Posted on Cancer, Diabetes

Individuals with type 2 diabetes at higher risk of certain cancers could be identified through a simple blood test.

Higher levels of pro-inflammatory cytokine interleukin-6 found to be associated with higher risk of a range of cancers; a healthy lifestyle and good blood sugar control could cut inflammation and cancer risk
Higher levels of the pro-inflammatory cytokine interleukin-6 are associated with a higher risk of various cancers. Adopting a healthy lifestyle and maintaining good blood sugar control may reduce inflammation and the risk of developing cancer.

At this year’s Annual Meeting of the European Association for the Study of Diabetes (EASD) in Madrid from September 9th to 13th, it will be discussed that a simple blood test could help identify individuals with type 2 diabetes who are at higher risk of certain cancers. People with type 2 diabetes are known to have a higher risk of developing cancers related to obesity, such as breast, kidney, womb, thyroid, ovarian, colorectal, pancreatic, and gastrointestinal cancers, as well as multiple myeloma. It is believed that chronic low-grade inflammation, which is common in both obesity and type 2 diabetes, plays a significant role in the development of cancer in these conditions.

Mathilde Dahlin Bennetsen and colleagues from the Steno Diabetes Center Odense explored whether differences in levels of proinflammatory cytokines could help identify individuals with type 2 diabetes at higher risk of certain cancers. This could lead to more targeted monitoring, early detection, and personalized treatment.

The study involved 6,466 members of the Danish Centre for Strategic Research in Diabetes (DD2) cohort, who were newly diagnosed with type 2 diabetes. At the start of the study, levels of the proinflammatory cytokines interleukin-6 (IL-6), tumour necrosis factor-alpha (TNF-alpha), and high-sensitivity C-reactive protein (hsCRP) were measured.

The participants were divided into three groups based on their IL-6 levels: the lowest third (IL6 < 0.94 pg/ml), the middle third (0.94-1.58 pg/ml) and the highest third (>1.58 pg/ml). They were then followed for a median of 8.8 years, during which 327 developed an obesity-related cancer. Higher levels of IL-6 at baseline were associated with a greater risk of developing an obesity-related cancer.

When the results were adjusted for age, sex, diabetes duration, alcohol consumption, waist circumference, physical activity, HbA1c (a measure of how well blood sugar is controlled), triglyceride levels, use of lipid-lowering drugs and use of diabetes medication, those in the highest group had a 51% higher risk of developing an OR cancer compared with those in the lowest group.TNF-alpha and hsCRP were only weakly associated with OR cancers compared to IL-6.

Taking smoking status into account did not alter the results. Additionally, when the researchers included baseline IL-6 levels along with other known risk factors for obesity-related cancers, it resulted in a slight but significant improvement in the ability to predict whether an individual would develop one of these cancers.

The inclusion of TNF-alpha or hsCRP did not enhance the predictive models, while higher IL-6 levels were found to be associated with the development of OR cancers in patients recently diagnosed with type 2 diabetes. Ms. Bennetsen suggested that a simple blood test in the future could help identify those at higher risk of these cancers. However, additional research is necessary to determine if such testing would improve early detection and management of these cancers.

Ms Bennetsen adds: “Understanding that higher levels of inflammation can indicate a greater risk of certain cancers highlights the importance of regular check-ups and effective diabetes management.“Maintaining a healthy lifestyle and adhering to treatment plans can potentially help manage inflammation and reduce cancer risk.”

Posted on Rheumatoid arthritis

“Revisiting the criteria for remission in rheumatoid arthritis.”

The first provisional criteria for defining remission in RA were established by EULAR and the ACR in 2011. Two types of remission definitions were agreed upon. The first, called the Boolean definition, required a person to have a score of 1 or less in each of four core variables: tender joint count, swollen joint count, patient global assessment (PtGA), and C-reactive protein (CRP) – a measure of inflammation. The index-based definition used the remission cut-off point of the Simplified Disease Activity Index (SDAI).

Critics have argued that the threshold of 1 or lower for the PtGA is too strict. Some patients may not meet this threshold even if they meet the other criteria. This is significant because PtGA is an important measure of disease activity and one of the most sensitive measures used in clinical trials. Recent data suggests that setting a higher threshold for the PtGA could improve agreement between the two sets of remission criteria.

