It has previously been observed that young children with type 1 diabetes have changes in brain structure, when compared to children without diabetes. However, it has not been known how these differences in brain structure might change over time. To help address this knowledge gap, Drs. Tsalikian and Tansey have helped conduct a multicenter longitudinal trial following over 100 children with type 1 diabetes. The children underwent repeated brain imaging with MRI over an average span of 6 years time. The results from this study have now been published in the prestigious journal Diabetes Care (link). The study found that the brains of children with type 1 diabetes exhibited smaller volume, and that this difference became greater over time. Importantly, higher blood sugar levels were correlated with greater loss of brain volume. These results lend further credence to the notion that loss of brain tissue is a complication of childhood diabetic hyperglycemia. Furthermore, the results suggest that meticulous glycemic control might prevent these structural brain changes. Since the study was correlative, these conclusions are not fully definitive and further study is needed. It remains crucial that children with diabetes be followed by an expert pediatric endocrinology team, such as at the University of Iowa. Several other of our division members contributed to this work, including study coordinators Julie Coffey MSN and Rachel Bisbee. We also thank the families and children who volunteered as participants in this study.
The University of Iowa Fraternal Order of Eagles Diabetes Research Center (FOEDRC) is being highlight this month in Iowa Magazine (link). You can read about work from the FOEDRC aimed at better treating and preventing diabetes. Our faculty members Drs. Norris, Tansey, and Tsalikian are mentioned.
“With the advent of techniques to strengthen brain regions, such as transcranial magnetic stimulation, it is possible that this type of research will help delineate important future interventions.” –Andrew Norris
Dr. Tansey and collaborators across the country have been studying brain function in children with and without type 1 diabetes. In a study published today (link) in the prestigious journal Diabetes, they report important differences between these two groups. They used functional magnetic imaging resonance (fMRI) to measure activation in various brain locations while the children were given memory tasks. Compared to children without diabetes, those with type 1 diabetes exhibited decreased memory performance relative to children without diabetes. Interestingly the children with type 1 diabetes showed greater increases in brain activation with harder tasks than those without diabetes, suggesting that their brains were working harder to compensate. More research is needed to understand how these effects of diabetes occur and how they might be modulated. With the recent advent of techniques to strengthen brain regions, such as transcranial magnetic stimulation, it is possible that this type of research will help delineate important future interventions. Also involved in the study from our Division were Dr. Tsalikian, Julie Coffey, Joanne Cabbage, Sara Salamati, and Rachel Bisbee.
“with the advent of techniques to strengthen brain regions, such as transcranial magnetic stimulation, might this type of research help guide possible interventions?” –Andrew Norris
Dr. Tsalikian and collaborators across the country have been studying brain cognitive function in children with and without type 1 diabetes. In a study just published in PLOS Medicine, they report interesting differences. They used functional magnetic imaging resonance (fMRI) to measure activation in various brain locations while the children were given tasks. Compared to children without diabetes, those with type 1 diabetes exhibited two differences. One of the observed changes was impaired control of a region towards the back of the brain and this impairment typically leads to diminished task performance. In contrast, there was enhanced activation of a region towards the front of the brain involved in executive control. It appears that these two changes balanced each other, in that the two groups had similar task performance. Simply put, it appears that the brains of children with type 1 diabetes are able to compensate for impairments presumably induced by long-term exposure to high blood sugars. More study is needed to understand this latter point in particular, for example would the pattern normalize if the blood sugars were held to the normal range during the study? Furthermore, more study is needed to understand the broader implications of this work, for example might these or related changes contribute to the increased risk of depression in persons with diabetes? Finally, with the advent of techniques to strengthen brain regions, such as transcranial magnetic stimulation, might this type of research help delineate important interventions? Also involved in the study from our Division were Dr. Tansey, Julie Coffey, Joanne Cabbage, Sara Salamati, and Rachel Bisbee.
