Yes / Coronary artery bypass graft (CABG) using autologous saphenous vein continues to be a gold standard procedure to restore the supply of oxygen-rich blood to the heart muscles in coronary artery disease (CAD) patients with or without type 2 diabetes mellitus (T2DM). However, CAD patients with T2DM are at higher risk of graft failure. While failure rates have been reduced through improvements in procedure-related factors, much less is known about the molecular and cellular mechanisms by which T2DM initiates vein graft failure. This review gives novel insights into these cellular and molecular mechanisms and identifies potential therapeutic targets for development of new medicines to improve vein graft patency. One important cellular process that has been implicated in the pathogenesis of T2DM is protein O-GlcNAcylation, a dynamic, reversible post-translational modification of serine and threonine residues on target proteins that is controlled by two enzymes: O-GlcNAc transferase (OGT) and O-GlcNAcase (OGA). Protein O-GlcNAcylation impacts a range of cellular processes, including trafficking, metabolism, inflammation and cytoskeletal organisation. Altered O-GlcNAcylation homeostasis have, therefore, been linked to a range of human pathologies with a metabolic component, including T2DM. We propose that protein O-GlcNAcylation alters vascular smooth muscle and endothelial cell function through modification of specific protein targets which contribute to the vascular re-modelling responsible for saphenous vein graft failure in T2DM.

Yes / The prevalence of Type 2 diabetes mellitus (T2DM) is escalating globally. Patients suffer from multiple complications including the development of chronic wounds that can lead to amputation. These wounds are characterised by an inflammatory environment including elevated tumour necrosis factor alpha (TNF-α). Dermal fibroblasts (DF) are critical for effective wound healing, so we sought to establish whether there were any differences in DF cultured from T2DM donors or those without diabetes (ND-DF). ND- and T2DM-DF when cultured similarly in vitro secreted comparable concentrations of TNF-α. Functionally, pre-treatment with TNF-α reduced the proliferation of ND-DF and transiently altered ND-DF morphology; however, T2DM-DF were resistant to these TNF-α induced changes. In contrast, TNF-α inhibited ND- and T2DM-DF migration and matrix metalloprotease expression to the same degree, although T2DM-DF expressed significantly higher levels of tissue inhibitor of metalloproteases (TIMP)-2. Finally, TNF-α significantly increased the secretion of pro-inflammatory cytokines (including CCL2, CXCL1 and SERPINE1) in ND-DF, whilst this effect in T2DM-DF was blunted, presumably due to the tendency to higher baseline pro-inflammatory cytokine expression observed in this cell type. Collectively, these data demonstrate that T2DM-DF exhibit a selective loss of responsiveness to TNF-α, particularly regarding proliferative and secretory functions. This highlights important phenotypic changes in T2DM-DF that may explain the susceptibility to chronic wounds in these patients. / This study was funded by an Iraqi government studentship to AHAA-R.

Yes / Increased cardiovascular morbidity and mortality in individuals with type 2 diabetes (T2DM) is a significant clinical problem. Despite advancements in achieving good glycaemic control, this patient population remains susceptible to macrovascular complications. We previously discovered that vascular smooth muscle cells (SMC) cultured from T2DM patients exhibit persistent phenotypic aberrancies distinct from those of individuals without a diagnosis of T2DM. Notably, persistently elevated expression levels of microRNA-145 co-exist with characteristics consistent with aging, DNA damage and senescence. We hypothesised that increased expression of microRNA-145 plays a functional role in DNA damage signalling and subsequent cellular senescence specifically in SMC cultured from the vasculature of T2DM patients. In this study, markers of DNA damage and senescence were unambiguously and permanently elevated in native T2DM versus non-diabetic (ND)-SMC. Exposure of ND cells to the DNA-damaging agent etoposide inflicted a senescent phenotype, increased expression of apical kinases of the DNA damage pathway and elevated expression levels of microRNA-145. Overexpression of microRNA-145 in ND-SMC revealed evidence of functional links between them; notably increased secretion of senescence-associated cytokines and chronic activation of stress-activated intracellular signalling pathways, particularly the mitogen-activated protein kinase, p38a. Exposure to conditioned media from microRNA-145 overexpressing cells resulted in chronic p38a signalling in naïve cells, evidencing a paracrine induction and reinforcement of cell senescence. We conclude that targeting of microRNA-145 may provide a route to novel interventions to eliminate DNA-damaged and senescent cells in the vasculature and to this end further detailed studies are warranted.

