Category Archives: Diabetes

A new report from a team of investigators based in Spain is providing evidence that suggests presence of diabetes does not increase risk of long-term post-COVID-19 symptoms.

An analysis of 1800 hospitalized patients from the first wave of the pandemic, results of the study indicate the number of post-COVID symptoms was similar between those with diabetes and those without. Results also indicate there were no between-groups differences observed for any specific post-COVID symptoms.

Current and previous evidence suggest that diabetes seems to play a more relevant role during the acute phase of COVID-19 rather than for the development of post-COVID symptomatology in previously hospitalized COVID-19 survivors, wrote investigators.

Few patient groups have received the amount of attention patients with diabetes have throughout the ongoing COVID-19 pandemic. A common comorbidity among patients with obesity, diabetes quickly became recognized as a risk factor for increased disease severity in patients with COVID-19. As the pandemic has raged on, concern over the long-term effects of COVID-19 has begun to grow. Sometimes referred to as long COVID, ability to predict those at greatest risk of long-term COVID-19 symptoms could have a substantial impact moving forward.

With this in mind, investigators from Spain sought to fill the apparent knowledge gap related to risk of long-term COVID-19 symptoms based on a diagnosis of diabetes by conducting a multicenter case-control study of patients hospitalized for SARS-CoV-2 infection from March 1-May 31, 2020, at a trio of public hospitals in Madrid.

From a sample cohort of 1800 patients hospitalized during the aforementioned time period, investigators identified 145 patients with a diagnosis of diabetes. Using these patients, investigators identified 290 age- and sex-matched controls without diabetes for inclusion. Investigators noted there were no differences in symptoms at hospital admission except for an increased prevalence of myalgia and a greater proportion of patients with diabetes reported comorbid hypertension, obesity, and migraine compared to their counterparts without diabetes.

Patients with diabetes were assessed for symptoms a mean of 7.6 months following hospital discharge. In total, just 19% were completely free of any post-COVID symptom during the follow-up period. Results of the investigators' analyses indicated the number of post-COVID symptoms were similar among patients with diabetes and those without diabetes (IRR, 1.06 [95% CI, 0.92-1.24]; P=.372).

Investigators also noted no differences were observed for presence of fatigue OR, 1.45 [95% ACI, 0.93-2.25]; P=.101), dyspnea on exertion (OR, 0.97 [95% CI, 0.64-1.47]; P=.886), and musculoskeletal pain (OR, 0.951 [95% CI, 0.76-1.18]; P=.367). Investigators also pointed out there were no between-groups differences observed among patients (OR, 1.07[95% CI, 0.71-1.62]; P=.728).

Our study showed that diabetes was not a risk factor for post-COVID symptoms when assessed an average of 7 months post discharge. Further, diabetes was not associated with differences in limitations of daily living activities after hospital discharge, wrote investigators.

This study, Diabetes and the Risk of Long-Term Post-COVID Symptoms, was published in Diabetes.

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Diabetes Not Associated with Increased Risk of Long-Term COVID-19 Symptoms - Endocrinology Network

The CDC's Diabetes Prevention Program is one of the first lifestyle- and behavior-based interventions to be proven, in a large clinical study, to be more effective than a comparable drug (in this case metformin). Digital implementations can make the DPP more accessible and more scalable, and a number of digital health companies have been tackling this for the last few years.

Fruit Street Health is one of those companies, and its CEO, Laurence Girard, joins host Jonah Comstock on today's HIMSSCast to discuss the challenges, opportunitiesand successes his company has had in this space.

Like what you hear? Subscribe to the podcast onApple Podcasts,SpotifyorGoogle Play!

Talking points:

More about this episode:

Fruit Street to deliver CDC's National Diabetes Prevention Program through live video classes

Fruit Street Health raises $3 million in doctors-only round

UK passes on Apple, Google's Bluetooth contact tracing tool, Fruit Street Health launches COVID-19 telemedicine platform and more digital health news briefs

AHIP, CDC to partner on diabetes prevention

Medicare to reimburse for Diabetes Prevention Program, including Omada's digital version

Diabetes Prevention Program under the Affordable Care Act is working, HHS Secretary Burwell says

American Medical Association pushes public, private health plans to cover National Diabetes Prevention Program

CMS calls for extending Diabetes Prevention Program into Medicare, proposes new doc fees to boost chronic care

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HIMSSCast: Taking the CDC's Diabetes Prevention Program digital - Mobihealth News

Why "Runsweet"? This came from advice from a person with type 1 diabetes who tried to "run sweet" toavoid hypos. We know we can do better!