The researchers collected patient data from four clinical trials that tested the effectiveness of different biological disease-modifying antirheumatic drugs (bDMARDs) compared to a placebo or methotrexate. The authors raised the threshold of the PtGA in 0.5 cm increments, from 1.0 up to 2.5. Additionally, they examined a Boolean definition that did not include the PtGA criterion at all.

t:As expected, using a patient global assessment (PtGA) of 2 cm resulted in higher remission rates compared to using 1 cm. Omitting PtGA altogether further increased the remission rates. It is important to note that there were no differences in radiographic progression observed in people with established rheumatoid arthritis (RA) who achieved remission according to the different definitions.It is important to note that while these revised definitions allow more people to be classified as in remission, the European League Against Rheumatism (EULAR) emphasizes that the definition of remission should remain strict. This is to ensure beneficial long-term outcomes and to prevent unnecessary treatment escalation.

remission criteria, to include a threshold of 2 cm rather than 1 cm for the PtGA criterion. It is proposed that this change be adopted both for future clinical trials and as a target in clinical

practice.

Posted on Multiple Sclerosis

MS clinicians listen up: Here’s how your patients need you to talk about brain atrophy with them.

For individuals with multiple sclerosis (MS), being informed by a doctor about their brain atrophy, an important predictive biomarker of MS disease progression, can evoke overwhelming fear and anxiety.

The University at Buffalo researchers, in collaboration with people with MS and their advocates, have analyzed the issue and devised solutions to improve patient understanding and potentially enhance self-care.

Titled “Communicating the Relevance of Neurodegeneration and Brain Atrophy to Multiple Sclerosis Patients: Perspectives from Patients, Providers, and Researchers,” the paper discusses how clinicians can effectively communicate highly sensitive and technical information about an individual’s progression of MS disease.

The research originated from a unique partnership between BNAC researchers and the centre’s Advisory Council. The council aims to offer a patient’s viewpoint to the centre’s globally recognized team of neuroimaging researchers. BNAC is an institute within the Department of Neurology at the Jacobs School. Zivadinov and his colleagues at BNAC have published some groundbreaking studies that have identified brain atrophy as a significant biomarker for the progression of MS disease.

Akin to a cancer diagnosis

“Our goal is to minimize misunderstanding and apprehension about brain atrophy, also known as brain volume loss, which can seem so devastating it can affect patients similarly to how a cancer diagnosis would,” said Penny Pennington, a lead author on the paper and co-chair of the Advisory Council’s Research and Education Committee. She has lived with MS for over 40 years.

In people with MS, small increments of neurodegeneration and resulting brain atrophy (brain volume loss), as measured by magnetic resonance imaging (MRI), are becoming increasingly better understood as important prognostic biomarkers that can predict patients’ progressive disability.

Based on their experience with patients’ reactions, some clinicians may prefer to avoid discussing atrophy altogether.

The authors found that general statements by clinicians, such as “what the research shows” for the larger population of people with MS, are often not helpful. They emphasized the need to be technically specific.

The paper presents a model for how the medical community can assess and integrate the views of patients, medical providers, and researchers to arrive at guidelines to help ensure that patients are given vital information about their disease progression.

While the paper focuses on multiple sclerosis, it could set a precedent for individuals with other medical conditions to address similar communication challenges.

Convincing patients

“Hard-to-hear or hard-to-communicate information can be crucial in convincing patients to make beneficial changes. However, an excessive or insufficient amount of information, or a rushed explanation, can have the opposite effect on patient care,” stated Pennington.

She added that this reality, coupled with the dramatic increase in the availability of online medical information, can contribute to an unavoidable dilemma for providers and widely disparate views about the best way to communicate with patients.

“By listening to the perspectives and achieving important consensus among the three critical types of players—patients, clinicians, and researchers,” said Pennington, “we arrived at 13 tangible recommendations for clinicians. There is a meaningful opportunity now for the MS community to come together to produce the necessary informative materials and standardize patient interaction practices.”

