Diabetes mellitus typ 2 är en kronisk sjukdom som innebär hyperglykemi orsakad av insulinresistens i kroppens vävnader. Långvarig hyperglykemi kan orsaka komplikationen angiopati vilket medför ökad risk för hjärt-kärlsjukdom och metabolt syndrom. Sjukdomen utvecklas långsamt och påverkas av livsstil och arv. Behandlingen består till stor del av livsstilsförändringar hos patienten avseende kost och motion. Aktuell litteraturstudie syftar till att belysa patientens upplevelse av en förändrad tillvaro efter diagnostisering av diabetes mellitus typ 2. Studien är en litteraturstudie och är baserad på nio kvalitativa vårdvetenskapliga artiklar. Materialet har analyserats och tematiserats och presenteras i tre huvudteman med respektive subteman. Resultatet visar att patienten upplever en förändrad tillvaro efter att ha fått diagnosen. Vardagen upplevs begränsad av sjukdomen och för att hantera den nya tillvaron sjukdomen medför skapas ett behov av ny och ökad kunskap hos patienter. Behandlingen innefattar livsstilsförändringar vilket ofta har en negativ påverkan på tillvaron för patienten. I resultatet uppfattas en genomgående brist på patientcentrerad vård av hälso- och sjukvården vilket leder till lidande för patienten. Sjuksköterskan behöver anpassa stödet och informationen till varje patient och få patienten att känna sig delaktig i sin vård för att nå fram till patienten i sitt arbete. Preventiva hälsofrämjande åtgärder skulle gynna hållbar utveckling och folkhälsa.

The adipose tissue lipid chaperones aP2 and mal1, also known as fatty acid binding proteins (FABPs), are significant molecules contributing to metabolic homeostasis, whereby their absence promotes physiological changes that improve systemic metabolism. Identification of palmitoleate as a lipokine generated in aP2-mal1 deficiency--originating from adipose and directing the lipogenic program in liver, established a role for these chaperones in linking adipocyte and hepatic function. We have recently demonstrated a functional role for secreted aP2 in the activation of gluconeogenesis and hepatic glucose output, further designating this molecule as an adipocyte-derived regulatory factor that influences liver metabolism. Key molecules linking the metabolism of nutrients in energy generating pathways are the nucleotide cofactors NAD and NADH. Together, these molecules function to coordinate the maintenance of redox reactions during normal cellular metabolism and act as required substrates for enzymes such as sirtuins and poly ADP-ribose polymerases. Using global metabolite profiling, we show that combined deficiency of the adipose tissue lipid chaperones aP2 and mal1 leads to a hepatic nucleotide imbalance resulting from metabolic reprogramming in liver. We demonstrate that this reprogramming of metabolite flux is accompanied by significant alterations in liver NAD metabolism and establish a role for aP2 in directing substrate utilization through inhibition of the rate-limiting enzyme for NAD synthesis, nicotinamide phosphoribosyltransferase. Several models for the proposed regulatory pathways that link nutrient metabolism to aging include mechanisms that are NAD dependent. Accordingly, we found that long-term FABP deficiency confers a strong resistance to aging related metabolic deterioration. Together, the findings presented in this thesis support a considerable role for FABPs in the regulation of NAD metabolism and healthspan.

