Brain Health in Youth With Normal Weight, Overweight and Obesity at Risk for Type 2 Diabetes (T2D) (Metabrain)

Brain Health Across the Metabolic Continuum in Youth at Risk for Type 2 Diabetes (T2D)

Investigators propose to study youth across the spectrum of body mass index (BMI) and dysglycemia. This approach will allow investigators to disentangle the relationship of key features of type 2 diabetes (T2D) risk (e.g. obesity) with intermediary physiologic changes (e.g. insulin resistance, inflammation, β-cell dysfunction and dysglycemia) that pose a risk for the brain. Investigators will determine which of these factors are most associated with differences in brain structure and function among groups, over time, and how these effects differ from normal neurodevelopment.

Study Overview

• Status: Recruiting
• Conditions: Inflammation; Insulin Resistance; Type 2 Diabetes Mellitus in Obese; Obesity, Childhood; Type2 Diabetes; Cognitive Decline; Dysglycemia; Overweight, Childhood; Brain Structure; Microvascular Complications; Diabetes in Adolescence
• Intervention / Treatment: Other: Observational

Detailed Description

Investigators will study three groups of pubertal youth, ages 12-17 yrs old (n=31 each): a group with normal weight and normal glucose tolerance (NW-NGT), a group with overweight/obesity and normal glucose tolerance (O-NGT), and a group with overweight/obesity and dysglycemia (O-DG). Groups will be comparable in age, sex, race/ethnicity, and socio-economic status (SES). Brain structure and function will be examined in all groups using magnetic resonance imaging (MRI) and cognitive tests at study entry (time 1/baseline), and after 21 months (time 2), focusing on a limited number of key outcome variables known to be consistently impaired in obesity or T2D. Targeted MRI measures will be regional volumes (e.g. hippocampus), neuroinflammation via restricted ratio from diffusion basis spectrum imaging (DBSI); hippocampus and white matter tracts), whole-brain cerebral blood flow via arterial spin labeling (ASL). Targeted cognitive measures will be delayed memory, processing speed, and executive function. The ultimate goal of this study is to determine how metabolic factors during neurodevelopment set the stage for the potentially profound, long-term impact of T2D on the brain and its functions. Given that the disease occurs at a time when brains are undergoing dramatic developmental processes, the aggressive nature of youth-onset T2D progression and complications in other organ systems, these results may provide guidance and justification for longer follow-up, interventional and/or mechanistic studies, and have important clinical implications.

• Study Type: Observational
• Enrollment (Estimated): 117

Contacts and Locations

• Study Contact: Name: Kaeli Spight; Phone Number: 314-362-4721; Email: kspight@wustl.edu
• Study Contact Backup: Name: Mary Borgschulte, RN, BSN, CDE; Phone Number: 314-952-8195; Email: Mary.b@wustl.edu

Study Locations

• United States
  • Missouri
    • Saint Louis, Missouri, United States, 63110
      • Recruiting
      • Washington University School of Medicine
      • Contact: Kaeli Spight; Phone Number: 314-362-4721; Email: kspight@wustl.edu
      • Contact: Samantha Ranck, MSW, MA; Phone Number: 314-362-6514; Email: blankens@wustl.edu
      • Principal Investigator: Tamara G Hershey, PhD
  • Pennsylvania
    • Pittsburgh, Pennsylvania, United States, 15224
      • Recruiting
      • UPMC Children's Hospital of Pittsburgh
      • Contact: Angela Akar, BS, CCRC; Phone Number: 412-692-5928; Email: angela.akar@chp.edu
      • Principal Investigator: Silva Arslanian, MD

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 12 years to 17 years (Child)
• Accepts Healthy Volunteers: Yes

• Sampling Method: Non-Probability Sample

Study Population

Pubertal youth ages 12-17 yrs. will be enrolled in a longitudinal design. Investigators chose to focus on the ages where there is the highest prevalence of impaired glucose tolerance (IGT) and T2D, reducing variability in neurodevelopmental and Tanner stages in the three cohorts. Investigators will follow participants for 21 months to ensure that enough time has passed to see changes in the stated outcome measures.

Description

Inclusion Criteria:

• 12-17 yrs. old at visit 1, 12-19 yrs. old at visit 2, Tanner II or above (determined through an exam by a pediatric endocrinologist or certified nurse practitioner trained in pediatric endocrinology), otherwise healthy except for obesity, <450 lbs. (due to MRI scanner limits), able and willing to lie flat within the MRI scanner and do cognitive testing, fluent in English.

Exclusion Criteria:

• Syndromic obesity, history of bariatric surgery, insulin treatment (metformin allowed if < 6 months) for T2D, contraindications for MRI (metal, claustrophobia), braces, pregnant (pregnancy test will be done on post-menarchal girls) or breastfeeding, inability to participate in cognitive testing due to sensory or language issues, intellectual disability, special education, pharmacologic treatment for Attention Deficit Hyperactivity Disorder (ADHD), prematurity (<36 weeks gestation), complications at birth, neurologic co-morbidities (e.g., seizures, stroke, head injury with >10 min loss of consciousness), significant psychiatric disorders (e.g., schizophrenia, bipolar disorder, current major depression), taking psychoactive medications (e.g., antipsychotics) that would interfere with testing or reporting illegal drug use. Self-reported smoking and alcohol use and length of time with obesity will be assessed by history (although these measures may not be fully reliable).

