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  • 1.
    Burén, Jonas
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine.
    Eriksson, Jan
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine.
    Is insulin resistance caused by defects in insulin's target cells or by a stressed mind?2005In: Diabetes/Metabolism Research Reviews, ISSN 1520-7552, E-ISSN 1520-7560, Vol. 21, no 6, p. 487-494Article in journal (Other academic)
    Abstract [en]

    The importance of understanding insulin action is emphasized by the increasing prevalence of insulin resistance in various populations and by the fact that it plays an important pathophysiological role in many common disorders, for example, diabetes, obesity, hypertension and dyslipidemia. The primary factors responsible for the development of insulin resistance are so far unknown, although both genetic and environmental factors are involved. The genetic defects responsible for the common forms of insulin resistance, for example, in type 2 diabetes, are largely unidentified. Some studies from our group as well as by other investigators suggest that cellular insulin resistance is reversible and that it may be secondary to factors in the in vivo environment. These may include insulin-antagonistic action of hormones like catecholamines, glucocorticoids, sex steroids and adipokines as well as dysregulation of autonomic nervous activity and they could contribute to the early development of insulin resistance. Some of these factors can directly impair glucose uptake capacity and this might be due to alterations in key proteins involved in insulin's intracellular signaling pathways. This article briefly summarizes proposed mechanisms behind cellular and whole-body insulin resistance. In particular, we question the role of intrinsic defects in insulin's target cells as primary mechanisms in the development of insulin resistance in type 2 diabetes and we suggest that metabolic and neurohormonal factors instead are the main culprits.

  • 2. Julin, Bettina
    et al.
    Willers, Carl
    Leksell, Janeth
    Lindgren, Peter
    Looström Muth, Karin
    Svensson, Ann-Marie
    Lilja, Mikael
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine. Unit of Research, Education, and Development, Östersund.
    Dahlström, Tobias
    Association between sociodemographic determinants and health outcomes in individuals with type 2 diabetes in Sweden2018In: Diabetes/Metabolism Research Reviews, ISSN 1520-7552, E-ISSN 1520-7560, Vol. 34, no 4, article id e2984Article in journal (Refereed)
    Abstract [en]

    Background: Concurrent multifactorial treatment is needed to reduce consequent risks of diabetes, yet most studies investigating the relationship between sociodemographic factors and health outcomes have focused on only one risk factor at a time. Swedish health care is mainly tax-funded, thus providing an environment that should facilitate equal health outcomes in patients, independent of background, socioeconomic status, or health profile. This study aimed at investigating the association between several sociodemographic factors and diabetes-related health outcomes represented by HbA(1c), systolic blood pressure, low-density lipoprotein cholesterol, predicted 5-year risk of cardiovascular disease, and statin use.

    Methods: This large retrospective registry study was based on patient-level data from individuals diagnosed with type 2 diabetes during 2010 to 2011 (n=416,228) in any of 7 Swedish regions (similar to 65% of the Swedish population). Health equity in diabetes care analysed through multivariate regression analyses on intermediary outcomes (HbA(1c), systolic blood pressure, and low-density lipoprotein), predicted 5-year risk of cardiovascular disease and process (i.e., statin use) after 1-year follow-up, adjusting for several sociodemographic factors.

    Results: We observed differences in intermediary risk measures, predicted 5-year risk of cardiovascular disease, and process dependent on place of birth, sex, age, education, and social setting, despite Sweden's articulated vision of equal health care.

    Conclusions: Diabetes patients' health was associated with sociodemographic prerequisites. Furthermore, in addition to demographics (age and sex) and disease history, educational level, marital status, and region of birth are important factors to consider when benchmarking health outcomes, e.g., average HbA(1c) level, and evaluating the level of health equity between organizational units or between different administrative regions.