Thank you all for the great feedback about the site. We now boast the widest sports content for people with diabetes on the web.we are now getting more than 30000 visits per month and are top in searches on Google. You continue to test the limits of what is possible, and have submitted great new content. Keep visiting. If youwant to post any content, mail it to us.Our forum is also very popular. We now alsohave a Facebookpage.

He has done it again! Rod Riddell's Marathon des Sables adventure with T1 DM

Major new focus on pump treatmentandhow to use your pump with exercise. New focus on guidelines forsafe exercise.

Can you help with research? We are recruiting for a study (ExTOD) on the effect of structured education on Exercise and Diabetes. See Reseach page if you can help

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Type 2 diabetes is a chronic disease that prevents your body from being able to properly use insulin. Its the result of increased insulin resistance and your pancreas not making enough insulin to manage your blood sugar (glucose) levels.

About 1 in 10 Americans has diabetes, and type 2 diabetes represents 90 to 95 percent of those cases, according to the Centers for Disease Control and Prevention (CDC).

There are many symptoms of type 2 diabetes. Its important to know what they are because diabetes because the condition can be prevented or delayed if caught early.

Read on for the most common symptoms of type 2 diabetes.

The symptoms of type 2 diabetes vary from person to person. They can develop slowly over many years and might be so mild that you dont notice them.

Polyuria, or excessive urination, is one of the 3 Ps of diabetes.

Your kidneys eventually cant keep up with the extra glucose in your bloodstream. Some of the glucose ends up in your urine and draws in more water. This leads to more frequent urination.

Adults naturally produce 1 to 2 liters of urine per day (a liter is about a quart). Polyuria is defined as more than 3 liters per day.

Excessive thirst, or polydipsia, is often a result of frequent urination. Your body urges you to replace lost fluids by making you feel thirsty.

Of course, everyone gets thirsty sometimes. Extreme thirst is uncharacteristic and persistent, no matter how often you replenish.

Excessive hunger is called polyphagia.

If you have type 2 diabetes, your body has a hard time turning glucose into energy. This makes you feel hungry. Eating introduces even more sugar that cant be processed, and it doesnt alleviate the hunger.

Diabetes increases your risk of several eye conditions, including:

The increased blood sugar from diabetes can damage blood vessels, including those in the eye, leading to blurry vision.

Fatigue can be a mental or physical tiredness that doesnt improve with rest. There are many causes of fatigue.

Its a difficult symptom to research, but a 2016 study concluded that people with type 2 diabetes may experience fatigue as a result of fluctuations between high and low glucose levels.

If you have type 2 diabetes, regular cuts and scratches can take longer to heal. Wounds on your feet are common and easy to overlook. Slow healing foot ulcers occur due to poor blood supply as well as damage to the nerves responsible for blood flow to the feet.

A 2020 study showed that diabetic foot ulcers dont mobilize the immune cells needed for proper inflammation and healing.

High glucose can damage the blood vessels that supply nutrients to your nerves. When your nerves dont receive enough oxygen and nutrients, they cannot function properly.

This is called diabetic neuropathy and is most common in your extremities.

Insulin resistance causes glucose to build up in the bloodstream instead of being turned into energy. This can cause your body to consume other energy sources, like muscle or fat tissue.

Your weight might naturally fluctuate a little. An unexplained loss of at least 5 percent of your body weight is generally agreed as a need to talk with your healthcare professional.

In addition to nerve damage and a weakened immune system, poor blood circulation also increases the chance of developing an infection in people with diabetes. Having more sugar in your blood and tissues allows infections to spread faster.

People with diabetes commonly develop infections of the:

Acanthosis nigricans is a skin condition that can be a symptom of diabetes. It appears as dark bands of skin that may have a velvety texture.

This is most common in body folds such as your armpits, neck, and groin, but can also occur elsewhere.

