Nelly Mauras, United States of America

Nelly Mauras, MD is Chief, Division of Endocrinology, Diabetes & Metabolism at the Nemours Children’s Health System in Jacksonville Florida, and at Wolfson Children’s Hospital. She is Professor of Pediatrics at the Mayo Clinic College of Medicine, affiliated with Nemours. Dr. Mauras is a clinical research scientist focused on the interactions and metabolism of hormones and nutrients in children and adolescents. Her research interests include type 1 diabetes, disorders of growth, estrogen action and Turner Syndrome. She has published over 200 peer reviewed papers in the literature to-date and has lectured extensively nationally and internationally. Dr. Mauras is one of 2 co-principal investigators for the Diabetes Research in Children Network (DirecNet), an NIH-funded consortium of 5 Pediatric diabetes centers and imaging and data coordinating center investigating the impact of type 1 diabetes on the brain in children. She is co-investigator in 2 other NIH-funded grants. Dr. Mauras has been or is a member of advisory panels, editorial boards, medical societies committees, and has served in NICHD study sections and expert NIH review panels and in multiple meeting program committees. She is funded by the National Institutes of Health, private foundations, as well as industry. Dr. Mauras remains an active clinician and teacher of pediatric house staff and pediatric and adult endocrine fellows at Nemours in Jacksonville.

Presenter Of 1 Presentation

The brain as a target of diabetes complications in children

Session Type
PLENARY SESSION
Date
20.02.2020, Thursday
Session Time
08:30 - 09:30
Channel
Auditorium A
Lecture Time
08:30 - 09:00

Abstract

Background and Aims / Part 1

Severe hypoglycemia may affect the developing brain, yet exposure to chronic hyperglycemia may also adversely impact brain development, particularly in children with early-onset T1D. In the Diabetes Research in Children Network, we are studying cognitive and neurodevelopmental consequences of T1D in a cohort of 144 children (initially 4-9 years old), and 70 age-matched non-diabetic controls.

Methods / Part 2

We performed unsedated structural MRI, using contemporary software, and age-appropriate cognitive testing. Lifetime A1c and glucose sensor data were also assessed.

Results / Part 3

We observed significant differences in total brain, gray matter (GM) and white matter (WM) volumes, and altered WM microstructure in T1D compared to controls, and slower brain growth after longitudinal, 18-months follow-up. These differences were highly correlated with metrics of hyperglycemia. Subsequent longitudinal follow-up through puberty shows that children with T1D had slower growth of total cortical and subcortical GM and WM than controls at all time-points; also lower verbal IQ and working memory scores, differences again associated with higher lifetime A1c. Using functional MRI, brain activation patterns showed increased recruitment of executive control areas in T1D, which possibly act to offset diabetes-related impairments in the default mode network (the brain’s “idle “system). We posit these findings may be compensatory mechanisms to facilitate cognitive and behavioral performance.

Conclusions / Part 4

In conclusion, these and other studies demonstrate that hyperglycemia is detrimental to the developing brain during the critical period of rapid brain maturation in children. The impact of improved glycemic control on the brain using artificial pancreas technologies, e.g., is being actively investigated and requires long-term study.

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