Three subcommittees, consisting of researchers, providers, and patients, were formed over two years. They hosted workshops and surveys to gather data on current specialty provider practices for discussing MRI findings and patient perceptions regarding MRI findings. Thirteen MS specialists from six academic and non-academic MS centers in the U.S. participated in the survey, along with 26 randomly selected patients from UB’s Jacobs MS Center for Treatment and Research.

Recommendations range from providing basic information on brain anatomy and neurodegeneration to cautions about the state of science and MRI technology. The paper includes a patient discussion guide as a resource for providers. The authors said explaining how an individual patient’s atrophy measurements compare with those associated with normal aging is especially important.

It is recommended that providers discuss with patients how inflammation and neurodegeneration in the brain are measured and how they contribute to brain atrophy in MS.

Healthcare providers should emphasize that MS is diagnosed based on clinical symptoms, not just radiological findings. Treatment decisions should not rely solely on MRI results. It’s crucial to communicate to people with MS the advantages of both physical and mental exercise in helping to build brain reserve. This, in turn, can slow or even reverse the neurodegeneration that leads to brain atrophy.

The authors found that the more a patient understands the role of brain atrophy and other MRI metrics, the more accepting they may be of the value of MS therapies.  

“It is extremely helpful to researchers to see how they can contribute to resolving the dilemma that now confounds so many clinicians and that results in so much unnecessary anxiety and confusion experienced by countless patients,” said Zivadinov.

Posted on Autism

“An autism-led study reveals important priorities for supporting autistic girls and gender diverse youth.”

Six key research areas identified by autistic young people

Autistic girls and gender-diverse youth identified six key research areas. Image courtesy University of Technology Sydney.

A new study led by autistic individuals and researchers from the University of Technology Sydney (UTS) sheds light on the challenges faced by autistic girls, women, and gender-diverse individuals within healthcare, the education system, and society.

The research paper “Nothing About Us, Without Us”: Research Priorities for Autistic Girls, Women, and Gender Diverse People in Australia emphasizes the critical need for inclusive support to enhance the well-being of autistic individuals. It also offers important insights for the National Autism Strategy, which is currently undergoing community consultation.

Study co-lead Dr. Rachel Grove from the UTS School of Public Health stated that the research aims to address the longstanding gaps in understanding the experiences of autistic women, girls, and gender-diverse individuals.

Historically, autism has been viewed through a gendered lens with incorrect assumptions that only boys can be autistic, resulting in oversight and inadequate support.

Dr. Grove emphasized the importance of having autistic individuals conduct the research.

Sarah Gurrin, a co-lead on the project and autistic herself, mentioned that researchers often study autism without understanding the lived experience and breadth of the condition.

“This research is crucial to prevent another lost generation of autistic girls, women, and gender diverse individuals.”

The researchers listened to the perspectives of over 100 autistic girls and gender-diverse individuals aged 7 to 17, deliberately excluding parents and health professionals in order to prioritize the voices of autistic youth.

As Hayley Clapham, a co-lead in the research, who has autism, explains, “For too long, autism research focused on children and young people has predominantly reflected the perspectives of clinicians, educators, and parents.”

“To ensure that research accurately responds to the needs and experiences of autistic young people, it is crucial that researchers prioritize their inclusion in shaping and informing research and outcomes that directly impact their lives.”

The findings, distilled into six key research priority areas for autistic young people, provide a roadmap for meaningful change.

The foremost concern expressed by autistic girls and gender-diverse young people was the need for greater understanding and support at school, including tailored inclusive support across all educational environments.

One autistic young person told the researchers:

“The fact is that I can be in a school system where I don’t receive the support I need because I’m not visibly struggling. I think there needs to be more awareness spread of how autism looks and that it’s not a little mould that someone can fit into.”

Autistic girls and gender-diverse young people also want a better understanding of their experiences, strengths and challenges related to puberty, sensory differences, and self-regulation needs and to see themselves represented in society and the media.

As one autistic young person put it:

“I didn’t see the representation of an autistic person that looked or acted like me, a girl, a teenager, all of these things.”

