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Publications (10 of 36) Show all publications
Jutterström, L., Stenlund, A.-L., Otten, J., Lilja, M. & Hellström Ängerud, K. (2024). Awareness of cardiovascular risk among persons with type 2 diabetes: a qualitative study. International Journal of Qualitative Studies on Health and Well-being, 19(1), Article ID 2294512.
Open this publication in new window or tab >>Awareness of cardiovascular risk among persons with type 2 diabetes: a qualitative study
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2024 (English)In: International Journal of Qualitative Studies on Health and Well-being, ISSN 1748-2623, E-ISSN 1748-2631, Vol. 19, no 1, article id 2294512Article in journal (Refereed) Published
Abstract [en]

PURPOSE: To describe the process of becoming aware of and acting on personal cardiovascular (CVD) risk in type 2 diabetes (T2D).

METHOD: A purposive sample of 14 persons living with T2D participated in semi-structured, open-ended, in-dept interviews. The interviews were analysed with grounded theory.

RESULT: The analysis identified the core category "Balancing emotions, integrating knowledge and understanding to achieve risk awareness and act on it." Five categories describe the movement from not being aware of the risk of cardiovascular disease (CVD) to becoming aware of this risk and taking action to reduce it. Persons with T2D need to transform their knowledge and experience of CVD risk and incorporate it in their individual situations. Emotional and existential experiences of CVD risk can lead to awareness about the severity of the condition and contribute to increased motivation for self-management. However, an overly high emotional response can be overwhelming and may result in insufficient self-management.

CONCLUSION: Persons with T2D seemed not to fully grasp their increased risk of CVD or recognize that self-management activities were aimed at reducing this risk. However, their awareness of CVD risk gradually increased as they came to understand the severity of T2D and became more emotionally and existentially engaged.

Place, publisher, year, edition, pages
Taylor & Francis, 2024
Keywords
Cardiovascular risk, patients’ experiences, primary health care, qualitative, risk awareness, type 2 diabetes
National Category
Nursing
Identifiers
urn:nbn:se:umu:diva-218860 (URN)10.1080/17482631.2023.2294512 (DOI)001127543500001 ()38112175 (PubMedID)2-s2.0-85180420063 (Scopus ID)
Funder
Umeå UniversityRegion VästerbottenVisare NorrDiabetesfonden
Available from: 2024-01-05 Created: 2024-01-05 Last updated: 2024-01-05Bibliographically approved
Olsson, S., Otten, J., Blusi, M., Lundberg, E. & Hörnsten, Å. (2023). Experiences of transition to adulthood and transfer to adult care in young adults with type 1 diabetes: a qualitative study. Journal of Advanced Nursing, 79(12), 4621-4634
Open this publication in new window or tab >>Experiences of transition to adulthood and transfer to adult care in young adults with type 1 diabetes: a qualitative study
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2023 (English)In: Journal of Advanced Nursing, ISSN 0309-2402, E-ISSN 1365-2648, Vol. 79, no 12, p. 4621-4634Article in journal (Refereed) Published
Abstract [en]

Aim: To explore young adults' experiences of living with type 1 diabetes in the transition to adulthood, including experiences of the transfer from paediatric to adult care.

Design: A qualitative approach was used.

Method: Ten young adults, six women and four men, aged 19–29 years, participated. Participants were recruited at their regular diabetes clinic from spring 2021 to spring 2022. Semi-structured interviews were transcribed and analysed using qualitative content analysis.

Findings: Dreaming of being nurtured towards self-reliance was the overarching theme. Personal experiences of the transition to adulthood, including the transfer from paediatric to adult care, were described in terms of struggling to find balance in daily life, dealing with feelings of being different, being gradually supported to achieve independence, and wishing to be approached as a unique person in healthcare.

Conclusion: In healthcare, it is important to emphasize not only diabetes-related factors but also emotional and psychosocial aspects of life connected to the transition to adulthood, including the transfer to adult care. The young adults wished to be seen as unique persons in healthcare during their emerging adulthood and should therefore be supported to achieve self-reliance through personal preparations for new challenges and for the consequences of transitioning to adulthood. Specialist nurses can provide appropriate knowledge and leadership.