  • 3.
    Ning, F
    et al.
    Department of Public Health, University of Helsinki, Helsinki, Finland.
    Qiao, Q
    Department of Public Health, University of Helsinki, Helsinki, Finland.
    Tuomilehto, J
    Department of Public Health, University of Helsinki, Helsinki, Finland.
    Hammar, N
    Department of Epidemiology, Institute of Environmental Medicine, Karolinska Institute, Stockholm, Sweden.
    Ho, S Y
    Department of Community Medicine, University of Hong Kong, Hong Kong SAR, China.
    Söderberg, Stefan
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine.
    Zimmet, P Z
    Baker IDI Heart and Diabetes Institute, Melbourne, Victoria, Australia.
    Shaw, J E
    Baker IDI Heart and Diabetes Institute, Melbourne, Victoria, Australia.
    Nakagami, T
    Diabetes Center, Tokyo Women's Medical University School of Medicine, Tokyo, Japan.
    Mohan, V
    Madras Diabetes Research Foundation, Dr Mohan's Diabetes Specialities Centre, Chennai, India.
    Ramachandran, A
    India Diabetes Research Foundation, Dr A. Ramachandran's Diabetes Hospitals, Chennai, India.
    Lam, T H
    Department of Community Medicine, University of Hong Kong, Hong Kong SAR, China.
    Andersson, S W
    Department of Clinical Nutrition, Sahlgrenska Academy at Göteborg University, Göteborg, Sweden.
    Janus, E D
    Department of Community Medicine, University of Hong Kong, Hong Kong SAR, China.
    Boyko, E J
    Department of Medicine, University of Washington, Seattle, WA, USA.
    Fujimoto, W Y
    Department of Medicine, University of Washington, Seattle, WA, USA.
    Pang, Z C
    Qingdao Centers for Disease Control and Prevention, Qingdao, China.
    Does abnormal insulin action or insulin secretion explain the increase in prevalence of impaired glucose metabolism with age in populations of different ethnicities?2010In: Diabetes/Metabolism Research Reviews, ISSN 1520-7552, E-ISSN 1520-7560, Vol. 26, no 4, p. 245-253Article in journal (Refereed)
    Abstract [en]

    The age-related increase in glucose intolerance may not be fully explained by the defect in HOMA-IR and HOMA-B. As HOMA-IR and HOMA-B are only surrogate measures of insulin sensitivity and insulin secretion, the results need to be further investigated.

  • 4.
    Otten, Julia
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine.
    Stomby, Andreas
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine.
    Waling, Maria
    Umeå University, Faculty of Social Sciences, Department of Food and Nutrition.
    Isaksson, Andreas
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Sports Medicine.
    Tellström, Anna
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine.
    Lundin-Olsson, Lillemor
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy.
    Brage, Søren
    Ryberg, Mats
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine.
    Svensson, Michael
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Sports Medicine.
    Olsson, Tommy
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine.
    Benefits of a Paleolithic diet with and without supervised exercise on fat mass, insulin sensitivity, and glycemic control: a randomized controlled trial in individuals with type 2 diabetes2017In: Diabetes/Metabolism Research Reviews, ISSN 1520-7552, E-ISSN 1520-7560, Vol. 33, no 1, article id e2828Article in journal (Refereed)
    Abstract [en]

    Background

    Means to reduce future risk for cardiovascular disease in subjects with type 2 diabetes are urgently needed.

    Methods

    Thirty-two patients with type 2 diabetes (age 59 ± 8 years) followed a Paleolithic diet for 12 weeks. Participants were randomized to either standard care exercise recommendations (PD) or 1-h supervised exercise sessions (aerobic exercise and resistance training) three times per week (PD-EX).

    Results

    For the within group analyses, fat mass decreased by 5.7 kg (IQR: −6.6, −4.1; p < 0.001) in the PD group and by 6.7 kg (−8.2, −5.3; p < 0.001) in the PD-EX group. Insulin sensitivity (HOMA-IR) improved by 45% in the PD (p < 0.001) and PD-EX (p < 0.001) groups. HbA1c decreased by 0.9% (−1.2, −0.6; p < 0.001) in the PD group and 1.1% (−1.7, −0.7; p < 0.01) in the PD-EX group. Leptin decreased by 62% (p < 0.001) in the PD group and 42% (p < 0.001) in the PD-EX group. Maximum oxygen uptake increased by 0.2 L/min (0.0, 0.3) in the PD-EX group, and remained unchanged in the PD group (p < 0.01 for the difference between intervention groups). Male participants decreased lean mass by 2.6 kg (−3.6, −1.3) in the PD group and by 1.2 kg (−1.3, 1.0) in the PD-EX group (p < 0.05 for the difference between intervention groups).

    Conclusions

    A Paleolithic diet improves fat mass and metabolic balance including insulin sensitivity, glycemic control, and leptin in subjects with type 2 diabetes. Supervised exercise training may not enhance the effects on these outcomes, but preserves lean mass in men and increases cardiovascular fitness.

