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  • 1. Fall, T
    et al.
    Ärnlöv, Johan
    Dalarna University, School of Education, Health and Social Studies, Medical Science.
    Berne, C
    Ingelsson, E
    The role of obesity-related genetic loci in insulin sensitivity2012In: Diabetic Medicine, ISSN 0742-3071, E-ISSN 1464-5491, Vol. 29, no 7, p. e62-e66Article in journal (Refereed)
    Abstract [en]

    Aims. Despite rapid advancements and many new diabetes susceptibility loci found in the past few years, few genetic variants associated with insulin sensitivity have been described, potentially attributable to the lack of larger cohorts examined with gold standard methods for insulin sensitivity assessment. There is a strong link between obesity and insulin sensitivity, and we hypothesized that known obesity susceptibility loci may act via effects on insulin sensitivity.

    Methods. A cohort of 71-year-old men without diabetes (Uppsala Longitudinal Study of Adult Men) underwent a euglycaemic-hyperinsulinaemic clamp and genotyping for genetic variants representing 32 loci recently reported to be associated with BMI (n = 926). The effect of these loci on the insulin sensitivity index (M/I ratio) was examined using linear regression.. An in silico replication was performed in publically available data for the three top single-nucleotide polymorphisms from the Meta-Analyses of Glucose and Insulin-related traits Consortium analyses of homeostasis model assessment of insulin resistance (n = 37 037).

    Results. Three loci (SH2B1, MTCH2 and NEGR1) were associated with decreased insulin sensitivity at a nominal significance (P ≤ 0.05) after adjustment for BMI, but did not hold for multiple comparison correction. SH2B1 rs7359397 was also associated with homeostasis model assessment of insulin resistance in the Meta-Analyses of Glucose and Insulin-related traits Consortium data set (P = 3.9 × 10(-3) ).

    Conclusions. Our study supports earlier reports of SH2B1 to be of importance in insulin sensitivity and, in addition, suggests potential roles of NEGR1 and MTCH2. 

  • 2.
    Garmo, Anna
    et al.
    Department of Internal Medicine, Falun Hospital, Health Care Dalarna, Falun, Sweden.
    Hörnsten, Åsa
    Department of Nursing, Umeå University, Umeå, Sweden.
    Leksell, Janeth
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing.
    “The pump was a saviour for me”: Patients’ experiences of insulin pump therapy2013In: Diabetic Medicine, ISSN 0742-3071, E-ISSN 1464-5491, Vol. 30, no 6, p. 717-723Article in journal (Refereed)
    Abstract [en]

    The present study formed part of a larger study examining the potential long-term effects of glycaemic control and treatment satisfaction in people with type 1 diabetes mellitus who changed from multiple daily insulin injections to insulin pump therapy. Individuals (n=46) who made the transition between May 1999 and February 2004 participated.

    Aim: The aim of the study was to describe experiences of the impact of insulin pump therapy in adults with type 1 diabetes mellitus who were using an insulin pump for >5 years.  

    Method: During spring 2009, a subgroup of 16 individuals were interviewed through a narrative approach on the effects of insulin pump therapy on daily life. The interviews were analysed using content analysis.

    Results: The overarching theme revealed that insulin pump therapy was experienced as both a shackle and a lifeline. Six subthemes emerged: Being subjected to the therapy versus being empowered by it; Dependence versus autonomy; Feeling vulnerable versus feeling strengthened; Perceiving their care as routinized versus perceiving it as providing greater flexibility; Feeling burdened versus relieved; and Being stigmatized versus having a normalized life.

    Conclusions: Users of insulin pump therapy have different views about and experience of having used the technical equipment over years. Both positive and negative views emerged. However, it is difficult to identify any general trends that cover all views and can predict which individuals will be able to manage pump therapy in the best way. Even so, the subthemes and theme that emerged could be used by physicians and diabetes specialist nurses when counselling and planning educational programmes aimed at supporting self- management among people with insulin pump treatment. 

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