Implications for the Profession: These findings can guide nurse specialists in support for emerging adults to achieve self-reliance and indicate the importance of person-centred care when experiencing transition and transfer.

Reporting Method: The study adhered to EQUATOR guidelines, and the COREQ checklist for qualitative studies was used as the reporting method.

Keywords
adolescence, adult care, emerging adulthood, emotional aspects, experiences, nursing, psychosocial aspects, qualitative, transfer, transition, type 1 diabetes, young adults
National Category
Nursing
Identifiers
urn:nbn:se:umu:diva-211810 (URN)10.1111/jan.15740 (DOI)001019706600001 ()37357405 (PubMedID)2-s2.0-85162989601 (Scopus ID)
Funder
Diabetesfonden
Available from: 2023-07-11 Created: 2023-07-11 Last updated: 2023-12-21Bibliographically approved
Östgren, C. J., Otten, J., Festin, K., Angerås, O., Bergström, G., Cederlund, K., . . . Sundström, J. (2023). Prevalence of atherosclerosis in individuals with prediabetes and diabetes compared to normoglycaemic individuals-a Swedish population-based study. Cardiovascular Diabetology, 22(1), Article ID 261.
Open this publication in new window or tab >>Prevalence of atherosclerosis in individuals with prediabetes and diabetes compared to normoglycaemic individuals-a Swedish population-based study
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2023 (English)In: Cardiovascular Diabetology, ISSN 1475-2840, E-ISSN 1475-2840, Vol. 22, no 1, article id 261Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Patients with type 2 diabetes have an increased risk of death and cardiovascular events and people with diabetes or prediabetes have been found to have increased atherosclerotic burden in the coronary and carotid arteries. This study will estimate the cross-sectional prevalence of atherosclerosis in the coronary and carotid arteries in individuals with prediabetes and diabetes, compared with normoglycaemic individuals in a large population-based cohort.

METHODS: The 30,154 study participants, 50-64 years, were categorized according to their fasting glycaemic status or self-reported data as normoglycaemic, prediabetes, and previously undetected or known diabetes. Prevalence of affected coronary artery segments, severity of stenosis and coronary artery calcium score (CACS) were determined by coronary computed tomography angiography. Total atherosclerotic burden was assessed in the 11 clinically most relevant segments using the Segment Involvement Score and as the presence of any coronary atherosclerosis. The presence of atherosclerotic plaque in the carotid arteries was determined by ultrasound examination.

RESULTS: Study participants with prediabetes (n = 4804, 16.0%) or diabetes (n = 2282, 7.6%) had greater coronary artery plaque burden, more coronary stenosis and higher CACS than normoglycaemic participants (all, p < 0.01). Among male participants with diabetes 35.3% had CACS ≥ 100 compared to 16.1% among normoglycaemic participants. For women, the corresponding figures were 8.9% vs 6.1%. The prevalence of atherosclerosis in the coronary arteries was higher in participants with previously undetected diabetes than prediabetes, but lower than in patients with known diabetes. The prevalence of any plaque in the carotid arteries was higher in participants with prediabetes or diabetes than in normoglycaemic participants.

CONCLUSIONS: In this large population-based cohort of currently asymptomatic people, the atherosclerotic burden in the coronary and carotid arteries increased with increasing degree of dysglycaemia. The finding that the atherosclerotic burden in the coronary arteries in the undetected diabetes category was midway between the prediabetes category and patients with known diabetes may have implications for screening strategies and tailored prevention interventions for people with dysglycaemia in the future.