  • 5. Svensson, MK
    et al.
    Tyrberg, M
    Nyström, Lennarth
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Arnqvist, HJ
    Bolinder, J
    Östman, J
    Gudbjörnsdottir, S
    Landin-Olsson, M
    Eriksson, JW
    The risk for diabetic nephropathy is low in young adults in a 17-year follow-up of the Diabetes Incidence Study in Sweden (DISS): Higher age and BMI at diabetes onset can be important risk factors2015In: Diabetes/Metabolism Research Reviews, ISSN 1520-7552, E-ISSN 1520-7560, Vol. 31, no 2, p. 138-146Article in journal (Refereed)
    Abstract [en]

    AIMS: To estimate the occurrence of diabetic nephropathy (DN) in a population-based cohort of patients diagnosed with diabetes as young adults (15-34 years). Methods: All 794 patients registered 1987-1988 in the Diabetes Incidence Study in Sweden (DISS) were invited to a follow-up study 15-19 years after diagnosis and 468 (58%) participated. Islet cell antibodies were used to classify type of diabetes.

    RESULTS: After median 17 years of diabetes 15% of all patients, 14% T1DM and 25% T2DM, were diagnosed with DN. 91% had micro- and 8.6% macroalbuminuria. Older age at diagnosis (HR 1.05; 95% CI 1.01-1.10 per year) was an independent and a higher BMI at diabetes diagnosis (HR 1.04; 95% CI 1.00-1.09 per 1 kg/m(2) ) a near-significant predictor of development of DN. Age at onset of diabetes (p = 0.041), BMI (p = 0.012) and HbA1c (p < 0.001) were significant predictors of developing DN between 9 and 17 years of diabetes. At 17 years of diabetes duration, a high HbA1c level (OR 1.06; 95% CI 1.03-1.08 per 1 mmol/mol increase) and systolic blood pressure (OR 1.08; 95% CI 1.05-1.12 per 1 mmHg increase) were associated with DN.

    CONCLUSIONS: Patients with T2DM diagnosed as young adults seem to have an increased risk to develop DN compared to those with T1DM. Older age and higher BMI at diagnosis of diabetes were risk markers of development of DN. In addition, poor glycaemic control but not systolic blood pressure at 9 years of follow up were risk markers for later development of DN.

  • 6. Zhang, L
    et al.
    Qiao, Q
    Tuomilehto, J
    Hammar, N
    Janus, E D
    Söderberg, Stefan
    Umeå University, Faculty of Medicine, Public Health and Clinical Medicine, Medicine.
    Mohan, V
    Ramachandran, A
    Dong, Y H
    Lam, T H
    Pang, Z C
    Blood lipid levels in relation to glucose status in seven populations of Asian origin without a prior history of diabetes: the DECODA study.2009In: Diabetes/Metabolism Research Reviews, ISSN 1520-7552, E-ISSN 1520-7560, Vol. 25, no 6, p. 549-557Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Dyslipidaemia commonly coexists with diabetes. We investigated the association of lipid profiles with glucose levels in populations of Asian origin without a prior history of diabetes. METHODS: Cross-sectional data of 10,374 men and 12,552 women aged 30-74 years from 14 cohorts, representing seven populations of Asian origin were jointly analysed. Multivariable adjusted linear regression analyses with standardized regression coefficients (beta) were performed to estimate relationships between lipids and plasma glucose. RESULTS: Within each glucose category, fasting plasma glucose (FPG) levels were correlated with increasing levels of triglycerides (TGs), total cholesterol (TC), TC to high-density lipoprotein (HDL) ratio and non-HDL cholesterol (non-HDL-C) (p < 0.05 in most of the ethnic groups) and inversely associated with HDL-C (p < 0.05 in some, but not all, of the populations). The association of lipids with 2-h plasma glucose (2hPG) followed a similar pattern as that for the FPG, except that an inverse relationship between HDL-C and glucose was more commonly observed for 2hPG than for FPG among different ethnic groups. CONCLUSIONS: Hyperglycaemia is associated with adverse lipid profiles in Asians without a prior history of diabetes. The 2hPG appears to be more closely associated with lipid profiles than does FPG. When assessing the risk of cardiovascular disease, the association of the dyslipidaemia with intermediate hyperglycaemia needs to be considered.

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