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 Researchers followed a group of diabetics for more than a decade,
offering 164 of them intensive counseling with diet and exercise
support designed to help them shed at least 7 percent of their
weight and keep it off. Another 155 diabetics received only a
standard disease education program.
The counseling group lost more weight and achieved greater gains in
cardiorespiratory fitness than their peers in the control group.
And, in a sign that weight loss might protect against
diabetes-related brain damage, the control group had smaller volumes
of gray matter and more white matter disease by the end of the
study. Smaller volumes of brain tissue and the presence of white
matter disease are linked to cognitive decline.
“If individuals with diabetes change their behavior in mid-life to
lose weight and increase physical activity, this can lead to
long-term benefits in brain health later in life,” said lead study
author Mark Espeland, a public health researcher at Wake Forest
School of Medicine in Winston-Salem, North Carolina.
Globally, about one in nine adults have diabetes, and the disease
will be the seventh leading cause of death by 2030, according to the
World Health Organization.
Most of these people have type 2, or adult-onset, diabetes. Their
bodies can't properly use or make enough of the hormone insulin to
convert blood sugar into energy.
The brain consumes about 20 percent of the energy the body uses, and
the main source of that energy is blood sugar, Espeland said.
Diabetes makes blood sugar a less reliable energy source, which can
compromise brain function and lead to cognitive decline over time.
To see if intensive lifestyle changes might counter the effect of
diabetes on the brain, Espeland and colleagues offered one group of
study participants intensive counseling, encouraged
calorie-restricted diets with limited amounts of fats and proteins
and set exercise goals of at least 175 minutes a week of moderate
activity, which amounts to brisk walking.
The counseling group participants initially had weekly sessions,
followed by monthly meetings for an extended period of time. By
contrast, the other group receiving just standard care was invited
to attend group classes a few times a year.
Over the first year, the intensive counseling group lost about 12
percent of their weight on average, compared with less than 1
percent in the control group. Cardiorespiratory fitness, or the
ability to supply oxygen to the muscles during exercise, improved
about 26 percent for the counseling group over the first year,
compared with 7 percent for the others.
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While the counseling group gave back some of these initial gains
over the course of the 10-year study, they still did better than the
other diabetics over the long run.
Total brain volume was similar between the two groups. But the
average volume of so-called white matter hyperintensities –
concentrations of white matter that represent damaged areas, which
can happen with age and be worsened by diabetes – was 28 percent
lower for the counseling group than the other participants.
Another sign of deterioration, the average volume of fluid-filled
cavities called ventricles, was 9 percent lower for the counseling
group than for the others.
Overall, both groups had similar cognitive function at the end of
the study, although the counseling group performed better on tests
of attention and processing speed.
One limitation is that researchers didn’t look at other factors that
might lead to better diabetes control and potentially protect the
brain, such as blood pressure, sleep apnea, depression, medication
use and inflammation, the authors note in the journal Diabetes Care.
Still, weight loss and other lifestyle changes reduce high glucose
levels that are toxic to the brain, Dr. Caterina Rosano, a
researcher at the University of Pittsburgh who wasn’t involved in
the study, said by email.
“The results from this and other studies suggest that a healthy
lifestyle with appropriate diet, exercise and cognitive stimulation
may help preserve brain function and structure in diabetics over
pharmacological treatment alone,” Dr. Joe Verghese, director of the
Montefiore-Einstein Center for the Aging Brain said by email.
SOURCE: http://bit.ly/1SyAuQA Diabetes Care, online March 29, 2016.
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