Yes / Early vascular ageing (EVA) is a pathological phenomenon whereby the vascular system ages more quickly than chronological age. This underpins many cardiovascular diseases including the complications of type 2 diabetes, aneurysm formation and hypertension. Smooth muscle cells (SMC) are the principal cell type in the vascular wall and maintain vascular tone. EVA-related phenotypic switching of these cells contributes towards disease progression. EVA is distinct from chronological ageing, and research is ongoing to identify a definitive molecular signature of EVA. This will facilitate the discovery of new clinical tests for early detection of EVA and identify therapeutic targets to halt (or prevent) EVA in SMC, thus reducing macrovascular morbidity and mortality.

<p dir="ltr">Diabetes has become an international health crisis with type 2 diabetes composing the majority of cases. Along with a variety of other systemic effects, type 2 diabetes increases fracture risk. This aspect of type 2 diabetes has become a topic of interest in preclinical research and has been investigated using rodent models of type 2 diabetes. Of these models, the Yellow Kuo Kondo (KK-A^y) mouse model has shown promise as an obese model of type 2 diabetes. In the KK-A^y model, mice heterozygous for a mutation in the agouti gene (A^y) are treated as an obese model of type 2 diabetes. Those that are homozygous (no mutation) are treated as non-diabetic, obese controls. While this model has been indicated to be non-diet dependent, recent data has revealed the efficacy of this model may be reliant on diet. Following approval from the Indiana University-Purdue University at Indianapolis School of Science Institutional Animal Care and Use Committee, mice of each sex and genotype were placed on separate diets. Half on a standard chow diet and the other half on a diet recommended by Jackson Laboratory for this strain. Animals were aged to 16 weeks of age with blood glucose and body weight monitored every other week. Animals were then sacrificed to collect whole blood, blood serum, the pancreas, bilateral tibiae, and bilateral femora. End-point metabolic impacts were assessed through hemoglobin A1c and serum insulin measures while skeletal measures were quantified using microcomputed tomography scanning and analysis. Through this research, it was determined diet did have a significant impact on the skeletal and metabolic phenotype associated with type 2 diabetes in the KK-A^ymodel. </p>

Yes / Smoking increases the risk of developing type 2 diabetes. However, several population studies also show a higher risk in people 3–5 years after smoking cessation than in continuing smokers. After 10–12 years the risk equates to that of never-smokers. Small cohort studies suggest diabetes control deteriorates temporarily during the first year after quitting. We examined whether or not quitting smoking was associated with altered diabetes control in a population study, for how long this association persisted, and whether or not this association was mediated by weight change. Methods We did a retrospective cohort study (Jan 1, 2005, to Dec 31, 2010) of adult smokers with type 2 diabetes using The Health Improvement Network (THIN), a large UK primary care database. We developed adjusted multilevel regression models to investigate the association between a quit event, smoking abstinence duration, change in HbA1c, and the mediating effect of weight change. Findings 10 692 adult smokers with type 2 diabetes were included. 3131 (29%) quit smoking and remained abstinent for at least 1 year. After adjustment for potential confounders, HbA1c increased by 0·21% (95% CI 0·17–0·25; p<0·001; [2·34 mmol/mol (95% CI 1·91–2·77)]) within the first year after quitting. HbA1c decreased as abstinence continued and became comparable to that of continual smokers after 3 years. This increase in HbA1c was not mediated by weight change. Interpretation In type 2 diabetes, smoking cessation is associated with deterioration in glycaemic control that lasts for 3 years and is unrelated to weight gain. At a population level, this temporary rise could increase microvascular complications.

