Tight blood sugar regulation may help reverse Type 1 diabetes brain damage

The moment a child or teen is diagnosed with Type 1 diabetes (T1D), their world changes. They’re immediately put on strict protocols to keep their blood sugar in line. It turns out these rules may also be necessary for reversing harmful brain damage caused by the disorder, according to a new study.

The research was conducted by doctors at Nemours Children’s Health in Jacksonville and Stanford University.

“We have known for some time that better control of blood glucose levels in persons with Type 1 diabetes can prevent or reduce damage to a number of biological systems (for example, kidney, eyes, nerves, blood vessels). Our new research joins with other studies to highlight that better control of blood glucose levels in children with Type 1 diabetes can potentially reduce injury to the maturing brain and lead to measurable improvements in brain development and function as well,” says lead author and co-principal investigator, Dr. Allan Reiss, the a professor of psychiatry and behavioral sciences, as well as radiology, at Stanford.

To conduct the study, the researchers included 42 participants between the ages 14 and 17 who have been diagnosed with Type 1 diabetes prior to eight years old and were receiving insulin therapy. They then used randomization to split the teenagers into two groups. One group used a hybrid closed-loop insulin delivery system and the other provided general diabetes care.

Closed-loop insulin delivery is used to help stabilize blood sugar levels while asleep, as sleeping makes it difficult to monitor hypoglycemic trends. It works by using a closed glucose monitor (CGM) to measure levels every five minutes through a sensor under the skin. The monitor is able to connect wirelessly to an insulin pump that adjusts the amount of insulin based on the levels read back to it. Over a six-month period, the researchers conducted cognitive assessments and multi-modal brain imaging with everyone.

 The results suggest that diligent, consistent control of blood sugar using CGM may be key to supporting brain development in adolescents with T1D. The participants in this group had significantly better outcomes than the standard care group when it came down to comparing them to normal brain development in adolescents. Those receiving CGM showed more promise in reaching appropriate cognition and functional brain activity that helps them mature at a pace of someone their age without the condition.

“These results offer hope that harm to the developing brain from Type 1 diabetes might be reversible with rigorous glucose control,” says the paper’s senior author, and co-principal investigator, pediatric endocrinologist Dr. Nelly Mauras, of Nemours Children’s Health Jacksonville and professor of pediatrics at Mayo Clinic College of Medicine. 

The work sets a solid precedent for future Type 1 diabetes treatment research frameworks.

This study is published in the journal Nature Communications.

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About the Author

Shyla Cadogan

Shyla Cadogan is a recent graduate from the University of Maryland, College Park with a Bachelor’s of Science in Nutrition and Food Science. She is on her way to becoming a Registered Dietitian, with next steps being completion of a dietetic internship at the University of Maryland Medical Center. Shyla has extensive research experience in food composition analysis and food resource management.

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