cent. As we build on this first discovery with more research, we hope to improve upon this accuracy, potentially creating a step-change in diagnosis.”

Amir Minerbi

Dr. Amir Minerbi, first author on the paper, along with his colleagues, have found a correlation between a disease involving chronic pain and alterations in the gut microbiome. CREDIT McGill University Health Centre

“People with fibromyalgia suffer not only from the symptoms of their disease but also from the difficulty of family, friends and medical teams to comprehend their symptoms,” says Yoram Shir, the senior author on the paper who is the Director of the Alan Edwards Pain Management Unit at the MUHC and an Associate Investigator from the BRaiN Program of the RI-MUHC. “As pain physicians, we are frustrated by our inability to help, and this frustration is a good fuel for research. This is the first evidence, at least in humans, that the microbiome could have an effect on diffuse pain, and we really need new ways to look at chronic pain.”

How the research was done

The research was based on a cohort of 156 individuals in the Montreal area, 77 of whom suffer from fibromyalgia. Participants in the study were interviewed and gave stool, blood, saliva and urine samples, which were then compared with those of healthy control subjects, some of whom lived in the same house as the fibromyalgia patients or were their parents, offspring or siblings.

The researchers’ next steps will be to see whether they get similar results in another cohort, perhaps in a different part of the world, and to do studies in animals to discover whether changes in bacteria play a role in the development of the disease.