Place, publisher, year, edition, pages
BioMed Central (BMC), 2023
Keywords
Atherosclerosis, Carotid arteries, Coronary arteries, Coronary computed tomography angiography, Diabetes, Prediabetes
National Category
Endocrinology and Diabetes
Identifiers
urn:nbn:se:umu:diva-215075 (URN)10.1186/s12933-023-01982-6 (DOI)37759237 (PubMedID)2-s2.0-85172780903 (Scopus ID)
Funder
Swedish Heart Lung Foundation, 2016-0315Knut and Alice Wallenberg Foundation, 2014-0047Swedish Research Council, 822-2013- 2000Vinnova, 2012-04476University of GothenburgKarolinska InstituteRegion StockholmLinköpings universitetLund UniversityUmeå UniversityUppsala UniversitySwedish Research Council, 2018-02527Swedish Heart Lung Foundation, 2021-03459AFA InsuranceEU, European Research Council, ERC-2018-STG801965Swedish Research Council, 2019-01471Swedish Heart Lung Foundation, 20190505Swedish Heart Lung Foundation, 20210184Swedish Research Council, 2021-06432
Available from: 2023-10-13 Created: 2023-10-13 Last updated: 2023-10-13Bibliographically approved
Prystupa, K., Renklint, R., Chninou, Y., Otten, J., Fritsche, L., Hoerber, S., . . . Wagner, R. (2022). Comprehensive validation of fasting-based and oral glucose tolerance test-based indices of insulin secretion against gold standard measures. BMJ Open Diabetes Research & Care, 10(5), Article ID e002909.
Open this publication in new window or tab >>Comprehensive validation of fasting-based and oral glucose tolerance test-based indices of insulin secretion against gold standard measures
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2022 (English)In: BMJ Open Diabetes Research & Care, ISSN 2052-4897, Vol. 10, no 5, article id e002909Article in journal (Refereed) Published
Abstract [en]

INTRODUCTION: With pre-diabetes and diabetes increasingly recognized as heterogeneous conditions, assessment of beta-cell function is gaining clinical importance to identify disease subphenotypes. Our study aims to comprehensively validate all types of surrogate indices based on oral glucose tolerance test (OGTT) and fasting measurements in comparison with gold standard methods.

RESEARCH DESIGN AND METHODS: The hyperglycemic clamp extended with glucagon-like peptide 1 (GLP-1) infusion and intravenous glucose tolerance test (IVGTT), as well as OGTT, was performed in two well-phenotyped cohorts. The gold standard-derived indices were compared with surrogate insulin secretion markers, derived from fasting state and OGTT, using both Pearson's and Spearman's correlation coefficients. The insulin-based and C-peptide-based indices were analyzed separately in different groups of glucose tolerance and the entire cohorts.

RESULTS: The highest correlation coefficients were found for area under curve (AUC) (I0-30)/AUC (G0-30), I30/G30, first-phase Stumvoll and Kadowaki model. These indices have high correlation coefficients with measures obtained from both insulin and C-peptide levels from IVGTT and hyperglycemic clamp. AUC (I0-120)/AUC (G0-120), BIGTT-AIR0-60-120, I30/G30, first-phase Stumvoll and AUC (I0-30)/AUC (G0-30) demonstrated the strongest association with incretin-stimulated insulin response.

CONCLUSIONS: We have identified glucose-stimulated and GLP-1-stimulated insulin secretion indices, derived from OGTT and fasting state, that have the strongest correlation with gold standard measures and could be potentially used in future researches and clinical practice.

Place, publisher, year, edition, pages
BMJ Publishing Group Ltd, 2022
Keywords
C-peptide, insulin, insulin secretion
National Category
Endocrinology and Diabetes
Identifiers
urn:nbn:se:umu:diva-199675 (URN)10.1136/bmjdrc-2022-002909 (DOI)000853814700001 ()36100292 (PubMedID)2-s2.0-85137782270 (Scopus ID)
Available from: 2022-10-05 Created: 2022-10-05 Last updated: 2023-05-23Bibliographically approved
Pillon, N. J., Smith, J. A., Alm, P. S., Chibalin, A. V., Alhusen, J., Arner, E., . . . Zierath, J. R. (2022). Distinctive exercise-induced inflammatory response and exerkine induction in skeletal muscle of people with type 2 diabetes. Science Advances, 8(36), Article ID eabo3192.
Open this publication in new window or tab >>Distinctive exercise-induced inflammatory response and exerkine induction in skeletal muscle of people with type 2 diabetes
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2022 (English)In: Science Advances, E-ISSN 2375-2548, Vol. 8, no 36, article id eabo3192Article in journal (Refereed) Published
Abstract [en]