Yes / To explore the perception of healthcare workers (HCWs) on diabetic foot ulcers (DFU) and foot care in Rotuma, Fiji. Using a qualitative study design, two focus group discussions (FGDs) were conducted among HCWs. A semistructured open-ended questionnaire was used to guide the discussion session. Each FGD was audiorecorded and was transcribed. The transcriptions were then manually analysed using thematic analysis. Rotuma hospital, Fiji. HCWs who were working in Rotuma hospital for at least a year and were involved in clinical foot care of type 2 diabetes mellitus patients were included. There were five main themes, namely, depth of knowledge, quality of care in practice, factors of influence on practice, lack of resources and capacity building. Participants had superficial knowledge that showed lack of in-depth scientific knowledge. A lack of staffing in the clinics affected the delivery of service. Additionally, patients defaulting clinics, late presentations with DFU and traditional medicine also affected the quality of healthcare service in clinics. There was also a need for a multidisciplinary team to prevent and manage DFU. HCWs mostly advised on glycaemic control and ignored offering foot care advice in clinics due mainly to the lack of sound knowledge on foot care. There was also a lack of resources, infrastructure, space and professional development opportunities, which negatively impacted how HCWs deliver foot care services to patients. HCWs lack significant in-depth knowledge on DFU and foot care. In addition, these are the availability of traditional medicine that delays presentations to hospital, further reducing the quality of services. HCWs need to keep their knowledge and skills updated through regular in-service training on foot care. Resources, infrastructure and supply chains need to be maintained by those in power to ensure HCWs deliver quality foot care services.

Thesis (MScMedSc)--University of Stellenbosch, 2011. / ENGLISH ABSTRACT: Introduction: A westernized diet rich in saturated fats and sugars, together with a sedentary lifestyle, has contributed to the dramatic increase in obesity during the last decade (Zimmett et al, 2001; Wild et al, 2004). Obesity is associated with dyslipidemia and insulin resistance which are major risk factors for the development of type 2 diabetes (T2D) (Zimmet et al, 2001, Kahn et al, 2006; Schröder et al, 2007). High-fat feeding in rodents induces symptoms similar to the human metabolic syndrome without progression to T2D (Woods et al, 2002; Weir and Bonner-Weir, 2007). The addition of fructose to a high-fat diet exacerbates the insulin resistance and leads to impaired pancreatic function of insulin secretion and glucose intolerance (Basciano et al, 2005; Stanhope et al, 2009). Aims: The aim of this study was to establish the effect of a high-fat and sucrose/fructose diet on glucose metabolism, the development of insulin resistance and β-cell dynamics. Methods: Weanling Wistar rats were randomized into two study groups; study one over an experimental period for three months and study two for twelve months. Each study consisted of a control group that received standard rat chow and water; and two experimental groups receiving either a high-fat diet and water (HFD) or a café diet consisting of HFD with the addition of 15% sucrose/fructose (CFD). Fasting glucose and insulin concentrations, intravenous glucose tolerance test (IVGTT), glucose stimulated insulin secretion rates and 2-deoxy-[3H]-D-glucose uptake in muscle, liver and fat were measured. The pancreata were harvested for immunohistochemical labeling of β-cells (insulin), α-cells (glucagon), GLUT2 (glucose transport) and MIB5 (proliferation). Samples of the pancreata were also collected for electron microscopy. Results and discussion: Feeding Wistar rats a CFD induced obesity, insulin resistance and glucose intolerance. By twelve months the rats had an impaired glucose response with increased IVGTT peak values, area under the curve (AUC) values and glucose clearance rates. Concomitantly, the glucose stimulated insulin secretion rate (GS-ISR) was attenuated. Stimulated glucose disposal as measured by 2-deoxy-[3H]-D-glucose uptake was reduced in muscle and adipose tissue at three months. By twelve months, due to the age of the rats, stimulated glucose uptake declined compared to three months with