A recent study published Aug 2019 in the New England Journal of Medicine (abstract link here) has shown that a drug called teplizumab can delay the onset of type 1 diabetes by 2 years on average in persons at risk. Teplizumab is a monoclonal anti-CD3 antibody, and as such interferes with the activation of T cells involved in attacking beta-cells of the pancreas. This is a significant step towards meaningful strategies to prevent type 1 diabetes. Not only are we thrilled at this development, but we are also proud that one of the senior faculty in our Division, Dr. Eva Tsalikian, helped conduct the research and write the article. Other staff in Iowa involved with the study included division faculty Dr. Michael Tansey, and research coordinators Joanne Cabbage & Julie Coffey.
Metformin is a first-line medication used to treat type 2 diabetes, where its main action is to improve insulin sensitivity and ultimately to decrease complication rates. In persons with type 1 diabetes, metformin alone is not effective treatment, because it can not replace the profound lack of insulin that occurs in this disease. However, some patients with type 1 diabetes, especially those who are obese, develop insulin resistance. Dr. Tansey and Dr. Tsalikian helped direct a recent study which found that 3 months of metformin treatment (in addition to insulin treatment) in these patients led to improvements in insulin sensitivity. Differing from type 2 diabetes however, hepatic insulin sensitivity was not improved. The results from this study are now published in the prestigious Journal of Clinical Endocrinology and Metabolism.
It has long been wondered what effects diabetes in kids may have on the developing brain. Recent studies suggest that higher glucose levels found in poorly controlled diabetes alter brain development. Dr. Tsalikian is an author on a recent manuscript (link) published in the prestigious journal Diabetologia furthering these observations. The multicenter observational trial found that among children with diabetes, those with higher average glucose levels had greater degrees of persistent disruption of their brain white matter, and that the changes in white matter were associated with worsened cognitive performance. These results suggest that good glucose control is important for future brain function in children with diabetes. However, since the study was observational and correlative, these conclusions are not truly definitive and further study is needed. It remains crucial that children with diabetes be followed by an expert pediatric endocrinology team, such as at the University of Iowa. Several other of our division members contributed to this work, including Dr. Tansey, along with study coordinators Julie Coffey MSN, Joanne Cabbage, and Sara Salamati.
We have been rated among the Best Children’s Hospitals for Diabetes & Endocrinology Care by the US News & World Report 13th annual national report, where we were ranked #21 nationwide. Other top ranked specialties at the University of Iowa Stead Family Children’s Hospital included neonatology, pediatric urololgy, pediatric orthopedics, pediatric nephrology, and pediatric cancer.
Dr. Tsalikian, who has long headed the Division of Pediatric Endocrinology & Diabetes, has been asked to serve as the interim Chair of Pediatrics at the University of Iowa and as the interim physician-in-chief of University of Iowa Stead Family Children’s Hospital. These requests recognize her strong leadership skills for leading an academic medical department focused on excellent clinical care and advancing treatment and prevention through cutting edge research. Dr. Tsalikian assumed these duties effective June 1, 2019. Dr. Tsalikian received her medical degree from the University of Athens. Her training in endocrinology research was obtained at the University of California San Francisco and at Mayo Clinic. She completed a pediatric residency at Children’s Hospital of Pittsburgh, and a Pediatric Endocrinology Fellowship at Children’s Hospital of Pittsburgh.
Dr. Tsalikian has helped author a recent manuscript aimed at better understanding whether diabetic ketoacidosis might impact brain development in children. This manuscript was published this month in the prestigious journal Diabetes Care (permanent link to manuscript, link to public free version). They found that children who had experienced moderate-to-severe diabetic ketoacidosis had altered brain dimensions and lower cognitive scores. These results, though only correlative, suggest that moderate-to-severe diabetic ketoacidosis has an adverse impact on the developing brain. Several other of our division members contributed to this work, including Dr. Tansey, along with study coordinators Julie Coffey MSN, Joanne Cabbage, and Sara Salamati.