The third priority outlines the pressing need for specialised mental health services tailored to the autistic experience. This is critical, given autistic women are 83% more likely to lose their lives by suicide than the general population.

One young person said:

“I spent years struggling in school until I mentally broke … Why does it take so long to help autistic females? Why do we have to be mentally exhausted?”

Other research priorities included friendships and relationships, inclusive policies and resources that affirm and respect diverse gender identities, and focus on support first. The researchers say this is critical given the greater gender diversity among autistic people.

The final research priority focuses on accommodations to make life easier, such as practical adjustments that alleviate stress, build capacity and promote autonomy.

The researchers also spoke to over 300 autistic women and gender-diverse adults, with a further eight key priorities identified, including understanding experiences of trauma, abuse and sexual violence and addressing barriers in healthcare, education and the workplace.

One autistic adult spoke of the importance of recognising the strengths of autistic young people and supporting them to flourish:

“I think these girls, these strengths and these brains need to be embraced and utilised. These brilliant, brilliant human beings… I wished I had those tools and that I was allowed to thrive and be who I am when I was that young.”

Tess Moodie, an autistic co-lead in the research, said, “For years, we have been saying there should be nothing about us without us.

“I am hopeful this will set the standard for commitments from future researchers, both for the priorities and authentically collaborating with autistic people in the co-development of research.

“This work sets the agenda for future research to help autistic young people live better lives in our neurotypical-centred world.”

Posted on Fibromyalgia

2 types of cognitive behavioural therapy (CBT) are equally effective for treating fibromyalgia.

Maria Hedman-Lagerlöf

Maria Hedman-Lagerlöf CREDIT Andreas Beronius

A recent study led by researchers at Karolinska Institutet found that there are no significant differences between exposure-based CBT and traditional CBT when it comes to treating fibromyalgia. Both forms of treatment resulted in a noticeable reduction in symptoms for people affected by the disease. This study, published in the journal PAIN, is one of the largest to date to compare different treatment options for fibromyalgia.



Approximately 200,000 people in Sweden are currently living with fibromyalgia, a long-term pain syndrome that causes widespread pain, fatigue, and stiffness in the body, resulting in significant suffering for patients. There is currently no cure for fibromyalgia, and existing drugs often provide inadequate relief, highlighting the need for more effective treatment methods. While cognitive behavioural therapy (CBT) has shown some effectiveness, there is a shortage of trained CBT practitioners and a lack of knowledge about which CBT methods are most effective.


The study compared two different forms of internet-delivered cognitive behavioural therapy in terms of how effectively they reduce the symptoms and functional impact of fibromyalgia.

In short, exposure-based CBT entails the participant systematically and repeatedly confronting situations, activities, and stimuli that the patient has previously avoided due to the association with pain, psychological discomfort, or symptoms such as fatigue and cognitive problems.

In traditional CBT, participants are presented with various strategies to work on during treatment, such as relaxation techniques, activity planning, physical exercise, and methods for managing negative thoughts and improving sleep.

The study showed that traditional CBT was, in general, equivalent to the newer treatment form of exposure-based CBT. 

“Despite our hypothesis, our study shows that the traditional form can be equally effective,” says Maria Hedman-Lagerlöf, psychologist and researcher at Karolinska Institutet.

The randomized study involved 274 people with fibromyalgia, who were randomly assigned to be treated with traditional or exposure-based CBT. The treatments were delivered online, and all participants had regular contact with their therapist. 

Participants were asked to answer questions about their mood and symptoms before, during, and after treatment. Following the 10-week treatment, 60 percent of those who received exposure-based CBT and 59 percent of those who received traditional CBT reported that the treatment had helped them.

“The fact that both treatments were associated with a significant reduction in the participants’ symptoms and functional impairment and that the effects were sustained for 12 months after completion of the treatment, indicates that the internet, as a treatment format, can be of great clinical benefit for people with fibromyalgia,” says Maria Hedman-Lagerlöf. “This is good news because it enables more people to access treatment.”

The study is the second largest to compare different psychological treatment options for fibromyalgia, according to the researchers.

“Our study is also one of the first to compare with another active, established psychological treatment,” says Maria Hedman-Lagerlöf.