Reach Out – Preventing Teen Suicide

Reach out to prevent teen suicide. This positive music video, created by Mayo Clinic, encourages troubled teens to communicate with an adult for help and support. It also depicts how teens can talk to adults in a variety of situations. Things can get better.

For more information-
Call: 1-800-273-TALK, 1-800-273-8255
Visit: http://www.suicidepreventionlifeline.org/

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Two diabetes medications don’t slow progression of type 2 diabetes in youth

 

News Release

Monday, June 25, 2018

NIH-funded study adds to growing evidence that condition is more aggressive in youth.

In youth with impaired glucose tolerance or recent-onset type 2 diabetes, neither initial treatment with long-acting insulin followed by the drug metformin, nor metformin alone preserved the body’s ability to make insulin, according to results published online June 25 in Diabetes Care. The publication is concurrent to a presentation of the results at the American Diabetes Association Scientific Sessions in Orlando, Florida.

The results come from a study of 91 youth ages 10-19, part of the larger Restoring Insulin Secretion (RISE) study. To determine if early, aggressive treatment would improve outcomes, participants at four study sites were randomly assigned to one of two treatment groups. The first received three months of glargine — a long-acting insulin — followed by nine months of metformin. The second received only metformin for 12 months. Participants were then monitored for three more months after treatment ended. RISE was funded primarily by the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) of the National Institutes of Health.

The RISE Pediatric Medication Study found that beta cell function — key to the body’s ability to make and release insulin — declined in both groups during treatment and worsened after treatment ended. An earlier NIH-funded study also found that type 2 diabetes progresses more rapidly in youth than previously reported in adults despite comparable treatment.

“Only two drugs are currently approved for youth with type 2 diabetes, and we were disheartened to find that neither effectively slows disease progression,” said Dr. Ellen Leschek, project scientist for the RISE Consortium and program director in NIDDK’s Division of Diabetes, Endocrinology, and Metabolic Diseases. “Type 2 diabetes in youth has grown with the obesity epidemic, and we need treatments that work for kids. It’s clear from this study and others that type 2 diabetes in youth is more aggressive than in adults.”

The results were published concurrently in Diabetes Care with two other manuscripts that compared participants of the pediatric trial with their adult counterparts in two other RISE trials. Using baseline assessments, RISE researchers found that the youth had more insulin resistance and other signs of disease progression than their adult counterparts at the same stage in the disease, results consistent with other earlier studies. As well, the pediatric group at baseline responded to the severe insulin resistance with a greater insulin response than adults, potentially a reason for the youth’s more rapid loss of beta cell function.

While the RISE pediatric group’s treatments did not preserve or improve beta cell function, results showed modest improvement in blood glucose with metformin in both groups.

“Metformin is still a useful method to lower the blood glucose levels of youth with type 2 diabetes, but metformin alone is not a long-term solution for many youth,” said Dr. Kristen Nadeau, principal investigator of the RISE Pediatric Medication Study and professor of pediatric endocrinology at the University of Colorado, Anschutz Medical Campus. “As RISE shows, there is an urgent and growing need for more research to find options to adequately slow or prevent progression of type 2 diabetes in youth.”

The longer a person has type 2 diabetes, the greater the likelihood of developing complications including heart, kidney, eye, and nerve diseases, making it critical for young people with type 2 diabetes to quickly achieve and sustain control of their blood glucose.  However, because type 2 diabetes has historically been an adult condition, information about how to effectively treat youth is limited, and pediatric diabetes experts have had to rely on best practices for adult treatment – an imperfect translation given the differences in physiology between the groups.

“Our understanding of how type 2 diabetes affects youth is still maturing, and we must continue to explore treatments to ensure that these young people can live long, healthy lives,” said NIDDK Director Dr. Griffin P. Rodgers. “These results give us another piece of the puzzle to find which therapies will treat youth with type 2 diabetes.”

The RISE Consortium comprises three trials, all using similar assessments to measure results, to be compared with one another when all trials of the study are completed. The goal of RISE is to find ways to reverse or slow the loss of insulin production and insulin release, so people at risk for type 2 diabetes or recently diagnosed with the disease can stay healthier longer.

The RISE Pediatric Medication Study (NCT01779375) was conducted at the Children’s Hospital Colorado/University of Colorado, Aurora; Children’s Hospital of Pittsburgh; Yale University, New Haven, Connecticut; and Indiana University, Indianapolis. The RISE adult trials are being conducted at VA Puget Sound Health Care System and University of Washington, both in Seattle; Indiana University; and the University of Chicago and Jesse Brown VA Medical Center, Chicago (NCT01779362); and at the University of Southern California, Los Angeles (NCT01763346). The RISE Coordinating Center is at The George Washington University Biostatistics Center, Rockville, Maryland. Learn more about RISE at www.risestudy.org.

NIH support for RISE comes primarily through NIDDK grants U01DK94430, U01DK94431, U01DK94406, U01DK94438, and U01DK094467, with additional support from the National Center for Advancing Translational Sciences. The Department of Veterans Affairs, Kaiser Permanente Southern California, and the American Diabetes Association also support the studies, with additional donations of supplies from Allergan Corporation, Apollo Endosurgery, Abbott Laboratories, and Novo Nordisk A/S.

