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Experts reflect on the past, present and future of diabetes

Over r the past 50 years, treatment and outcomes for diabetes have changed dramatically. At a recent symposium, experts looked back at how lives have changed over the past 5 decades and what remains to be addressed over the next 5.

The symposium was held at the American Diabetes Association's (ADA) 75th Scientific Sessions.

"There are things that have happened over the past 50 years that clearly make life a lot better for people," says Dr. Fred Whitehouse, of the Henry Ford Health System in Detroit, MI. "There's been a lot of change, most of it for the better, but what people want is a cure and we don't have that yet."

Dr. Whitehouse has overseen many changes in how people with diabetes have been treated. When he first started treating people with the condition, the only form of treatment was the injection of animal insulin, obtained from cows or pigs, which could sometimes cause adverse reactions.

Nowadays, human insulin is used, produced by microorganisms and delivered through a variety of different systems including insulin pumps. There are now fewer adverse reactions and no fear of supplies running out, Dr. Whitehouse says, with methods of delivery that are more accurate than ever before.

Glucose levels can also be tracked more accurately. Previously, diabetes control could only be assessed by analyzing the levels of sugar in urine. There are many more options available to patients now, including the noninvasive A1C test that measures average levels over 3 months, "showing whether a person is on the right road or not," states Dr. Whitehouse.

As methods for treating and tracking the disorder have improved for patients, so too has the collective understanding of diabetes shared by researchers and clinicians. It takes a long time for research to make a clinical impact and recent years have seen the results of 50 years of hard work.

Dr. Daniel Porte, Jr., a professor at the University of California-San Diego, describes one of the most recent discoveries in the field:

"This year, amazingly enough to me, it was discovered that insulin sent to the central nervous system not only feeds back to the brain, it also affects glucose production. It regulates the islet cells, so there is a complete integration of the endocrine system and the nervous system. It took 40 years to discover this."

Originally, the endocrine and nervous systems were believed to function completely independently of each other, with glucose the sole regular of insulin.

In 50 years, 'complications of diabetes should become historical memories'

Dr. Porte states that with diabetes research, it is crucial to be patient. "For example, the drugs we use now to treat diabetes were first studied 30 to 40 years ago. And there are many more than the one or two that were being used back in the 1970s."

Such research not only leads to an improved understanding of diabetes but of other conditions as well. "We now believe that perhaps impaired insulin action in the central nervous system leads to the behavioral changes we see in Alzheimer's patients," Dr. Porte explains.

Dr. Michael Brownlee, associate director for biomedical sciences at the Albert Einstein College of Medicine's Diabetes Research Center in New York City, NY, states that diabetes is such a serious health problem due to its complications. His research on the mechanisms that cause complications such as eye and kidney disease has led to great change.

"Prior to the Diabetes Control and Complications Trial (DCCT) study that was published [in 1993], the general dogma was that diabetes caused both metabolic changes and complications, which had nothing to do with each other. They were just two parallel manifestations of the disease," he says.

"Now it's known that prolonged high glucose levels increase the risk for eye and kidney complications associated with diabetes, and maintaining tighter control of blood glucose levels reduces that risk."

Although the landscape of diabetes treatment and research has changed radically over the past 50 years, physicians are still only able to manage the disease rather than cure it. Dr. Robert Ratner, chief scientific & medical officer for the ADA, outlines what needs to be done:

"The next 50 years must elucidate the mechanisms by which both type 1 and type 2 diabetes occur, along with those critical steps at which we might intervene to prevent disease. Treatments must provide optimal glucose and metabolic control, without the risk of hypoglycemia, and complications of diabetes should become historical memories."

If research and treatment can progress at the same rate over the next 5 decades as it has over the past 5, who is to say what can be accomplished?

Tomado de McIntosh, J. (2015, June 8). "Experts reflect on the past, present and future of diabetes." Medical News Today. Retrieved from

http://www.medicalnewstoday.com/articles/295011.php.

Teen cannabis users have poor long-term memory in adulthood

Teens who were heavy marijuana users -- smoking it daily for about three years -- had an abnormally shaped hippocampus and performed poorly on long-term memory tasks, reports a new study. The hippocampus is important to long-term memory, which is the ability to remember life events. The brain abnormalities and memory problems were observed during the individuals' early twenties, two years after they stopped smoking marijuana.