Link:
Type 2 Diabetes Symptoms in Women and Men: What to Know - Healthline

Even if you're one of the more than 34 million people with diabetes, according to the Centers for Disease Control and Prevention, there's so much confusing information out there that what's fact and what's gotten oversimplified or distorted isn't quite clear. But knowing how to prevent and treat this condition, the rate of which has doubled in the last 20 years, is key to keeping it under control. And because diabetes dramatically increases your risk of cardiovascular problems such as heart disease and stroke, taking it seriously could save your life.

Check out these diabetes myths and set yourself straight.

Emilija ManevskaGetty Images

Sugar does not cause diabetes. Being overweight, however, is one of the major risk factors, and foods that are high in added sugar tend to be high in calories. But keep in mind that fat has twice as many calories as sugar, says Matt Petersen, managing director of medical information at the American Diabetes Association. Another potential culprit: eating red meat. If youre at risk, your best bet is to lower your total calorie intake and get those calories from nutrient-rich foods like non-starchy vegetables, whole grains, and low-fat protein and dairy, says Christine Lee, M.D., of the National Institute of Diabetes and Digestive and Kidney Diseases. And when you have a hankering for a sweet, focus on foods with naturally occurring sugar.

Theres a reason type 1 diabetes isnt called juvenile diabetes anymoreyou can get it at any age, says Petersen. Five percent of U.S. adults have been diagnosed with type 1, but sometimes grown-ups are misdiagnosed with the more common type 2, says Sara Pinney, M.D., a pediatric endocrinologist at Childrens Hospital of Philadelphia. The two types of diabetes have different causes: In type 1 diabetes, the body attacks the pancreatic beta cells by mistake, causing them to stop making insulin, the hormone that lowers glucose in the blood, says Dr. Pinney. With type 2, the pancreas makes insulin, but the body doesnt respond well to it. Patients with type 1 need to take insulin to normalize their blood sugar, or they will become very ill. To tell the difference, your doctor may test for certain antibodies in your blood.

Most people dontmany are able to control their diabetes through diet and exercise, oral medication, or a combination of both. Of those with type 2 diabetes, only 40% use insulin, according to the Centers for Disease Control and Prevention. Your need for insulin may change with age, though. Eventually, to keep your blood glucose levels in a healthy range, you might need to use it, Petersen says. And thats OK. Its just that your disease has progressed and now youre taking the best step to manage it. (And if you have type 1 diabetes, you will need to take insulin right from the start.)

It can take monthsor even yearsfor symptoms to get extreme enough for people to figure out on their own that they have type 2 diabetes, says Dr. Pinney. Thats because the most common signs, increased urination and thirst, are easy to overlook or to write off as part of getting older. By the time more noticeable symptoms like blurry vision or tingling hands and feet prompt someone to make a doctors appointment, he or she may have had elevated blood sugars for a long time. An estimated 24% of people with diabetes are undiagnosed, which is why doctors recommend that those with major risk factorssuch as being 45 or older, being overweight, or having a family history of diabeteshave their A1C tested periodically. This simple blood draw will give your doc a snapshot of your blood glucose levels over the past three months and is one way to diagnose diabetes.

Nope! While it may help people lose weight, exercise (even if you dont drop pounds) also increases your insulin sensitivity, which naturally lowers your blood glucose. Studies have shown that a single bout of exercise can improve insulin sensitivity by up to 50% for as long as 72 hours after the sweat session. And even if your weight stays exactly the same, exercise can lower your A1C (long-term glucose levels) and your odds of developing diabetes. Thats because when muscle cells are active, theyre able to take up glucose and use it for energy without needing any insulin, says Petersen. Exercise is kind of a miracle treatment in its own way.

This article originally appeared in the May 2020 issue of Prevention.

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Diabetes Myths - Blood Sugar and Testing Explained - Prevention.com

In a small, preliminary study, researchers have found that people with type 2 diabetes who also have a BMI that falls within a moderate range can reverse their diabetes by losing weight.

The researchers reported their findings at the Annual Meeting of the European Association for the Study of Diabetes.

Type 2 diabetes is the most common form of diabetes, accounting for around 91.2% of diabetes cases in the United States.

The condition occurs when a persons body does not produce enough insulin or if the insulin no longer works effectively. Insulin normally helps glucose enter the cells of the body. In the absence of insulin, glucose stays in the blood, where it can damage organs and tissues.