L’influence de l’état métabolique sur l’olfaction a été particulièrement étudiée ces dernières années. Le statut nutritionnel et les hormones impliquées dans la prise alimentaire sont capables de moduler le système olfactif, du neurone individuel jusqu’au comportement. Il semble donc logique que les pathologies liées à l’alimentation puissent induire des dysfonctionnements olfactifs. De fait, les patients atteints de diabète de type 2 (DT2) présentent des capacités olfactives réduites bien que les effets du DT2 en lui-même soient toujours inconnus. Dans cette étude, nous nous sommes intéressés à la modulation de l’olfaction chez des souris rendues diabétiques après consommation d’un régime enrichi en fructose (HFruD). Les animaux présentent un DT2 précoce après 8 semaines de régime. De plus, ils montrent une baisse de leurs capacités olfactives globales. Les réponses électrophysiologiques aux odorants de la muqueuse olfactive et des neurones sensoriels olfactifs (OSN) sont diminuées après 8 semaines de HFruD. Une augmentation du nombre d’OSN ainsi qu’une diminution de l’apoptose ont lieu dans la muqueuse olfactive, indiquant que le HFruD induit un changement de la dynamique cellulaire dans ce tissu. Nos résultats démontrent que, chez le rongeur, l’olfaction est modulée par un régime diabétogène enrichi en fructose. Des changements fonctionnels, anatomiques et comportementaux surviennent au sein du système olfactif à un stage précoce de la pathologie, indiquant que le DT2 en lui-même est suffisant pour perturber l’olfaction. Les changements métaboliques ayant lieu durant la mise en place du DT2 pourraient être à l’origine des dysfonctionnements olfactifs. / The influence of metabolic status on olfactory processes has been thoroughly investigated over the last few years. Both nutritional status and hormones implicated in food metabolism can effectively modulate the olfactory system from the single neuron to the behavior. Thus, it seems likely that metabolic disorders such as type 2 diabetes (T2D) can induce olfactory dysfunctions. In fact T2D patients display poor olfactory performances however the effects of diabetes in itself (as well as underlying mechanisms) are still unknown. In this study, we investigated the modulation of olfaction in young adult male mice caused by a high-fructose diet (HFruD) inducing T2D in rodents. Animals displayed early diabetic state after only 4 weeks of HFruD. In addition, animals exhibited a decrease in olfactory capacities for both neutral and food odors. These behavioral effects persisted and were amplified after 8 weeks of HFruD. Electrophysiological responses to odorants of both olfactory mucosa and olfactory sensory neurons were reduced in HFruD animals after 8 weeks of diet. Immunohistochemistry experiments then revealed an increase in the number of olfactory sensory neurons and a reduction of apoptosis in the OM indicating that HFruD modifies cell dynamics. Our results demonstrate that, in rodents, olfaction is modified by HFruD-induced diabetes. Functional, anatomical and behavioral changes occurred in the olfactory system even at a very early stage of the disease, indicating that T2D in itself can disrupt olfaction. Metabolic changes taking place during the onset of T2D may trigger olfactory dysfunctions.

L’inflammasome NLRP3, un complexe protéique pro-inflammatoire, joue un rôle essentiel dans le processus pathologique de l’athérosclérose et du diabète de type 2 (DT2). Il est responsable de la maturation de la pro-IL-1β et de la pro-IL-18 respectivement en IL-1β et IL-18 biologiquement actives. L’objectif de cette étude consiste à identifier et caractériser un inhibiteur spécifique de l’inflammasome NLRP3 qui pourrait contribuer à limiter l’évolution des plaques d’athérome et l’installation du DT2. Au cours de cette thèse, nous avons isolé l’Arglabine d’une plante, Artemisia glabella, connue pour ses vertus anti-tumorales. L’effet de l’Arglabine a été étudié au niveau des macrophages et des cellules β-pancréatiques, et chez des souris ApoE2.Ki et ApoE2.Ki/NLRP3-/- placées sous régime High Fat Diet (HFD). Les résultats in vitro montrent que l’Arglabine réduit, d’une façon dose-dépendante, l’activité de l’inflammasome NLRP3 et inhibe l’expression des protéines Nlrp3, IL-1β et caspase-1. Elle induit l’autophagie en augmentant significativement l’expression de la LC3-II au niveau des macrophages murins en culture. L’injection intra-péritonéale de deux doses journalières d’Arglabine (2.5 ng/g de m.c.) à des souris ApoE2.Ki placées sous régime HFD, normalise le profil lipidique et réduit l’oxydation des LDL au niveau du plasma des souris. Elle réduit le nombre des monocytes pro-inflammatoires (Ly-6Chigh) et augmente le nombre des monocytes anti-inflammatoires (Ly-6Clow). Au niveau des lésions artérielles, l’Arglabine oriente les macrophages présents vers un phénotype anti-inflammatoire M2. L’ensemble de ces résultats montre un rôle athéroprotecteur de l’Arglabine : elle réduit la surface des lésions artérielles au niveau du sinus aortique ainsi qu’au niveau de la totalité de l’aorte des souris ApoE2.Ki placées sous régime athérogène. De plus, le traitement par l’Arglabine normalise le profil glycémique et insulinémique des souris ApoE2.Ki. Elle