Study Plan

How is the study designed?

Number of groups / cohorts

3

Cohorts and Interventions

Group / Cohort	Intervention / Treatment
Normal Weight-Normal Glucose Tolerant (NW-NGT); (1) a group that is the normal weight (BMI<85th%) and has normal glucose tolerance (NW-NGT)	Other: Observational; Investigators are observing brain health over time (21 months) in these groups
Overweight and/or obese and has normal glucose tolerance (O-NGT); (2) a group that is overweight and/or obese (BMI >85th%) and has normal glucose tolerance (O-NGT)	Other: Observational; Investigators are observing brain health over time (21 months) in these groups
Overweight and/or Obese and has dysglycemia (O-DG); (3) group that is overweight and/or obese (BMI >85th%) and has dysglycemia (O-DG; fasting plasma glucose ≥100 mg/dl and/or 2-hour glucose ≥140 mg/dl oral glucose tolerance test (OGTT) and laboratory-based HbA1c ≥5.8 and ≤8.0%, if treatment naïve).	Other: Observational; Investigators are observing brain health over time (21 months) in these groups

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
hippocampal volume	To determine hippocampal volumes, investigators will use the validated, objective and semi-automatic segmentation program Automated MRI Brain Volumetry System (volBrain). Hippocampal volumes will be obtained for each subject at each visit for primary analyses. Left and right volumes will be averaged, since lateralized findings are not hypothesized.	21 months - Visit 1 and Visit 2 are 21 months apart
restricted fraction	Investigators will use Diffusion Basis Spectrum Imaging (DBSI) models on diffusion weighted images (DWI) to assess restricted fraction within the hippocampus and throughout white matter tracts.	21 months - Visit 1 and Visit 2 are 21 months apart
Whole brain cerebral blood flow	Pseudo-continuous arterial spin labeling (pCASL) will be used to measure cerebral blood flow (CBF) implemented with an arterial spin labeling (ASL) sequence 228 and volume navigators (vNavs) to minimize motion artifact. Global CBF across pairs of frames will be scaled additively to the median value. Investigators will assess the number of voxels that statistically deviate from a normative value ('distributed deviating voxels') and compared between groups.	21 months - Visit 1 and Visit 2 are 21 months apart
Declarative Memory	Investigators will use the total score from the Paired Associates Memory Test, an experimental cognitive task measuring delayed declarative memory	21 months - Visit 1 and Visit 2 are 21 months apart
Processing speed	Investigators will use the raw scores from the NIH Toolbox Pattern Comparison Processing Speed task.	21 months - Visit 1 and Visit 2 are 21 months apart
Executive Function	Investigators will use an average of the (z scores) from the NIH Toolbox Flanker Inhibitory Control & Attention, Dimensional Change Card Sort and List Sorting tasks.	21 months - Visit 1 and Visit 2 are 21 months apart

Collaborators and Investigators

• Sponsor: Washington University School of Medicine
• Collaborators: National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK)
• Investigators: Principal Investigator: Tamara A Hershey, PhD, Washington University School of Medicine; Principal Investigator: Silva Arslanian, MD, UPMC Children's Hospital of Pittsburgh

Study record dates

Study Major Dates

• Study Start (Actual): May 24, 2022
• Primary Completion (Estimated): October 31, 2026
• Study Completion (Estimated): October 31, 2027

Study Registration Dates

• First Submitted: February 11, 2022
• First Submitted That Met QC Criteria: March 11, 2022
• First Posted (Actual): March 14, 2022

Study Record Updates

• Last Update Posted (Actual): April 11, 2024
• Last Update Submitted That Met QC Criteria: April 10, 2024
• Last Verified: April 1, 2024

More Information

Terms related to this study

• Keywords: Brain, Health, Youth, Type 2 Diabetes Mellitus, overweight, obesity
• Additional Relevant MeSH Terms: Mental Disorders; Pathologic Processes; Glucose Metabolism Disorders; Metabolic Diseases; Neurocognitive Disorders; Endocrine System Diseases; Overnutrition; Nutrition Disorders; Body Weight; Hyperinsulinism; Cognition Disorders; Diabetes Mellitus; Diabetes Mellitus, Type 2; Obesity; Inflammation; Pediatric Obesity; Cognitive Dysfunction; Insulin Resistance; Overweight
• Other Study ID Numbers: 202107019; 1R01DK126826-01A1 (U.S. NIH Grant/Contract)

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: YES
• IPD Plan Description: Investigators affirm that data and research resources will be shared. Any shared data will have low re-identification potential. The Research Design & Biostatistics Group of the investigative team's Washington University's Clinical Translational Science Award (CTSA) provides access to the REDCap database to facilitate secure data sharing with approved investigators within the University as well as with approved collaborators. De-identified MRI scans will be shared with approved investigators through the Central Neuroimaging Data Archive (CNDA), an online, secure image archive system.
• IPD Sharing Time Frame: within 12 months of end of data collection, data entry, quality control and image processing
• IPD Sharing Access Criteria: PI will need to request data for legitimate scientific purpose.
• IPD Sharing Supporting Information Type: STUDY_PROTOCOL

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No