This means that a person with type 2 diabetes has an increased risk of several health issues, including stroke, heart disease, issues with their feet, kidney disease, dental issues, and bladder problems.

According to researchers writing in the journal Nutrients, scientists for a long time believed that type 2 diabetes was incurable, so they primarily focused on how people should manage symptoms of the condition.

However, evidence now suggests that if individuals who are overweight or have obesity achieve and maintain weight loss, they can reverse type 2 diabetes.

In the present small, preliminary study, researchers have gone one step further and examined whether weight loss might reverse type 2 diabetes even in those whose weight falls within the moderate BMI range.

Medical News Today spoke with the studys first author, Dr. Ahmad Al-Mrabeh, a Transitional Research Fellow at the Centre for Cardiovascular Science at Queens Medical Research Institute at the University of Edinburgh in the United Kingdom.

He explained that they decided to explore whether weight loss could be effective at reversing type 2 diabetes for people with moderate BMI after looking at the results of their previous research.

We observed that the metabolic profile changed markedly after following a low calorie diet even when the change in body weight was [] minor. We, therefore, wanted to test whether inducing modest weight loss could achieve remission in those who are non-obese, said Dr. Al-Mrabeh.

According to the principal investigator of the study, Prof. Roy Taylor, Director of the Newcastle Magnetic Resonance Centre at Newcastle University, U.K., [o]ur previous research has shown that weight loss of 1015% can achieve remission in people with type 2 diabetes who are overweight or obese.

Doctors tend to assume, however, that type 2 diabetes has a different cause in those who arent overweight. This means that, unlike those who are overweight, those who are of [moderate] weight arent usually advised to lose weight before being given diabetes drugs and insulin.

Instead, theres a tendency to start them on insulin and other medication at a much earlier stage.

What weve shown is that if those of [moderate] weight lose 10-15% of their weight, they have a very good chance of getting rid of their diabetes.

This should be a wake-up call to doctors, and, with 1 in 10 of the 4.5 million people with type 2 diabetes in the U.K. of [moderate] weight at diagnosis, there is no time to be lost in getting the message across.

Prof. Taylor

The study involved just 23 people. Of these, 12 individuals had a type 2 diabetes diagnosis with an average age of 58.3 years and an average BMI of 24.5. The remaining 11 did not have diabetes and were of similar age and BMI. This group acted as the control.

The Centers for Disease Control and Prevention (CDC) classify BMI scores of 18.524.9 as healthy.

All participants followed a low calorie diet for 2 weeks, consuming no more than 800 calories each day. The researchers then supported them to maintain their new weight for 46 weeks.

They completed this cycle two or three times until all participants had reduced their body weight by 1015%.

The researchers measured each participants visceral fat and insulin sensitivity before, during, and after the study.

At the end of the study, the researchers matched the people with diabetes with control participants of the same age, sex, and BMI. The scientists found that the individuals with diabetes lost more than twice as much fat in their liver compared with the controls.

In the diabetes group, fat in the pancreas reduced from 5.1% to 4.5%. Also, their average triglyceride levels fell from 1.6 millimoles per liter to 1.0 millimoles per liter a significant reduction similar to the control group.

Most significantly, two-thirds of the participants found that their type 2 diabetes went into remission and could stop taking their medication.

Prof. Taylor says that [t]hese results, while preliminary, demonstrate very clearly that diabetes is not caused by obesity but by [carrying too much weight] for your own body. Its due to having too much fat in your liver and pancreas, whatever your BMI.

In the liver, this excess fat prevents insulin from working normally. In the pancreas, it causes the beta cells to stop producing insulin.

Dr. Al-Mrabeh said to MNT that the results may be reproducible in larger studies, however, it is important to understand the mechanisms of excess fat buildup within these vital metabolic organs (liver and pancreas) in non-obese people.

Speaking with MNT, Prof. Pl R. Njlstad, Leader of the Center for Diabetes Research at the University of Bergen, Norway, said that [t]he findings are interesting and indicate that weight loss is also important in non-obese individuals with type 2 diabetes.

Prof. Njlstad added that [m]ore studies are needed with an increased number of study participants and increased time of follow up, in addition to investigating the effect of other factors, such as age, sex, and ethnicity.