réduit également l’activité de la caspase 3 au niveau des îlots de Langerhans et augmente de manière dose-dépendante l’expression de la protéine Bcl-2 au niveau des cellules β-pancréatiques. Par ailleurs, nous avons montré une augmentation de l’expression de protéines impliquées dans l’autophagie telles que la Becline 1 et la LC3-II sous l’effet de l’Arglabine. Ainsi, l’Arglabine réduit non seulement l’activité de l’inflammasome NLRP3 mais améliore aussi la survie des cellules β-pancréatiques. L’Arglabine constitue donc une molécule très prometteuse dans le traitement des maladies cardiovasculaires et le DT2. / The NLRP3 inflammasome activity is abnormally elevated in many human inflammatory diseases, including cardiovascular and metabolic diseases such as atherosclerosis and type 2 diabetes mellitus (T2DM) respectively. Therefore, there is considerable interest in the identification of effective therapeutics that selectively inhibit the NLRP3 inflammasome pathway. In this study, we have identified Arglabin as a potential small molecule inhibitor that targets the NLRP3 inflammasome activity in cell culture and in an animal model, the ApoE2.Ki mice fed a high-fat Western-type diet (HFD). Arglabin, a plant sesquiterpene lactone, has been used extensively as an herbal remedy that proved effective in treating cancer of the liver, lungs and breast at early stages. Arglabin inhibited, in a concentration-dependent manner, IL-1β and IL-18 production in lipopolysaccharide and cholesterol crystal-activated cultured mouse peritoneal macrophages. In addition, Arglabin activated autophagy as evidenced by the increase in LC3-II protein. Intraperitoneal injection of Arglabin (2.5 ng/g body weight twice daily for 13 weeks) into female ApoE2.Ki mice fed a HFD resulted in a decreased IL-1β plasma level and reduced plasma levels of total cholesterol and triglycerides. Treatment of ApoE2.Ki mice fed a HFD with Arglabin significantly reduced the plasma concentration of anti-oxLDL antibodies. Moreover, Arglabin oriented the proinflammatory M1 macrophages into the anti-inflammatory M2 phenotype in spleen and arterial lesions. Consequently, a marked reduction in atherosclerotic lesions was observed in the median areas in the sinus and whole aorta. In comparison to vehicle-treated mice, Arglabin reduced plasma levels of glucose and insulin. Immunohistochemical analysis revealed the presence of active caspase 3 in Langerhans islets of ApoE2.Ki mice fed a HFD that was significantly inhibited by Arglabin treatment. Moreover, Arglabin reduced susceptibility to apoptosis in cultured INS-1 cells by increasing concentration-dependently Bcl-2 levels, which led to concomitantly decreased Bax/Bcl-2 ratio. In cultured INS-1 cells, Arglabin increased the expression of the autophagic markers Becline 1 and LC3-II in a concentration-dependent manner. Consequently, our results indicate survival-promoting properties of the Arglabin molecule in pancreatic β-cells.In conclusion, our findings demonstrate that Arglabin may represent a promising new drug to treat atherosclerosis and T2DM.

The purpose of this thesis was to aid in the development of a web-based physical activity intervention for people with type 2 diabetes living in remote and rural areas. Chapter 1 introduces the research area, the design of the thesis and the key research questions. The thesis is then made up of 5 key studies. Study one, a systematic review of the literature was conducted and reported in chapter 2. This review identified the technologies that have previously been used to promote physical activity in type 2 diabetes, it identified the methodological quality of each included technology and the key components for effective change. Web based technology was the most commonly used and the most effective in increasing physical activity using components such as goal setting and physical activity trackers. These results informed study 2 (chapter 3) which explored patient and health professional's views on diabetes, physical activity and use of the internet. The need for clear information was identified with regard to diabetes as well as the call for accurate physical activity advice in relation to diabetes for both patients and health professionals. Study 3 (chapter 4) explored key information and components for an effective website. Included features were the need for a personalised approach; detailed advice on how the body responds to physical activity; a physical activity tracker and goal setting. The need for a 'virtual trainer' for support, advice and help with goal setting and interactive maps showing physical activity opportunities were all deemed important. The fourth study, chapter 5 described the design of the website and its features as well as the protocol for a six month pilot randomised controlled trial to examine the effectiveness of the development website, with and without interactive design elements. The final study in this thesis (chapter 6), describes the physical activity, physiological and biochemical results from a randomised controlled trial to test the effectiveness of the website and its features. The final chapter summarises the findings in response to the research questions and the future recommendations based on the outcomes.

