Autophagy delivers damaged organelles and protein aggregates to lysosomes for degradation during nutrient deprivation and cellular stress. Here, we examined the importance of autophagy and lysosomal homeostasis in β-cells under the stresses induced by hypoxia and islet transplantation.
Inflammation has been linked to the pathophysiology of diabetic kidney disease in adults. Metabolic and hemodynamic abnormalities are thought to activate the phagocyte system and lead to proinflammatory cytokine release, which are associated with CKD progression. We hypothesized that inflammation, measured via select urine cytokines, is associated with progression of albuminuria in youth with type 2 diabetes (T2D).
Type 2 diabetes (T2DM) is rising in children, and nephropathy, hypertension and albuminuria are important comorbidities, as they are risk factors for future end-stage renal disease and mortality. However, the burden of these conditions in pediatric T2DM is unknown. We conducted a systematic review and meta-analysis to determine the prevalence of hypertension and albuminuria in pediatric T2DM.
Sodium glucose cotransporter-2 (SGLT2) inhibition reduces the risk of cardiorenal complications in people with diabetes, possibly by altering energy substrate pathways. It has been hypothesized that SGLT2 inhibitors improve mitochondrial efficiency and may induce a shift towards increased lipid utilization as an energy substrate. In this exploratory, posthoc analysis, we investigated the effects of SGLT2 inhibition on plasma lipid and tricarboxylic acid (TCA) cycle metabolites in patients with type 1 diabetes (T1D).
In type 1 diabetes, dysfunctional β-cells may play a role in the initiation of autoimmunity and β-cell destruction is required for progression to the disease state. To date, there are no approved drugs that offer robust β-cell protection, and our understanding of the processes that control β-cell survival remain incomplete. High-throughput screens conducted in our laboratory showed that carbamazepine, an FDA-approved Na+ channel inhibitor, protects mouse β-cells from multiple stresses, and follow-up studies in NOD mice demonstrated a protection from type 1 diabetes.
Human embryonic stem cell-derived β-like cells (hESCs) serve as a promising option for the future treatment of type 1 diabetes. The ability to manipulate insulin expression in hESCs-derived β cells in a reversible and minimally invasive manner holds potential to improve their functional maturity and expand their utility for basic research. The light-activated CRISPR effector (LACE) system combines guide RNA specificity with transcriptional activators fused to blue light-sensing proteins. This technique makes it possible to modulate endogenous gene expression in a rapid, specific, reversible and light-inducible manner using LED array.
The majority (80%) of medical management for diabetes takes place in primary care. In Ontario, 8.8% of the population does not have a primary care provider (PCP), which can result in delays accessing guideline-recommended diabetes care.
People with diabetes who experience housing instability and homelessness have more severe diabetes-related complications than their housing-stable peers. We sought to explore the perspectives of Canadian health care and social service providers who care for this population regarding the common barriers to diabetes management experienced by their homeless patients.
Adverse cardiovascular outcomes can be prevented through healthy behaviours promoted by self-management education support (SMES) programs. Factors that modify reception of SMES programs remain unexplored. We aimed to examine reception of a SMES program, and how perceptions were influenced by the mode of delivery and by coreceipt of copayment elimination.
Diabetes registries can identify epidemiologic trends, care gaps, inform health policy and are associated with better processes and outcomes of care. As part of the FORGE AHEAD, a participatory research program partnering with First Nations (FN) communities in Canada, local community data gatherers (CDGs) were hired and trained to populate the FN Diabetes Surveillance System (FNDSS) web-based diabetes registry/surveillance tool.
We examined trends in incidence and location of care for youth with type 1 diabetes (T1D) in the province of Nova Scotia (NS).
Quality improvement (QI) programs rarely consider how their intervention can be sustained long term. A survey of authors of randomized trials of diabetes QI interventions included in an ongoing systematic review found that 78% of trials reported improved quality of care, but 40% of these trials were not sustained after study completion. This study further explores if, how and why the effective diabetes interventions were sustained, spread or scaled.
Prior analyses of data from real-world use of the FreeStyle LibreTM (Abbott) flash glucose monitoring system have associated frequency of scanning with greater time in range, lower hypoglycemia, mean glucose and glucose variability. Our objective is to assess outcomes in patients using flash glucose monitoring in Canada, including more recently available data. Anonymized data collected in Canada through uploads from FreeStyle Libre™ flash glucose readers were analyzed through February 2020. To understand the relationship between time in range with scanning frequency, individuals were divided into 10 equal-size groups based on scanning frequency.
Adolescents with type 1 diabetes (T1D) have worsening glycemic control as they transition to adult care. Few longitudinal studies have assessed the mitigating effect of transition interventions. This study evaluated the effect of a T1D adolescent transition program on clinical outcomes.
Housing instability results in numerous barriers to effective diabetes self-management, contributing to excessive morbidity and mortality. Programs targeting these groups have refined strategies to engage this population. We sought to characterize these strategies and identify transferable aspects that could help others to better support these patients.
As a diabetes educator, understanding the client’s baseline knowledge of their food intake is important in helping clients to better understand how they may improve their eating habits. In Ottawa, being a multicultural city, understanding clients’ food intake can be challenging, but with smartphones becoming widely available in Canada and worldwide, there is an opportunity to use the smartphone as a means of education.
Around 80% of people living with diabetes have their diabetes managed in a primary care setting. Collaboration among the client, diabetes educator (DE) and primary care provider (PCP) is the key. Providing diabetes support and education can be overwhelming for providers in a primary care setting. The availability of multiple AHA and requirements for follow up after initiation alone can be a challenge but, most importantly, the prevention of polypharmacy, improvement in taking medications accurately and following dietary changes is a great challenge for new immigrants.
Barriers to prioritizing exercise within the glycemic treatment algorithm for type 2 diabetes mellitus (T2DM) exist. We report on year 3 of an iterative QI process, STAND, to operationalize “exercise as medicine” in a diabetes management clinic located in southwestern Ontario. Year 3 featured the introduction of group visits; expansion of our prescription beyond resistance exercise (RE) to include aerobic (AT) and sedentary behaviour (SB); and use of wearable technology.
Clinical practice guidelines recommend ≥150 minutes/week of moderate-to-vigorous-intensity physical activity (MVPA) in adults with type 2 diabetes. However, self-reported physical activity data suggest that most adults with type 2 diabetes are insufficiently active. Our aim was to evaluate the associations between objectively measured physical activity, sedentary behaviour and cardiometabolic health in adults with type 2 diabetes in a representative sample of the Canadian population.
Recent evidence suggests that short and poor sleep quality, along with poor diet and lack of physical activity (PA), is associated with poor glycemic control among adults living with diabetes, increasing risks of complications. The study’s objective was to document sleep, diet and PA according to diabetes presence and type.
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