Dr. Al-Mrabeh said to MNT that he will continue developing the initial findings.

I have recently moved to the University of Edinburgh to establish an independent research program looking into the mechanisms of how excess fat causes damage to the pancreas in type 2 diabetes. My aim is to dissect these mechanisms using both human and animal studies.

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Diabetes: Losing visceral fat more important than overall weight - Medical News Today

Male patients with young-onset type 2 diabetes were found to be at 72% greater risk of retinopathy compared with those who received a diagnosis at 50 years or older.

Risk of retinopathy may increase with diabetes duration, particularly in male patients with young-onset type 2 diabetes (T2D), according to abstract findings presented recently at the virtual Annual Meeting of the European Association for the Study of Diabetes (EASD) and to be published in Diabetologia.

Amid an increasing incidence of type 1 diabetes and T2D in younger generations, researchers noted that patients with young-onset T2D incur a high lifetime risk of complications and reduced life expectancy.

Notably, incidence of retinopathy, one of the leading causes of blindness among working-age adults worldwide, has been indicated to affect up to 80% of patients within 15 years after diabetes diagnosis, which may pose a substantial financial burden for these populations if left untreated.

Seeking to further investigate the prevalence of retinopathy and coronary heart disease (CHD), another common complication, in patients with young-onset T2D, the investigators conducted a cross-sectional study of data collected from Norwegian general practice electronic medical records (EMRs).

In the study, EMRs of 10,242 adults with T2D from 2014 were collected. Additionally, to explore relationships between age at diagnosis and complications, they compared patients with young-onset T2D (diagnosis by age 40 years) and those diagnosed at 50 years or older (n = 6627) on clinical outcomes, retinopathy, and CHD via multivariate logistic regression, with multilevel multiple imputation performed to reduce potential bias due to missing data, noted researchers.

Within the cohort, prevalence of young-onset T2D was 10.2% (n = 980; 55.6% were male), in which mean age was 33.3 years at diagnosis and 44.7 years in 2014. Comparably, the mean age for the cohort aged 50 and older was 62.7 years at diagnosis and 70.4 years in 2014.

Compared with the 50 and older cohort, mean glycated hemoglobin (A1C) levels were indicated to be higher in patients with young-onset T2D (60 mmol/mol vs 52 mmol/mol), with incidence of high A1C levels found more frequently at diagnosis in these populations as well (7.6% vs 6.9%). Higher A1C levels were observed in men with young-onset T2D, but levels were similar in women of both age groups.

In those with young-onset T2D, A1C levels were higher already from the point of diabetes diagnosis but also increased more rapidly with time, noted the accompanying press release. In other words, if 2 people had T2D for the same length of time, A1C levels would likely be higher in the one diagnosed at a younger age.

In assessing disease-related complications, retinopathy was shown to develop at an earlier age, with prevalence found to be nearly 3 times higher in patients with young-onset diabetes compared with those who received a diagnosis at 50 years or older (15.5 vs 5.9%).

After accounting for potential confounders, risk of retinopathy was significantly higher in both male and female patients with young-onset T2D. However, after further adjusting for potential mediators (diabetes duration, A1C, and systolic blood pressure), risk was reported to remain significantly high in men with young-onset T2D compared with those diagnosed at 50 or older (odds ratio, 1.72; 95% CI, 1.29-2.29), but not in women (odds ratio, 1.34; 95% CI, 0.95-1.89).

Risk of CHD was shown to be more related to current age than to diabetes duration. Of note, study authors said that diagnosis of T2D may be more likely to be delayed in men, who tend to visit their general practitioner less often than women.

It is important that young-onset T2D is detected early enough and treated adequately to reduce the likelihood of retinopathy and other complications, said study author Katrina Tibballs, PhD student at the University of Oslo, Norway, in a statement. The current guidelines on diabetes prevention and treatment should be updated to reflect the higher risk of complications in those with young-onset diabetes, particularly the elevated risk of retinopathy in men.

Reference

Tibballs KL, Jenum AK, Sandberg S, et al. Young-onset type 2 diabetes: clinical outcomes in Norwegian general practice. Presented at: EASD Annual Meeting 2021; September 27-October 1, 2021; Stockholm, Sweden. Abstract 139.

