Psychological interventions for adherence, metabolic control, and coping with stress in adolescents with type 1 diabetes:a systematic review

Background The aim of this review was to summarize and identify the variations in the effectiveness of psychological interventions on adherence,metabolic control,and coping with stress in adolescents with type 1 diabetes(T1D).Methods An electronic search of literature was performed using PubMed(NLM),Embase(Ovid),CINAHL Plus(EBSCO-host),PsycINFO(Ovid),and Google Scholar.The search was limited to include articles reported the effect of one of the psychological interventions:cognitive behavioral therapy(CBT),coping skills training(CST),stress management,or psychotherapy intervention.The report included peer-reviewed articles published in English from January 1990 until May 2019in adolescents with T1D,and summarizes the results of 24 studies that met the inclusion criteria.Results Psychological interventions showed differential effects on adherence,metabolic control,and coping with stress in adolescents with T1D.Behavioral interventions using principles of CBT appear to have a superior positive effect on regimen adherence compared with other types of psychological protocols.In contrast,metabolic control was significantly improved with the implementation of CST and some forms of CBT.Stress management and psychotherapy interventions showed significant promises for adolescents to cope with their diabetes-related daily stressors.Conclusions However,the findings may add some promises to diabetes management in adolescents,additional research to understand the effect of these interventions is needed.

Prospective evaluation of gastric emptying using ^(13)C-octanoic breath test in relationship with the metabolic control in patients with type 1and type 2 diabetes

The aims were to prospectively evaluate the association of glycemic control (HbAlc) with gastric emptying in newly diagnosed Type 1 diabetic patients and subjects with longterm diabetes mellitus. Furthermore, the day to day variability of gastric emptying for solids should be assessed. Methods 13 C octanoic breath tests were performed in 15 type 1 diabetic subjects on two separate days within one week. The influence of metabolic control on gastric emptying was prospectively examined over a mean of 8 months in 14 patients with newly diagnosed type 1 diabetes and 44 long term diabetic patients (type 1: n=31; type 2: n=13).Patients with longterm diabetes were stratified according to their HbA 1c at follow up (group 1: HbA 1c U7.5%, n=17; group 2 HbA 1c >7.5%, n=27). 13 C octanoic breath tests were sampled with an isotope selective non dispersive infrared spectrometer. The gastric emptying parameters were calculated using nonlinear regression analysis of the time course of 13 CO 2 exhalation:half emptying time (t 1/2 ) and lag phase (t lag ). Results The intraindividuell coefficient of variation was 17.8% for t 1/2 , and 28.2% for t lag . Mean t 1/2 and t lag in newly diagnosed type 1 diabetics were normal at baseline and were significantly increased at follow up. In patients with longterm diabetes, gastric emptying was unchanged during follow up. Gastric emptying was significant delayed in group 2 compared with group 1 at baseline and follow up respectively. There was a significant correlation between HbA 1c and t 1/2 , t lag at follow up. Conclusions 13 C octanoic breath test has a relatively good reproducibility in patients with type 1 diabetes. Gastric emptying times are already significantly increased after few months in newly diagnosed type 1 diabetes. There is a more pronounced delay of gastric emptying in longterm diabetic subjects with poor compared to patients with good metabolic control.

Hypothalamic circuits and aging:keeping the circadian clock updated

Over the past century,age-related diseases,such as cancer,type-2 diabetes,obesity,and mental illness,have shown a significant increase,negatively impacting overall quality of life.Studies on aged animal models have unveiled a progressive discoordination at multiple regulatory levels,including transcriptional,translational,and post-translational processes,resulting from cellular stress and circadian derangements.The circadian clock emerges as a key regulator,sustaining physiological homeostasis and promoting healthy aging through timely molecular coordination of pivotal cellular processes,such as stem-cell function,cellular stress responses,and inter-tissue communication,which become disrupted during aging.Given the crucial role of hypothalamic circuits in regulating organismal physiology,metabolic control,sleep homeostasis,and circadian rhythms,and their dependence on these processes,strategies aimed at enhancing hypothalamic and circadian function,including pharmacological and non-pharmacological approaches,offer systemic benefits for healthy aging.Intranasal brain-directed drug administration represents a promising avenue for effectively targeting specific brain regions,like the hypothalamus,while reducing side effects associated with systemic drug delivery,thereby presenting new therapeutic possibilities for diverse age-related conditions.

Bile acids control inflammation and metabolic disorder through inhibition of NLRP3 inflammasome

With the support by the National Natural Science Foundation of China,the research team led by Prof.Wang Di(王迪)at the Immuno metabolism Lab,Institute of Immunology,Zhejiang University School of Medicine,uncovered the mystery of Bile Acids control inflammation and metabolic disorder,which was published in Immunity(2016,45:802—816)).