Genetic heterogeneity, lifestyle factors, gene-gene or gene-environment interactions are the determinants of T2D which puts Hispanics and populations with African ancestry at higher risk of developing T2D. In this dissertation, the genetic associations of PPARGC1A polymorphisms with T2D and its related phenotypes (metabolic markers) in Haitian Americans (cases=110, controls=116), African Americans (cases=120, controls=124) and Cuban Americans (cases=160, controls=181) of South Florida were explored. Five single nucleotide polymorphisms of gene PPARGC1A were evaluated in each ethnicity for their disease association. In Haitian Americans, rs7656250 (OR= 0.22, pp=0.03) had significant protective association with T2D but had risk association in African Americans for rs7656250 (OR=1.02, p=0.96) and rs4235308 (OR=2.53, p=0.03). We found that in Haitian American females, both rs7656250 (OR=0.23, pp=0.03) had protective association with T2D. In African American females, rs7656250 (OR=1.14, p=0.78) had risk association whereas in males, it had significant protective effect (OR=0.37, p=0.04). However, the risk association exhibited by rs4235308 was stronger in African American females (OR=2.69, p=0.03) than males (OR=1.16, p=0.72). In Cuban Americans, only rs7656250 showed significant risk association with T2D (OR=6.87, p=0.02) which was stronger in females alone (OR=7.67, p=0.01). We also observed significant differences among correlations of PPARGC1A SNPs and T2D phenotypes. Positive correlation was observed for log Hs-CRP with rs3774907 (pp=0.03) in Cuban Americans respectively. Correlation of log A1C with rs7656250 (p=0.02) was positive in Cuban Americans while it was negative for rs3774907 in Haitian Americans (ppPPARGC1A correlations with T2D and its phenotypes among the three ethnicities studied (ii) the associations of PPARGC1A SNPs showed significant effect modification by sex. The findings suggest that variations in effects of PPARGC1A gene polymorphisms among three ethnicities and between sexes may have biomedical implications for the development of T2D as well as the phenotypes related to T2D.

Bakgrund: Typ 2-diabetes är en växande folksjukdom som ökar världen över för varje år. Typ 2-diabetes leder ofta till komplikationer kopplade till sensoriska och cirkulatoriska nedsättningar och i kombination med högt blodsocker försvåras läkningsprocessen och ökar uppkomsten av diabetessår. Diabetsessår är svårläkta och kan leda till amputation. Syftet med studien var att samla kunskap över vilka omvårdnadsåtgärder som sjuksköterskan kan använda sig av för att förebygga diabetessår hos personer med typ 2-diabetes. Metod: Denna studie är en systematisk litteraturöversikt. En systematisk litteratursökning gjordes i CINAHL och Web of Science, där 14 artikler valdes ut efter kvalitetsgranskningen. Inklusionskriterier var personer med typ 2-diabetes och exklusionskriterier var farmakologiska åtgärder, olika typer av omläggningsmaterial och kirurgiska åtgärder. Resultat: I resultatet framkom två huvudkategorier som förebyggande åtgärder mot uppkomst av diabetessår, dessa kategorier var information och utbildning samt identifikation och kontroll av foten. Personen behöver stöd och information av sjuksköterskan för att förstå vikten av egenkontroll och hur den kan utföras. Sjuksköterska är oftast den som först möter personen och behöver därför i ett tidigt skede identifiera riskfaktorer för att förebygga uppkomsten av diabetessår. Slutsats: Genom ett personcentrerat och evidensbaserat arbete kan sjuksköterskan uppnå målet med att utforma individanpassade omvårdnadsåtgärder, hos personer med diabetessår och förbättra hälsan hos individerna.   Nyckelord: Typ 2-diabetes, diabetessår, förebyggande åtgärder, omvårdnadsintervention och systematisk litteraturöversikt.

