Stories about: diabetes

Can we bypass the bypass to treat diabetes?

Diagram of Roux-en-Y gastric bypass
Gastric bypass surgery creates a small pouch in the stomach and connects it directly to the small intestine. Why does it help type 2 diabetes? (Wikimedia Commons)

Research shows that gastric bypass surgery, aside from inducing weight loss, resolves type 2 diabetes. Though weight loss and improved diabetes often go hand-in-hand, patients who undergo gastric bypass usually end up seeing an improvement in their type 2 diabetes even before they lose weight.

But why? To investigate, a research team led by Nicholas Stylopoulos, MD, of Boston Children’s Hospital’s Division of Endocrinology, spent a year studying rats and observed that after gastric bypass surgery, the way in which the small intestine processes glucose changes. They saw the intestine using and disposing of glucose, and showed that it thereby regulates blood glucose levels in the rest of the body, helping to resolve type 2 diabetes.

Basically, as the team reported recently in Science, the small intestine—widely believed to be a passive organ—is actually a major contributor to the body’s metabolism.

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Silencing immune attacks in type 1 diabetes

Could diabetes be treated without insulin shots? (Tess Watson/Flickr)
Could diabetes be treated without insulin shots? (Tess Watson/Flickr)

For decades, patients have managed their type 1 diabetes by injecting themselves with insulin to regulate the glucose in their blood. While this form of medical management addresses the immediate danger of low insulin levels, long-term complications associated with diabetes, like heart and kidney diseases, still threaten more than 215,000 children currently living with the disease in the United States.

“Insulin injections can manage hyperglycemia by reducing the patient’s glucose levels, but it is not the cure,” says Paolo Fiorina, MD, PhD, of the Nephrology Division at Boston Children’s Hospital.

Fiorina is currently involved in new research targeting a molecular pathway that triggers diabetes in the first place—potentially providing a permanent cure. It could potentially change the face of diabetes treatment in children.

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Participatory surveillance in public health: Sharing is caring

Sharing via social media is a great opportunity for collecting better public health data and encouraging healthy behavior changes. (bengrey/Flickr)

We humans are sharing creatures. We talk about ourselves, what we think, what we know. If we weren’t like this, cocktail parties would be really boring, and Facebook and Twitter wouldn’t exist.

Nor would health care. At the most basic level, health care relies on give-and-take between patients and doctors—patients sharing their symptoms and concerns with doctors, and doctors sharing their knowledge with patients.

The same holds true for public health. Prevention and control efforts require lots of patients and doctors to share information so that public health agencies know where to target their resources.

But the give-and-take in public health is often slow and cannot always detect conditions or complications at rates that reflect reality. And usually it’s one-way—from the patient or public to surveyors.

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Empowering patients: Intelligent devices and apps for better health

Melinda Tang, MEng, is a software developer for the Innovation Acceleration Program at  Boston Children’s Hospital.

When children return home from the hospital after surgery, parents can be overwhelmed by the written information and instructions for follow-up. At the MIT Media Lab’s Health and Wellness Hackathon earlier this year, the focus was on empowering patients to take an active role in their health. As my colleague Brian Rosman described, our team from Boston Children’s Hospital attended and spent two weeks developing “Ralph,” a mobile application for managing post-operative care that incorporates an avatar and features of gaming to engage and motivate children to follow their regimen. I was one of the primary programmers for our group.

We won third place, working alongside five other talented teams. Here are some snapshots of what they were up to — helping patients manage asthma, diabetes, pain, cardiac rehab and more.

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Nanomedicine: Can islet-targeting drugs nip diabetes in the bud?

Spherical nanoparticle (Fangting/Wikimedia Commons)

Recent research on Type 1 diabetes has begun focusing on prevention: Studies indicate that children start developing diabetes-related autoantibodies sometimes years before they develop clinical diabetes requiring insulin shots. The autoantibodies are an indicator of insulitis – a precursor condition in which the insulin-producing islets in the pancreas become inflamed and infiltrated with white blood cells.

In animal models, immune-suppressing drugs have been shown to blunt this attack by curbing the number of white blood cells circulating in the body. That reduces the need for insulin treatment – but at a high cost: Given systemically, the high doses needed to suppress the immune attack cause kidney toxicity, reduce the ability to fight infections, and decrease the body’s ability to respond to insulin.