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Young-Onset Type 2 Diabetes Linked With Higher Risk of Retinopathy in Men - AJMC.com Managed Markets Network

Oct. 1, 2021 -- Almost half of young adults with type 2 diabetes develop a potentially blinding eye complication called diabetic retinopathy within a dozen years after diagnosis, new research reveals.

The findings, from one of the longest-running nationally representative studies in the U.S. focusing on youth-onset type 2 diabetes, provide crucial guidance on diabetes management and eye care to young patients and their families, as well as doctors and the public, says study author Rose Gubitosi-Klug, MD, a pediatric endocrinologist at UH Rainbow Babies and Childrens Hospital in Cleveland, OH.

My colleagues and I in pediatrics are alarmed, Gubitosi-Klug says.

Initially, about 14% of participants had very early changes to the eye. When we looked a second time just 7 years later, about half are now experiencing changes to the eye, some with advanced disease thats not normally seen until someone is in their fourth or fifth decade of life.

The study was published online Sept. 16 in the journal Diabetes Care.

Half of Patients with Average Age of Just 25 Had Signs of Eye Damage

Diabetic retinopathy -- the leading cause of blindness in working-age adults and one of the top reasons for preventable blindness -- is characterized by damage to the blood vessels at the back of the eye. These abnormal vessels resemble scar tissue that can pull the retina out of place, causing blurriness, floaters, or severe vision loss.

Scientists had believed that U.S. rates of diabetic retinopathy would double between 2010 and 2050, but with this new data, we expect this rate will more than double, says Gubitosi-Klug, whos also a professor of pediatrics at Case Western Reserve School of Medicine in Cleveland.

Previously, the TODAY (Treatment Options for Diabetes in Adolescents and Youth) study had reported a 13.9% prevalence of diabetic retinopathy in young people who had had type 2 diabetes for an average of about 5 years. Seven years later, between 2017 and 2018, 420 of the original 517 participants again had retinal photograph tests that were evaluated for the presence of diabetic retinopathy and its advance.

In the later analysis, 49% of participants -- whose average age was just 25 -- had developed diabetic retinopathy. While 39% had mild or very mild cases of the eye condition, about 4% had its most severe form. Compared with mildly affected patients, those with more extreme progression had higher blood sugar and blood pressure levels, as well as more health problems.

Participants represented diverse racial and ethnic groups, including Hispanic, Black, and Native American people considered at higher risk of developing type 2 diabetes, making the findings generalizable to the American public, Gubitosi-Klug notes.

Treat Youths Early, Prevent Complications

About 210,000 youths in the U.S. under age 20 are estimated to have diabetes, according to the American Diabetes Association. These patients should strive to tightly control blood sugar levels and work closely with their doctors to do so, Gubitosi-Klug advises.

Even if their vision is OK now, diabetes likes to take effect on your tissues earlier, so see your doctors and follow up with an ophthalmologist, she says. And dont skip those eye screenings.

Beyond the study findings related to eye health, doctors should understand that children at a young age are not only developing diabetes, but developing the complications of diabetes, Gubitosi-Klug continues.

I think theres been hesitancy to aggressively treat them with medications for diabetes or high blood pressure because theyre young. But waiting is putting them on the path to developing these complications.

Even people without diabetes should be aware of this issue, she says.

We need to work with families to overcome barriers to make sure healthy food is available to all, and that schools and kids can focus together on healthy eating and activity to help prevent these kids going on to have diabetes.

And routine eye exams should also include the extra step of dilated retinal testing, Gubitosi-Klug says. With about 1 in 10 Americans diagnosed with diabetes, and another 88 million with prediabetes, such testing could reveal early signs of diabetic retinopathy or other dangerous vision changes.

Theres good news: If we catch early lesions and improve diabetes control, we know from other studies that some eye findings can improve, she says. So, theres always a benefit in trying to improve your diabetes management.

WebMD Health News

Diabetes Care: Development and Progression of Diabetic Retinopathy in Adolescents and Young Adults With Type 2 Diabetes: Results From the TODAY Study.