no difference between groups. After three months the diets had no observable effect on the islets using light microscopy. However, by twelve months morphological changes were observed in both the HFD and CFD groups. In the HFD group large hypertrophied irregular islets with fibrous changes were observed. In the CFD group these morphological changes were more prominent with fibrous segregation and disruption of the normal endocrine arrangement. In addition, the presence of inflammatory cells within the affected islets is consistent with T2D. Conclusion: High-fat diet fed to Wistar rats induced obesity, abdominal adiposity and insulin resistance. The addition of sucrose/fructose to a high-fat diet exacerbated the insulin resistance and resulted in glucose intolerance and mild hyperglycemia. Morphological changes in the large islets were observed which are consistent with the development of T2D. / AFRIKAANSE OPSOMMING: Inleiding: ‘n Verwesterde dieët, ryk aan versadigde vette en suikers tesame met 'n passiewe lewenstyl, het bygedra tot die dramatiese verhoging in vetsug gedurende die laaste dekade (Zimmett et al, 2001; Wild et al, 2004). Vetsug word met dislipidemie en insulienweerstandigheid geassosieer wat hoof risikofaktore is vir die ontwikkeling van tipe 2 diabetes (T2D) (Zimmet et al, 2001; Kahn et al, 2006; Schröder et al, 2007). Hoë-vet voeding in knaagdiere induseer simptome soortgelyk aan menslike metaboliese sindroom sonder die ontwikkeling van T2D (Woods et al, 2002; Weir and Bonner-Weir, 2007). Die byvoeging van fruktose tot 'n hoë-vet dieët vererger insulienweerstandigheid en lei tot verswakte pankreas funksie, insuliensekresie en glukoseintoleransie (Basciano et al, 2005; Stanhope et al, 2009). Doelwitte: Die doelwitte van die studie was om die effek van hoë-vet en sukrose/fruktose voeding op glukosemetabolisme, die ontwikkeling van insulienweerstandigheid en β-sel dinamika te bepaal. Metodes: Gespeende Wistar rotte was in twee groepe gerandomiseer; studie een oor ʼn tydperk van drie maande en studie twee oor ʼn tydperk van twaalf maande onderskeidelik. Elke studie het 'n kontrole groep met standaard rot kos en water (control); en twee experimentele diëte wat of ʼn hoë-vet dieët en water (HFD) of 'n kafeedieët groep wat die HFD met die byvoeging van 15% sukrose/fruktose in hul drink water (CFD) ontvang. Fastende glukose en insulien, binneaarse glukose toleransie toets (IVGTT), glukose gestimuleerde insulien sekresie tempo en 2-deoxi-[3H]-D-glukose opname in spier, lewer en vet is gebruik om die effek van die dieët op glukosemetabolisme te bepaal. Die pankreata is uitgehaal vir immunohistochemiese identifisering van β-selle (insulien), α-selle (glukagoon), GLUT2 (glukose transport) en MIB5 (proliferasie). Monsters van die pankreata was ook vir elektronmikroskopie versamel. Resultate en bespreking: Voeding van ʼn CFD aan Wistar rotte induseer vetsug, insulienweerstandigheid en glukose-intoleransie Teen twaalf maande toon die rotte 'n verswakte respons tot glukose met verhoogde IVGTT piekwaardes, AUC waardes en glukose opruimingswaardes. Terselfdetyd is die glukose gestimuleerde insuliensekresie tempo (GS-ISR) ook verswak. Gestimuleerde glukose opruiming, soos deur 2-deoxi-[3H]-D-glukose opname bepaal, was verlaag in spier en vetweefsel teen drie maande. Teen twaalf maande, weens die ouderdom van die rotte, is die gestimuleerde glukose opname verlaag in vergelyking met drie maande sonder 'n verskil tussen groepe. Na drie maande kon geen sigbare morfologiese verskille met ligmikroskopie tussen die diëte waargeneem word nie. Teen twaalf maande is morfologiese verskille waargeneem in beide die HFD en die CFD groepe. In die HFD groep is groot hipertrofiese onreëlmatige eilande met fibrotiese verandering waargeneem. In die CFD groep was die morfologiese verandering meer gevorder met fibrotiese onderverdeling en ontwrigting van die normale endokriene rangskikking. Die teenwoordigheid van inflammatoriese selle in die geaffekteerde eilande is verenigbaar met T2D. Afleiding: Die voer van 'n hoë-vet dieët aan Wistar rotte veroorsaak vetsug, abdominale adipositeit en insulienweerstandigheid. Die byvoeging van sukrose/ fruktose tot die hoë-vet dieët vererger die insulienweerstandigheid en veroorsaak glukoseintoleransie en matige hiperglukemie. Morfologiese veranderings in die groter eilande was verenigbaar met T2D.