That’s a tough sell for a child who doesn’t yet have symptoms of diabetes – but that’s where nanotechnology can help, say researchers at the Wyss Institute for Biologically Inspired Engineering at Harvard University and Children’s Hospital Boston. What if immunosuppressants could be delivered in far smaller doses, just to where they’re needed in the pancreas?

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Avoiding the needle: Engineering blood vessels to secrete drugs

Within days of injecting a cell mix into mice, numerous blood vessels form. Can these vessels be made to secrete drugs, without the need for IVs or injections?

People who rely on protein-based drugs often have to endure IV hookups or frequent injections, sometimes several times a week. And protein drugs – like Factor VIII and Factor IX for patients with hemophilia, alpha interferon for hepatitis C, interferon beta for multiple sclerosis — are very expensive.

What if they could be made by people’s own bodies?

Combining tissue engineering with gene therapy, researchers at Children’s Hospital Boston showed that it’s possible to get blood vessels, made from genetically engineered cells, to secrete drugs on demand directly into the bloodstream. They proved the concept recently in the journal Blood, reversing anemia in mice with engineered vessels secreting erythropoietin (EPO).

This technology could potentially deliver other protein drugs,

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Connecting unexpected dots between cancer and diabetes

George Daley and his lab may have found a new way to connect the dots between cancer and diabetes. (michelle.gray/Flickr)

Most of us think about cancer as a disease of genes gone awry – of mutations, deletions, duplications, etc. causing unchecked cell growth.

But could you also view cancer as a metabolic disorder, like type 2 diabetes? George Daley and his lab in the Stem Cell Transplantation Program at Children’s have found some intriguing molecular links that make this a plausible idea.

While it’s not yet clear what this means for patients with either disease, the findings help untangle some very perplexing data about human genetics and diabetes risk, and could change doctors’ thinking about the treatment of both conditions down the road.

Scientists have long known that cancerous and healthy cells don’t use sugar in the same ways.

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In diabetes, inflammation may be part of the solution, not the problem

Boosting proteins normally triggered by inflammation may be a new treatment approach for Type 2 diabetes.

Low-grade inflammation caused by obesity is widely believed to contribute to insulin resistance and type 2 diabetes. But, as it turns out, inflammation activates two proteins that appear critical for maintaining good blood sugar levels. Reporting in Nature Medicine, endocrinology researcher Umut Ozcan demonstrates that activating either of these proteins artificially can normalize blood sugar in severely obese and diabetic mice.

That’s a completely new way of looking at diabetes, and suggests a very different way of treating it.

“This finding is completely contrary to the general dogma in the diabetes field,” says Ozcan. “For 20 years, inflammation has been seen as detrimental, whereas it is actually beneficial.”

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Putting technology to work to get kids exercising

Obesity among children is on the rise, but just telling them to out and get more exercise doesn’t work well. Tracy Curran hopes technology and counseling can help. (Photo: Wagner T. Cassimiro "Aranha"/Flickr)

[Ed. Note: This is the second in a series about Children’s Hospital Boston staff who received Patient Services Research Grants in 2011. This grant program engages the professional staff in the Department of Patient Services in high quality pediatric research with the ultimate goal of improving child health]

We all look at babies and fall in love with their chubby little legs and paunchy bellies. (When my younger son was a baby, a friend often jokingly threatened to “eat him like a marshmallow.”)

Cute as it is in babies, though, children can’t afford to have that cushioning as they get older. Obesity threatens the future health of a whole generation of children, putting them at risk for a host of long-term health problems like high blood pressure, type 2 diabetes (increasingly starting in childhood) and cardiovascular disease. This is on top of more immediate problems like sleep apnea, asthma, low self-esteem, depression, fatty liver disease (which can turn into cirrhosis) and joint pain.

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Tapping crowds for science: From galaxies to diabetes

Photo: ausnahmezustand/Flickr

What do a project cataloging pictures of galaxies, an RNA folding game, and a call for people with diabetes to contribute data all have in common?

Each is part of a new revolution in science. Called “citizen science,” this revolution takes science out of traditional academic or industrial environments and into the population at large, asking the general public to take part in activities that further particular areas of research.

Citizen science projects tap the aggregate computing power of crowds to help collect or analyze huge data sets, running the gamut from online games (e.g., FoldIt, EteRNA) to screen savers that make use of your computer while it’s asleep (e.g., SETI@home) to projects asking people to count or categorize images from large-scale astronomy projects (e.g., GalaxyZoo, Stardust@home). Some even try to reduce animal-vehicle collisions on the nation’s roadways by cataloging and mapping roadkill.

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