Mechanistic insights into the molecular events by which exercise enhances the skeletal muscle phenotype are lacking, particularly in the context of type 2 diabetes. Here, we unravel a fundamental role for exercise-responsive cytokines (exerkines) on skeletal muscle development and growth in individuals with normal glucose tolerance or type 2 diabetes. Acute exercise triggered an inflammatory response in skeletal muscle, concomitant with an infiltration of immune cells. These exercise effects were potentiated in type 2 diabetes. In response to contraction or hypoxia, cytokines were mainly produced by endothelial cells and macrophages. The chemokine CXCL12 was induced by hypoxia in endothelial cells, as well as by conditioned medium from contracted myotubes in macrophages. We found that CXCL12 was associated with skeletal muscle remodeling after exercise and differentiation of cultured muscle. Collectively, acute aerobic exercise mounts a noncanonical inflammatory response, with an atypical production of exerkines, which is potentiated in type 2 diabetes.

Place, publisher, year, edition, pages
NLM (Medline), 2022
National Category
Physiology
Identifiers
urn:nbn:se:umu:diva-199460 (URN)10.1126/sciadv.abo3192 (DOI)000911968500015 ()36070371 (PubMedID)2-s2.0-85137461286 (Scopus ID)
Funder
Novo Nordisk, 17OC0030088Knut and Alice Wallenberg Foundation, 2018.0094Diabetesfonden, 2018-357Swedish Research Council, 2015-00165Swedish National Centre for Research in Sports, P2019-0140Swedish National Centre for Research in Sports, P2020-0064AstraZeneca, 2014-2019Novo Nordisk, 21SA0072747Swedish Heart Lung Foundation, 2017-0669Swedish Heart Lung Foundation, 2020-0627Diabetesfonden, 2018-336Novo Nordisk, 20SA0064144
Available from: 2022-09-26 Created: 2022-09-26 Last updated: 2023-09-05Bibliographically approved
Karlsson, T., Augustin, H., Lindqvist, M., Otten, J., Petersson, K., Storck-Lindholm, E., . . . Winkvist, A. (2022). Effect of the New Nordic Diet compared with usual care on glucose control in gestational diabetes mellitus: Study protocol for the randomized controlled trial intervention with new Nordic DIet in women with GestatiOnal diabetes mellitus (iNDIGO). Contemporary Clinical Trials, 115, Article ID 106706.
Open this publication in new window or tab >>Effect of the New Nordic Diet compared with usual care on glucose control in gestational diabetes mellitus: Study protocol for the randomized controlled trial intervention with new Nordic DIet in women with GestatiOnal diabetes mellitus (iNDIGO)
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2022 (English)In: Contemporary Clinical Trials, ISSN 1551-7144, E-ISSN 1559-2030, Vol. 115, article id 106706Article in journal (Refereed) Published
Abstract [en]

Background: Gestational diabetes mellitus (GDM) is a pregnancy complication associated with short- and long-term health consequences for mother and child. First line treatment is diet and exercise but there is a recognized knowledge gap as to what diet treatment is optimal. A healthy Nordic diet has been associated with improved health but no studies in women with GDM exist. The New Nordic Diet (NND) is an initiative with the purpose to develop a healthy Nordic diet including foods with the potential to grow in Nordic countries; including fruit, berries, vegetables, whole-grain cereal products, nuts, fish, and rapeseed oil. The purpose of the intervention with new Nordic DIet in women with GestatiOnal diabetes mellitus (iNDIGO) is to test if the NND compared with usual care improves glucose control in women with GDM.

Methods: The iNDIGO study is a randomized parallel controlled trial where 50 women with GDM will be randomized to either an NND or usual care for 14 days (30–32 weeks of gestation). Participants in the NND group will receive menus and food bags containing foods to be consumed. Primary outcome is glycemic control (time in target) measured using continuous glucose monitoring. Compliance to the dietary intervention will be tested using dietary biomarkers and adherence questionnaires.

Conclusion: Diet treatment represents first line treatment in GDM but it remains unclear what type of diets are effective. iNDIGO is an efficacy study and will provide evidence as to whether a healthy Nordic diet can improve glucose control in women with GDM.