Abstract Polycystic ovary syndrome (PCOS) is the most common endocrine disorder affecting reproductive aged women, with reproductive, metabolic and cardiovascular implications across the life span. The typical features of PCOS include irregular menstruation, androgen excess and polycystic ovaries in ultrasonography. The majority of women with PCOS are overweight or obese, and, at least partly, obesity-driven metabolic abnormalities often coexist with PCOS. Despite intensive research, it has remained unclear whether PCOS per se is a risk factor of metabolic abnormalities, and cardiovascular disease and events. The main aim of the current work was to investigate whether PCOS is an independent risk factor of metabolic abnormalities and cardiovascular diseases. The study population consisted of the prospective population-based Northern Finland Birth Cohort 1966, and we used data collected at ages 14, 31 and 46. The definition of PCOS was based on self-reported PCOS symptoms at age 31 and/or PCOS diagnosis by age 46. The results revealed that weight gain in early life was a risk factor for the development of PCOS. As for metabolic outcomes, at age 46, normal-weight women with PCOS did not display increased odds of abnormal glucose metabolism. However, weight gain during early adulthood was significantly associated with abnormal glucose metabolism in women with PCOS by age 46. Interestingly, PCOS per se was already associated with elevated blood pressure at age 31 and hypertension at age 46, independently of obesity. Women with PCOS also displayed reduced cardiac vagal activity, which was associated with metabolic abnormalities and hypertension. Furthermore, even though no major anatomical or functional impairments were observed in echocardiography, women with PCOS displayed a significantly greater prevalence of myocardial infarction and a two-fold higher prevalence of cardiovascular events than controls. In conclusion, our findings indicate that even though PCOS is an independent risk factor of metabolic derangements, related obesity is a major metabolic risk factor in these women. The role of PCOS in cardiovascular events per se remains controversial and requires follow-up of this cohort. Given all this, maintaining normal weight and preventing weight gain, especially during early adulthood, should be the main priority in the prevention of adverse metabolic changes in women with PCOS. / Tiivistelmä Munasarjojen monirakkulaoireyhtymä (polycystic ovary syndrome, PCOS) on lisääntymisikäisten naisten yleisin hormonaalinen häiriö aiheuttaen runsaasti sairastavuutta ja terveydenhuollon kustannuksia. PCOS:n diagnostisiin kriteereihin kuuluvat epäsäännöllinen kuukautiskierto, lisääntynyt miessukupuoli-hormonivaikutus sekä monirakkulaiset munasarjat. Merkittävä osa oireyhtymää sairastavista naisista on ylipainoisia tai lihavia ja oireyhtymän kanssa yhtä aikaa esiintyykin useita, ainakin osittain ylipainosta johtuvia, metabolisia häiriöitä. Lukuisista tutkimuksista huolimatta on kuitenkin epäselvää, altistaako PCOS itsessään metabolisille häiriöille sekä sydän- ja verisuonisairauksille. Väitöskirjatutkimuksen tavoitteena oli selvittää, onko PCOS itsenäinen metabolisten ja sydän- ja verisuonisairauksien riskiä lisäävä tekijä. Tutkimus pohjautui Pohjois-Suomen syntymäkohortti 1966 tutkimuksen 14-, 31- ja 46-vuotisseurantoihin. PCOS luokittelu perustui 31- ja 46-vuotiskyselyissä itse ilmoitettuihin tyypillisiin PCOS oireisiin ja/tai diagnoosiin. Tutkimuksessa havaittiin, että 14- ja 31-ikävuoden välillä tapahtuva painonnousu oli yhteydessä PCOS diagnoosiin myöhemmällä iällä. 