Das polyzystische Ovarsyndrom (PCOS) mit einer Prävalenz von 5 % – 10 % ist eine der häufigsten Endokrinopathien bei Frauen vor der Menopause. Wie bisher vermutet, handelt es sich bei PCOS um ein sogenanntes multifaktorielles Krankheitsgeschehen. Einzelne Manifestationen des Metabolischen Syndroms (MetS), wie Hyperandrogenämie, Insulinresistenz (IR) und damit verbundene Hyperinsulinämie, Dyslipidämie und ein erhöhter CRP-Spiegel, werden bereits als Risikofaktoren für Typ 2 Diabetes mellitus (DM-II) und kardiovaskulären Krankheiten (KVK) bei den Patientinnen mit PCOS verwendet. Die Konzentrationen von Leptin und Adiponektin könnten nützliche und zuverlässige Marker für das Ausmaß der metabolischen Störung bei PCOS-Patientinnen sein. In zahlreichen Studien wurde davon berichtet, dass eine additive Gabe von Metformin die IR und andere Surrogat-Parameter des MetS in gleicher Weise bei adipösen und normalgewichtigen Probandinnen verbessert. In dieser Studie wurde der Insulin-Spiegel im Rahmen eines oralen Glukose-Toleranz-Test bei der Erstdiagnose und ca. ein bis eineinhalb Jahren nach der Metformintherapie bestimmt. Die Nüchtern-Insulinwerte der Vor-Therapie-Gruppe sind im Vergleich zur Nach-Therapie-Gruppe bei 75 % der Teilnehmerinnen signifikant aus dem hyperinsulinämischen Bereich in den normoinsulinämischen Bereich abgesunken (29.7 ± 6.7 µU/ml bzw. 13.7 ± 2.7 µU/ml, P = 0.045). Vergleichbar signifikant haben sich die Werte nach ein und zwei Stunden verbessert (154.5 ± 13.6 µU/ml vs. 96.2 ± 13.9 µU/ml, P = 0.0096 bzw. 128.0 ± 19.0 µU/ml vs. 59.2 ± 13.3 µU/ml, P = 0,0104). Konsistent damit senkte sich der HOMA-Index (5.9 ± 1.4 vs. 2.8 ± 1.6, P = 0,521). Die Leptin-Konzentration sank um 50 % (39.9 ± 9.7 vs. 20.3 ± 2.9 ng/ml, P = 0.0737 bzw. (mittlere Insulinspiegel nüchtern) 29.7 ± 6.7 µU/ml vs. 13.7 ± 2.7 µU/ml, P = 0,045), und die Adiponektin-Konzentration der Nach-Therapie-Gruppe im Vergleich zur Vor-Therapie-Gruppe stieg deutlich an (5.34 ± 0.6 vs. 6.35 ± 0.8 ug/ml, P = 0.4666, ns). Somit sind die Plasmaspiegel von Leptin und Adiponektin günstige Marker zur Risikoabschätzung und Diagnostik eines PCOS, zweitens eine metabolische Frühdiagnostik, und eine frühere Erwägung und Anwendung einer Strategie zur Senkung der Insulinresistenz sind aus präventiver Sicht ratsam.