Teens who were heavy marijuana users -- smoking it daily for about three years -- had an abnormally shaped hippocampus and performed poorly on long-term memory tasks, reports a new Northwestern Medicine study.

The hippocampus is important to long-term memory (also known as episodic memory), which is the ability to remember autobiographical or life events.

The brain abnormalities and memory problems were observed during the individuals' early twenties, two years after they stopped smoking marijuana.

Young adults who abused cannabis as teens performed about 18 percent worse on long-term memory tests than young adults who never abused cannabis.

"The memory processes that appear to be affected by cannabis are ones that we use every day to solve common problems and to sustain our relationships with friends and family," said senior author Dr. John Csernansky, the Lizzie Gilman professor and chair of psychiatry and behavioral sciences at Northwestern University Feinberg School of Medicine and Northwestern Memorial Hospital.

The study will be published March 12 in the journal Hippocampus.

The study is among the first to say the hippocampus is shaped differently in heavy marijuana smokers and the different looking shape is directly related to poor long-term memory performance. Previous studies of cannabis users have shown either the oddly shaped hippocampus or poor long-term memory but none have linked them.

Previous research by the same Northwestern team showed poor short-term and working memory performance and abnormal shapes of brain structures in the sub-cortex including the striatum, globus pallidus and thalamus.

"Both our recent studies link the chronic use of marijuana during adolescence to these differences in the shape of brain regions that are critical to memory and that appear to last for at least a few years after people stop using it," said lead study author Matthew Smith, assistant professor of psychiatry and behavioral sciences at the Feinberg School of Medicine.

The longer the individuals were chronically using marijuana, the more abnormal the shape of their hippocampus, the study reports. The findings suggest that these regions related to memory may be more susceptible to the effects of the drug the longer the abuse occurs.

The abnormal shape likely reflects damage to the hippocampus and could include the structure's neurons, axons or their supportive environments.

"Advanced brain mapping tools allowed us to examine detailed and sometimes subtle changes in small brain structures, including the hippocampus," said Lei Wang, also a senior study author and an assistant professor of psychiatry and behavioral sciences at Feinberg. The scientists used computerized programs they developed with collaborators that performed fine mappings between structural MRIs of different individuals' brains.

Subjects took a narrative memory test in which they listened to a series of stories for about one minute, then were asked to recall as much content as possible 20 to 30 minutes later. The test assessed their ability to encode, store, and recall details from the stories.

The groups in the study started using marijuana daily between 16 to 17 years of age for about three years. At the time of the study, they had been marijuana free for about two years. A total of 97 subjects participated, including matched groups of healthy controls, subjects with a marijuana use disorder, schizophrenia subjects with no history of substance use disorders, and schizophrenia subjects with a marijuana use disorder. The subjects who used marijuana did not abuse other drugs.

The study also found that young adults with schizophrenia who abused cannabis as teens performed about 26 percent more poorly on memory tests than young adults with schizophrenia who never abused cannabis.

In the U.S., marijuana is the most commonly used illicit drug, and young adults have the highest -- and growing -- prevalence of use. Decriminalization of the drug may lead to greater use. Four states have legalized marijuana for recreational use, and 23 states plus Washington D.C. have legalized it for medical use.

Because the study results examined one point in time, a longitudinal study is needed to definitively show if marijuana is responsible for the observed differences in the brain and memory impairment, Smith said.

"It is possible that the abnormal brain structures reveal a pre-existing vulnerability to marijuana abuse," Smith said. "But evidence that the longer the participants were abusing marijuana, the greater the differences in hippocampus shape suggests marijuana may be the cause."

Other Northwestern authors include senior author Hans C. Breiter and coauthors Derin J. Cobia, James L. Reilly, Andrea G. Roberts and Kathryn I. Alpert.

The study was funded by the National Institute of Mental Health of the National Institutes of Health, grants R01 MH056584 and P50 MH071616.

Tomado de:Northwestern University. (2015, March 12). Teen cannabis users have poor long-term memory in adulthood. ScienceDaily. Retrieved May 19, 2015 from www.sciencedaily.com/releases/2015/03/150312082906.htm