46-vuotiaana normaalipainoisilla PCOS naisilla ei ollut suurentunut tyypin 2 diabetes riski, mutta painonnousu varhaisaikuisuudessa oli merkittävästi yhteydessä sokeriaineenvaihdunnan häiriöön PCOS naisilla. PCOS oli yhteydessä kohonneeseen verenpaineeseen 31-vuotiaana ja hypertensioon 46-vuotiaana ylipainosta riippumatta. Oireyhtymään liittyvät metaboliset häiriöt olivat tärkein sydämen autonomisen hermoston säätelyyn vaikuttava tekijää, kun taas PCOS itsessään ei vaikuttanut autonomisen hermoston toimintaan. PCOS:ään sairastavien naisten sydämen rakenne ja funktio eivät merkitsevästi poikenneet kontrolloiden vastaavista muuttujista. Kuitenkin suhteellisen nuoresta iästä huolimatta PCOS naisilla esiintyi enemmän sydäninfarkteja ja kaksi kertaa enemmän sydän- ja verisuonitapahtumia, kuin kontrolleilla. Tutkimuksen tulokset osoittavat, että vaikkakin PCOS on itsenäinen riskitekijä metabolisille häiriöille, oireyhtymään liittyvä ylipaino vaikuttaa merkittävästi metabolisten häiriöiden esiintymiseen. PCOS:n ja sydän- ja verisuonitautitapahtumien yhteyden tarkempi tutkiminen vaatii kohortin jatkoseurantaa. Painonhallinnan tukemisen tulisi olla PCOS:ää sairastavien naisten hoidon kulmakivi.

Intermittent fasting (IF) is a recently popularized meal timing strategy whereby individuals abstain continuously from any energy intake for 16 to 20 hours each day, subsequently condensing energy intake into a short period spanning 4 to 8 hours. We aimed to test the effects of intermittent fasting in 10 individuals with Type 2 Diabetes Mellitus in conjunction with recommendations to consume a high protein diet in a 6 to 8 week withdrawal study. This study consisted of three phases: baseline, intervention, and follow-up. During the 2-week baseline and intervention phases participants consumed meals at regular times. Biochemical, anthropometric, and physical activity measurements were taken at the end of each phase. Participants reported morning, afternoon and evening self-monitored blood glucose and fasting duration on a daily basis, in addition to completing a remote food photography diary three times within each study phase. Despite the short duration of the intervention phase, intermittent fasting led to significant decreases in weight, BMI, morning SMBG, and overall reductions in waist circumference, C-reactive protein, energy intake, carbohydrate intake, and fat intake. There were significant variations between participants in response to intermittent fasting in respect to changes in lipids and insulin sensitivity, which could not be explained by baseline biochemical or anthropometric measures, fasting duration, energy intake, or physical activity. Upon cessation of intermittent fasting, biochemical changes regressed towards baseline values during the follow-up period. Intermittent fasting was well tolerated by most participants, and no severe adverse events were noted. Morning nausea was the most common complaint, which abruptly ceased when medication timing was changed.