Place, publisher, year, edition, pages
Elsevier, 2022
Keywords
Continuous glucose monitoring, Gestational diabetes mellitus, Glycemic variability, Nordic diet, Pregnancy, Randomized controlled trial
National Category
Endocrinology and Diabetes Nutrition and Dietetics
Identifiers
urn:nbn:se:umu:diva-192871 (URN)10.1016/j.cct.2022.106706 (DOI)000788294200006 ()35158086 (PubMedID)2-s2.0-85125129794 (Scopus ID)
Funder
Forte, Swedish Research Council for Health, Working Life and Welfare, 2018-00483
Available from: 2022-03-11 Created: 2022-03-11 Last updated: 2023-09-05Bibliographically approved
Otten, J., Tavelin, B., Söderberg, S. & Rolandsson, O. (2022). Fasting C-peptide at type 2 diabetes diagnosis is an independent risk factor for total and cancer mortality. Diabetes/Metabolism Research Reviews, 38(3), Article ID e3512.
Open this publication in new window or tab >>Fasting C-peptide at type 2 diabetes diagnosis is an independent risk factor for total and cancer mortality
2022 (English)In: Diabetes/Metabolism Research Reviews, ISSN 1520-7552, E-ISSN 1520-7560, Vol. 38, no 3, article id e3512Article in journal (Refereed) Published
Abstract [en]

Aims: We assessed the association between insulin resistance and blood glucose concentrations at type 2 diabetes diagnosis and future development of diabetes-related complications and mortality.

Materials and Methods: This retrospective cohort study included 864 individuals with type 2 diabetes (median age 60 years) whose fasting C-peptide and HbA1c were measured at diabetes diagnosis. The median follow-up time until death or study end was 16.4 years (interquartile range 13.3−19.6). The association between C-peptide and mortality/complications was estimated by Cox regression adjusted for sex, age at diabetes diagnosis, smoking, hypertension, BMI, total cholesterol, and HbA1c. C-peptide and HbA1c were converted to Z scores before the Cox regression analysis.

Results: An increase by one standard deviation in fasting C-peptide at diabetes diagnosis was associated with all-cause (hazard ratio [HR] 1.33; 95% confidence intervals [CI] 1.12–1.58; p = 0.001) and cancer mortality (HR 1.51; 95% CI 1.13–2.01; p = 0.005) in the fully adjusted model. An increase by one standard deviation in HbA1c at diabetes diagnosis was associated with all-cause mortality (HR 1.24; 95% CI 1.07–1.44; p = 0.005), major cardiovascular events (HR 1.20; 95% CI 1.04–1.39; p = 0.015), stroke (HR 1.36; 95% CI 1.09–1.70; p = 0.006), and retinopathy (HR 1.54; 95% CI 1.34–1.76; p < 0.0001) in the fully adjusted model.

Conclusions: Fasting C-peptide at type 2 diabetes diagnosis is an independent risk factor for total and cancer-related mortality. Thus, treatment of type 2 diabetes should focus not only on normalising blood glucose levels but also on mitigating insulin resistance.

Place, publisher, year, edition, pages
John Wiley & Sons, 2022
Keywords
cancer mortality, diabetes mellitus type 2, insulin resistance, mortality
National Category
Endocrinology and Diabetes
Identifiers
urn:nbn:se:umu:diva-190001 (URN)10.1002/dmrr.3512 (DOI)000720975500001 ()34780669 (PubMedID)2-s2.0-85119586636 (Scopus ID)
Funder
Norrbotten County CouncilRegion Västerbotten
Available from: 2021-12-07 Created: 2021-12-07 Last updated: 2022-07-12Bibliographically approved
Rosén, A., Otten, J., Stomby, A., Vallin, S., Wennberg, P. & Brunström, M. (2022). Oral glucose tolerance testing as a complement to fasting plasma glucose in screening for type 2 diabetes: population-based cross-sectional analyses of 146 000 health examinations in Västerbotten, Sweden. BMJ Open, 12(6), Article ID e062172.
Open this publication in new window or tab >>Oral glucose tolerance testing as a complement to fasting plasma glucose in screening for type 2 diabetes: population-based cross-sectional analyses of 146 000 health examinations in Västerbotten, Sweden
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2022 (English)In: BMJ Open, E-ISSN 2044-6055, Vol. 12, no 6, article id e062172Article in journal (Refereed) Published
Abstract [en]

OBJECTIVE: To assess the effect of adding an oral glucose tolerance test (OGTT) to fasting plasma glucose (FPG) in terms of detection of type 2 diabetes (T2D) and impaired glucose tolerance (IGT).