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Alarming Number of Youths with Type 2 Diabetes Have Eye Damage - WebMD

Significance

Methods to detect type 1 diabetes (T1D) progression prior to clinical diagnosis are needed. T1D results from autoreactive T cells infiltrating the islets of Langerhans, destroying insulin-producing -cells. Overt disease takes years to present, and at diagnosis, there is substantial -cell loss. Therapeutic intervention to preserve -cell mass is hampered by an inability to follow presymptomatic T1D progression. Several immunotherapies can delay T1D development. However, identifying at-risk individuals and tracking whether therapeutic interventions are impacting disease progression, are lacking. We present ultrasound imaging of nanodroplet (ND) contrast-agent accumulation within the islet. ND accumulation is dependent on immune infiltration; therefore, it tracks presymptomatic T1D development and progression to diabetes. This provides an opportunity to guide therapeutic treatments to prevent T1D.

Type 1 diabetes (T1D) results from immune infiltration and destruction of insulin-producing cells within the pancreatic islets of Langerhans (insulitis). Early diagnosis during presymptomatic T1D would allow for therapeutic intervention prior to substantial -cell loss at onset. There are limited methods to track the progression of insulitis and -cell mass decline. During insulitis, the islet microvasculature increases permeability, such that submicron-sized particles can extravasate and accumulate within the islet microenvironment. Ultrasound is a widely deployable and cost-effective clinical imaging modality. However, conventional microbubble contrast agents are restricted to the vasculature. Submicron nanodroplet (ND) phase-change agents can be vaporized into micron-sized bubbles, serving as a microbubble precursor. We tested whether NDs extravasate into the immune-infiltrated islet microenvironment. We performed ultrasound contrast-imaging following ND infusion in nonobese diabetic (NOD) mice and NOD;Rag1ko controls and tracked diabetes development. We measured the biodistribution of fluorescently labeled NDs, with histological analysis of insulitis. Ultrasound contrast signal was elevated in the pancreas of 10-wk-old NOD mice following ND infusion and vaporization but was absent in both the noninfiltrated kidney of NOD mice and the pancreas of Rag1ko controls. High-contrast elevation also correlated with rapid diabetes onset. Elevated contrast was also observed as early as 4 wk, prior to mouse insulin autoantibody detection. In the pancreata of NOD mice, infiltrated islets and nearby exocrine tissue were selectively labeled with fluorescent NDs. Thus, contrast ultrasound imaging with ND phase-change agents can detect insulitis prior to diabetes onset. This will be important for monitoring disease progression, to guide and assess preventative therapeutic interventions for T1D.

Author contributions: M.A.B. and R.K.P.B. designed research; D.G.R., M.C., A.K.U., V.T.P., and R.K.P.B. performed research; D.G.R. and M.C. analyzed data; and D.G.R. and R.K.P.B. wrote the paper.

The authors declare no competing interest.

This article is a PNAS Direct Submission. M.V.H. is a guest editor invited by the Editorial Board.

This article contains supporting information online at https://www.pnas.org/lookup/suppl/doi:10.1073/pnas.2022523118/-/DCSupplemental.

All data and analysis are available to be shared upon request. Raw data, including czi microscopy files (for histology), Vevo ultrasound data files (for ultrasound images), and glucose and mIAA data have been deposited at https://www.ebi.ac.uk/biostudies/studies/S-BIAD189.

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Detecting insulitis in type 1 diabetes with ultrasound phase-change contrast agents - pnas.org

ONE in ten people could have diabetes by 2030, experts warn.

Rising obesity levels mean 5.5 million adults will have the disease within a decade up from 4.9 million today, charity Diabetes UK said.

1

And a further 17 million will be at risk of Type 2 because of their weight.

CEO Chris Askew said: Were at the tipping point of a public health emergency and need action today to stop it.

Its a sobering thought that, if we dont act, hundreds of thousands more will face the life-changing news that they have Type 2 diabetes.

With the right care and support, diabetes complications can be avoided and cases of Type 2 diabetes can be put into remission or prevented altogether.

Most people with Type 2 diabetes around 90 per cent of all cases get it because of an unhealthy lifestyle. Type 1 cannot be prevented.

Diabetes UK has called for government investment in weight-loss programmes, diabetes prevention and check-ups to stop patients getting complications.

Two-thirds of Brits are overweight. The NHS is already delivering the worlds largest type 2 diabetes prevention programme.

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One in ten people 5.5 million adults could have diabetes by 2030, experts warn... - The US Sun