The NIDDK, part of the NIH, conducts and supports basic and clinical research and research training on some of the most common, severe, and disabling conditions affecting Americans. The Institute’s research interests include: diabetes and other endocrine and metabolic diseases; digestive diseases, nutrition, and obesity; and kidney, urologic, and hematologic diseases. For more information, visit www.niddk.nih.gov.

About the National Institutes of Health (NIH):
NIH, the nation’s medical research agency, includes 27 Institutes and Centers and is a component of the U.S. Department of Health and Human Services. NIH is the primary federal agency conducting and supporting basic, clinical, and translational medical research, and is investigating the causes, treatments, and cures for both common and rare diseases. For more information about NIH and its programs, visit www.nih.gov.

NIH…Turning Discovery Into Health®

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NIMH » Therapy Reduces Risk in Suicidal Youth

 

Preventing suicide has proven to be a difficult public health challenge. The suicide rate has climbed in recent years across age groups. In adolescents, suicide is the second leading cause of death. For every young person who dies by suicide, many more have suicidal thoughts, attempt suicide, or deliberately injure themselves without intending suicide.

To date, there have not been any research-validated treatments for preventing suicide among youth. And research has found that it’s hard to get adolescents with suicidal thoughts to start and stay with existing treatments.

Researchers at the University of Washington, Seattle Children’s Research Institute, and collaborators at the Los Angeles Biomedical Research Institute at Harbor- University of California, Los Angeles (UCLA) Medical Center, and the David Geffen School of Medicine at UCLA are addressing the treatment void for adolescents. A recent clinical trial of a psychotherapy called dialectical behavior therapy (DBT)—which has been shown to be effective in reducing suicide-related behavior in adults—showed that DBT can also reduce suicide attempts and suicidal behavior in adolescents.

“We have a real need for more evidence-based interventions to help suicidal youth,” said Jane Pearson, Ph.D., chair of the Suicide Research Consortium in NIMH’s Division of Services and Intervention Research. “This study is significant because it reinforces previous DBT studies with adolescents. DBT shows clear promise for helping at-risk youth develop skills that will set them on a “life preserving” path.”

For this study, Elizabeth McCauley, Ph.D., and colleagues enrolled youth ages 12-18 who were at risk for suicide. The adolescents entering the study had attempted suicide at least once, had a history of repeated self-injury, and had trouble with emotional control—for example, unstable, intense, and often negative moods. Youth entering the trial were randomly assigned to either DBT or a comparison treatment, individual and group-supported therapy (IGST).

By the end of the first six months of the trial, suicide attempts and non-suicidal self-injury (NSSI) were significantly less likely in youth receiving DBT than those receiving IGST. Self-harm, which combines both suicide attempts and NSSI, was about a third as likely in DBT recipients compared with those in IGST. Of 65 youth randomly assigned to IGST who completed the end of treatment assessment, 9 had one suicide attempt and 5 had two or more; out of 72 assigned to DBT, 6 had one suicide attempt and 1 had two or more.

Twelve months after the trial began, rates of self-harm had declined in both groups; the rate was still lower in the DBT group, but the difference was not great enough—given the number of participants in the trial—to be statistically significant. Nonetheless, the benefit seen in the first months potentially saved lives; the authors point out that clinical trials of greater size or length may demonstrate a more sustained advantage to DBT and may assess whether altering components of the therapy could increase its effectiveness.

Another finding of the study was that youth receiving DBT attended more treatment sessions and were more likely to complete DBT treatment (attend at least 24 individual sessions) than youth receiving IGST. The greater success in this respect of DBT may have been an element in the difference in treatment effectiveness relative to IGST.

DBT was developed by Marsha Linehan, Ph.D., senior author on this report, for treatment of people who are suicidal and have symptoms of borderline personality disorder, which is marked by a pattern of unstable moods, self-image, and behavior. The risk of suicide among those with borderline personality disorder is high; recurrent suicidal behavior is among the diagnostic criteria for the disorder. Among the essential elements of DBT are skills training aimed at helping a person regulate emotions, for example, their reactions to stresses; and developing coping strategies to deal with life challenges, including social interactions and relationships with friends and family. The therapy includes individual psychotherapy, multi-family group skills training, youth and parent telephone coaching, and weekly therapist team coaching.

Comparing DBT with another therapy that has some of the general elements common to psychotherapy provides an opportunity to evaluate the effectiveness of the specific components that set DBT apart from other therapies. Comparing DBT with no treatment or treatment as usual would not offer the same insight into the elements that contribute to effectiveness.

The paper reporting this study is online June 20 in JAMA Psychiatry.

Grants

MH090159; MH093898

Clinical Trial

NCT01528020

Reference

McCauley E et al. Efficacy of dialectical behavior therapy for adolescents at high risk for suicide: a randomized clinical trial. JAMA Psychiatry. 2018 June 20. doi: 10.1001/jamapsychiatry.2018.1109. [Epub ahead of print]

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Teen Suicide Prevention

In this video created by Mayo Clinic, teens describe common signs that a teen is considering suicide and provide encouragement for communicating directly and immediately for support and safety. It also Includes suggestions for what to say to a teen who may be at risk for suicide and ways to keep them safe. Things can get better.

For more information-
Call: 1-800-273-TALK, 1-800-273-8255
Visit: http://www.suicidepreventionlifeline.org/

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