La mortalité du diabète de type 2 est liée à ses complications cardiovasculaires (CVD). L'identification de nouveaux biomarqueurs associés à la dysfonction endothéliale, permettrait d'en améliorer le dépistage, la prévention. Au cours du diabète de type 2, l'hyperglycémie est associée à un fort stress oxydant. Nous nous sommes proposés ici d'évaluer l'impact de la glycoxydation sur la principale protéine circulante, l'albumine, et d'identifier si les modifications glycoxydatives de l'albumine dans le diabète avait un rôle dans la phyiopathologie des CVD du diabète de type 2. Nous avons pu mettre en évidence des modifications structurales et fonctionnelles importantes de l'albumine au cours du diabète de type 2 avec la formation entre autres de produits avancés de glycation (AGEs). Ces modifications glycoxydatives sont associées à des effets cellulaires pro-oxydant et pro-inflammatoire via une augmentation de l'expression du Récepteur aux AGEs (RAGE). Ces observations suggèrent que les formes glycoxydées d'albumine présentent un rôle central dans les mécanismes menant à la dysfonction endothélilale. Il reste néanmoins à évaluer l'intérêt du dosage des formes modifiées de l'albumine dans le dépistage des CVD au cours d'une étude clinique prospective de grande ampleur. Le développement d'une méthode de dosage rapide et reproductible des fractions d'albumine modifiées, comme celui de l'IMA (albumine modifiée par l'ischémie), en faciliterait la mise en œuvre. / Type 2 diabetes is dramatically associated with an enhanced cardiovascular complication risk. The identification of novel biomarkers associated with endothelial dysfunction remains highly warranted to improve diabetes screening and prevention. Oxidative stress and protein modifications are frequently observed in numerous disease states. Albumin, the major circulating protein in blood, can undergo increased glycoxidation in diabetes. Objectives of my thesis were to clarify the impact of glycoxidative modification of albumin on its structure and its functions and to determine whether such impairments may be encountered in albumin purified from diabetics. The occurrence of oxidative modifications was found to be enhanced in in vitro glycoxidized HAS and albumin purified from diabetics, after determination of their free thiol group content, relative electrophoretic migration, carbonyl content, and antioxidant activities. In addition, glycoxidized albumin exhibited impaired pharmaceutic molecule binding capacities. Cells treated with glycoxidized albumin exhibited a proinflammatory state attested by an overgeneration of intracellular reactive oxygen species, enhancements in RAGE expression, and an accumulation of carbonylated proteins.Methods to detect IMA (ischemia modified albumin) were developed and applied to diabetics patients. Relationships have been established between specific pathological parameters (cardiovascular disorders, hyperglycemia…) with an enhanced glycoxidative modification of albumin in diabetics. We thus propose that impaired albumin structure and function in relation in the enhanced oxidant stress observed in diabetics might be involved in the increased mortality risk of these patients.

Many diseases are caused by proteins or peptides folding incorrectly and aggregating into fibrils or plaques, including Alzheimer’s disease, Parkinson's disease and type II diabetes. Amyloid formation in the human pancreas occurs via the aggregation of a 37 amino acid peptide called amylin or IAPP which is shown to be toxic to pancreatic β cells. Amylin (IAPP) aggregation initiates a large number of events, leading ultimately to cell death. However the exact cytotoxic action of human IAPP and also the underlying molecular events leading from amylin (IAPP) aggregation to β cell death is still unknown. The toxic effect of human amylin (IAPP) is thought to involve changes in the expression of several genes and proteins. Further transcriptional and proteomics studies in this field can therefore facilitate the identifications of new targets whose expression are affected by amylin (IAPP). These information could be further used to construct an integrated model of the signalling and regulatory pathways through which amylin (IAPP) interacts with cellular metabolism.To investigate the effects of amylin (IAPP) aggregation on the islets proteome in this study, rat Rin-5F cell line, reported as a model of pancreatic β cell, was used. MTT assay was initially performed to determine the effect of IAPP on the cell viability at different time points. The isolated proteins form the untreated and IAPP treated Rin-5F cells were then fractionated by off gel electrophoresis and analysed by quantitative label free LC- MS/MS approach.Label free quantification of IAPP treated Rin-5F cells has identified the altered expression of many proteins, some of which were previously suggested in the literature to be involved in the pathogenesis of type 2 diabetes. These proteins were map to several pathways (including glycolysis and proteasome) whose expressions were significantly affected upon amylin (IAPP) exposure. The IAPP responsive proteins were also structured into a well connected network. Some of the hub proteins identified in this network were greatly affected as the result of IAPP treatments of RIN-5F cells. Our data therefore revealed the effect of IAPP on several proteins and pathways that might be important in the pathogenesis of type 2 diabetes.