A BAT-Centric Approach to the Treatment of Diabetes: Turn on the Brain

The marked (18)F-flurodeoxyglucose uptake by brown adipose tissue (BAT) enabled its identification in human positron emission tomography imaging studies. In this Perspective, we discuss how glucose extraction by BAT and beige adipose tissue (BeAT) sufficiently impacts on glycemic control. We then present a unique overview of the central circuits modulated by gluco-regulatory hormones, temperature, and glucose itself, which converge on sympathetic preganglionic neurons and whose activation syphon circulating glucose into BAT/BeAT. Targeted stimulation of the sympathetic nervous system at specific nodes to selectively recruit BAT/BeAT may represent a safe and effective means of treating diabetes. [Display omitted] •BAT/BeAT are sites of significant glucose uptake in rodents and humans•BAT/BeAT function sufficiently regulate glycemia•Temperature and various glucoregulatory hormones stimulate glucose uptake by BAT/BeAT•CNS circuits converge at the IML to increase glucose uptake by BAT/BeAT via the SNS Insulin lowers blood glucose by stimulating its uptake by peripheral tissues. Hankir et al. discuss the emerging concept that in diabetes the sympathetic nervous system can substitute for diminished insulin receptor signaling downstream of brain circuits targeted by temperature and glucoregulatory hormones that promote glucose uptake by brown adipose tissue.