DESIGN: Retrospective analysis of serial cross-sectional screening study. SETTING: Population-based health examinations within primary care in Västerbotten County, Sweden.

PARTICIPANTS: Individuals aged 40- 50 and 60 years with participation from 1985 to 2017. Those with previously diagnosed diabetes and FPG≥7 mmol/L were excluded.

PRIMARY AND SECONDARY OUTCOME MEASURES: Prevalence of hyperglycaemia on the OGTT (IGT and T2D defined as 2-hour postload capillary plasma glucose of 8.9-12.1 mmol/L and ≥12.2 mmol/L, respectively). Analyses were further stratified by age, sex and risk factor burden to identify groups at high or low risk of IGT and T2D on testing. The numbers needed to screen (NNS) to prevent one case of T2D through detection and treatment of IGT was estimated, combining prevalence numbers with average progression rates and intervention effects from previous meta-analyses.

RESULTS: The prevalence of IGT ranged from 0.9% (95% CI 0.7% to 1.1%) to 29.6% (95% CI 27.4% to 31.7%), and the prevalence of T2D ranged from 0.06% (95% CI 0.02% to 0.11%) to 7.0% (95% CI 5.9% to 8.3%), depending strongly on age, sex and risk factor burden. The estimated NNS to prevent one case of T2D through detection and lifestyle treatment of IGT ranged from 1332 among 40-year-old men without risk factors, to 39 among 60-year-old women with all risk factors combined.

CONCLUSIONS: The prevalence of hyperglycaemia on OGTT is highly dependent on age, sex and risk factor burden; OGTT should be applied selectively to high-risk groups to avoid unnecessary testing in the general population.

Place, publisher, year, edition, pages
BMJ Publishing Group Ltd, 2022
Keywords
impaired glucose tolerance, non-diabetic hyperglycemia, oral glucose tolerance test, prediabetes, screening, type 2 diabetes
National Category
Endocrinology and Diabetes
Identifiers
urn:nbn:se:umu:diva-196821 (URN)10.1136/bmjopen-2022-062172 (DOI)000810036900028 ()35676014 (PubMedID)2-s2.0-85131654381 (Scopus ID)
Available from: 2022-06-20 Created: 2022-06-20 Last updated: 2023-09-05Bibliographically approved
Chorell, E., Otten, J., Stomby, A., Ryberg, M., Waling, M., Hauksson, J., . . . Olsson, T. (2021). Improved peripheral and hepatic insulin sensitivity after lifestyle interventions in type 2 diabetes is associated with specific metabolomic and lipidomic signatures in skeletal muscle and plasma. Metabolites, 11(12), Article ID 834.
Open this publication in new window or tab >>Improved peripheral and hepatic insulin sensitivity after lifestyle interventions in type 2 diabetes is associated with specific metabolomic and lipidomic signatures in skeletal muscle and plasma
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2021 (English)In: Metabolites, ISSN 2218-1989, E-ISSN 2218-1989, Vol. 11, no 12, article id 834Article in journal (Refereed) Published
Abstract [en]

Lifestyle interventions with weight loss can improve insulin sensitivity in type 2 diabetes (T2D), but mechanisms are unclear. We explored circulating and skeletal muscle metabolite signatures of altered peripheral (pIS) and hepatic insulin sensitivity (hIS) in overweight and obese T2D individuals that were randomly assigned a 12-week Paleolithic-type diet with (diet-ex, n = 13) or without (diet, n = 13) supervised exercise. Baseline and post-intervention measures included: mass spectrometry-based metabolomics and lipidomics of skeletal muscle and plasma; pIS and hIS; ectopic lipid deposits in the liver and skeletal muscle; and skeletal muscle fat oxidation rate. Both groups lowered BMI and total % fat mass and increased their pIS. Only the diet-group improved hIS and reduced ectopic lipids in the liver and muscle. The combined improvement in pIS and hIS in the diet-group were associated with decreases in muscle and circulating branched-chain amino acid (BCAA) metabolites, specifically valine. Improved pIS with diet-ex was instead linked to increased diacylglycerol (34:2) and triacylglycerol (56:0) and decreased phosphatidylcholine (34:3) in muscle coupled with improved muscle fat oxidation rate. This suggests a tissue crosstalk involving BCAA-metabolites after diet intervention with improved pIS and hIS, reflecting reduced lipid influx. Increased skeletal muscle lipid utilization with exercise may prevent specific lipid accumulation at sites that perturb insulin signaling.

Place, publisher, year, edition, pages
MDPI, 2021
Keywords
Branched-chain amino acids (BCAA), Diacylglycerol (DAG), Diet, Ectopic fat, Exercise training, Hepatic insulin sensitivity (hIS), Peripheral insulin sensitivity (pIS), Skeletal muscle, Type 2 diabetes
National Category
Physiology Nutrition and Dietetics Endocrinology and Diabetes
Identifiers
urn:nbn:se:umu:diva-190949 (URN)10.3390/metabo11120834 (DOI)000735530300001 ()34940592 (PubMedID)2-s2.0-85121572914 (Scopus ID)
Funder
The Kempe Foundations, JCK-1725Swedish Heart Lung Foundation, 20150553
Available from: 2022-01-05 Created: 2022-01-05 Last updated: 2023-09-05Bibliographically approved
Otten, J., Stomby, A., Waling, M., Chorell, E., Ryberg, M., Svensson, M. B., . . . Olsson, T. (2021). The liver-alpha-cell axis after a mixed meal and during weight loss in type 2 diabetes. Endocrine Connections, 10(9), 1101-1110
Open this publication in new window or tab >>The liver-alpha-cell axis after a mixed meal and during weight loss in type 2 diabetes
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2021 (English)In: Endocrine Connections, E-ISSN 2049-3614, Vol. 10, no 9, p. 1101-1110Article in journal (Refereed) Published
Abstract [en]

Objective: Glucagon and amino acids may be regulated in a feedback loop called the liver-alpha-cell axis with alanine or glutamine as suggested signal molecules. We assessed this concept in individuals with type 2 diabetes in the fasting state, after ingestion of a protein-rich meal, and during weight loss. Moreover, we investigated if postprandial glucagon secretion and hepatic insulin sensitivity were related.

Methods: This is a secondary analysis of a 12-week weight-loss trial (Paleolithic diet ± exercise) in 29 individuals with type 2 diabetes. Before and after the intervention, plasma glucagon and amino acids were measured in the fasting state and during 180 min after a protein-rich mixed meal. Hepatic insulin sensitivity was measured using the hyperinsulinemic-euglycemic clamp with [6,6-2H2]glucose as a tracer.

Results: The postprandial increase of plasma glucagon was associated with the postprandial increase of alanine and several other amino acids but not glutamine. In the fasted state and after the meal, glucagon levels were negatively correlated with hepatic insulin sensitivity (rS = −0.51/r = −0.58, respectively; both P < 0.05). Improved hepatic insulin sensitivity with weight loss was correlated with decreased postprandial glucagon response (r = −0.78; P < 0.001).

Conclusions: Several amino acids, notably alanine, but not glutamine could be key signals to the alpha cell to increase glucagon secretion. Amino acids may be part of a feedback mechanism as glucagon increases endogenous glucose production and ureagenesis in the liver. Moreover, postprandial glucagon secretion seems to be tightly related to hepatic insulin sensitivity.

Place, publisher, year, edition, pages
Bioscientifica, 2021
Keywords
Amino acids, Glucagon, Hepatic insulin sensitivity, Mixed meal, Type 2 diabetes
National Category
Endocrinology and Diabetes
Identifiers
urn:nbn:se:umu:diva-188157 (URN)10.1530/EC-21-0171 (DOI)000704561100017 ()2-s2.0-85115733491 (Scopus ID)
Available from: 2021-10-07 Created: 2021-10-07 Last updated: 2023-09-05Bibliographically approved
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Identifiers
ORCID iD: ORCID iD iconorcid.org/0000-0001-9016-1139

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