Outcomes In Early Diagnosis And Intervention For Gestational Diabetes
Funder
National Health and Medical Research Council
Funding Amount
$162,876.00
Summary
Gestational diabetes mellitus (GDM) is a common complication of pregnancy with significant maternal and fetal consequences. The benefits of screening and treatment for GDM after 24 weeks’ gestation are well known, however there is little evidence for early screening and intervention for women with high risk for GDM. The primary aim of this study is to determine whether early diagnosis and intervention improves pregnancy outcomes in GDM, specifically fetal overgrowth.
In the last decade there has been a substantial increase in the number of overweight and obese individuals. Obesity is now a major public health issue in Australia and, along with its associated disorders of type 2 diabetes and heart disease, incurs significant health care costs. There is a widespread awareness of the problem, but it has proved difficult to bring this obesity epidemic under control, and unless we can understand the underlying causes, the trend seems set to continue. This researc ....In the last decade there has been a substantial increase in the number of overweight and obese individuals. Obesity is now a major public health issue in Australia and, along with its associated disorders of type 2 diabetes and heart disease, incurs significant health care costs. There is a widespread awareness of the problem, but it has proved difficult to bring this obesity epidemic under control, and unless we can understand the underlying causes, the trend seems set to continue. This research proposal seeks to define the mechanisms which lead to the development of obesity. Evidence from a large range of clinical and population-based studies has shown that infants who are exposed to an increased supply of nutrients before birth have an increased risk of being overweight or obese as children and adults. It is not however, fully understood why this occurs. In normal adults, factors released by fat cells play an important role in the maintenance of energy balance, and changes in the levels of these factors in the fat cell or in the circulation can lead to increased weight gain and the development of poor sensitivity of the body's tissues to the actions of hormones, such as insulin. Fat cells develop before birth, and therefore changes in nutrient supply to the fetus have the potential to alter the functional properties of fat cells for life. In this proposal, we will investigate the effect of being exposed to an increased supply of nutrients in fetal life on the properties of fat cells after birth and define how such changes explain the development of obesity in these individuals. Understanding the mechanisms which link the risk of obesity to events before birth will allow clinicians of the future to provide children who are born to overweight, glucose-intolerant or diabetic mothers with a healthy start to life.Read moreRead less
THE CYCLE OF OBESITY: Two Generations Of A Pregnancy Cohort To Investigate Obesity Epigenetics
Funder
National Health and Medical Research Council
Funding Amount
$1,117,795.00
Summary
Obesity has increased 3-5 fold in the last fifty years, overtaking smoking as the greatest killer. In recent history, each generation has experienced greater amounts of obesity and at younger ages. Being exposed in the womb to mother’s obesity transmits the risk to the child, possibly by changing our epigenetic profile and how our DNA code is read. We need to break this vicious cycle. This study is a world first, investigating 2 generations with respect to obesity and epigenetic profiles.
Pregnancy And Neonatal Diabetes Outcomes In Remote Australia (PANDORA) Cohort
Funder
National Health and Medical Research Council
Funding Amount
$2,395,410.00
Summary
The PANDORA study is a longitudinal birth cohort study recruited from a clinical register of Northern Territory women with diabetes in pregnancy (DIP). We will also recruit a comparator group of mothers without DIP and babies. Follow-up of mothers and infants to 3 years post-delivery will be from medical records, questionnaires and clinical assessment. Rates of progression to type 2 diabetes will be assessed among mothers, and growth, feeding patterns and diabetes risk markers among infants.
Xenotransplantation Of Encapsulated Insulin-producing Pig Cells
Funder
National Health and Medical Research Council
Funding Amount
$763,316.00
Summary
The ideal treatment for insulin-dependent diabetes is the replacement of insulin-producing cells. Currently, this is carried out using a whole pancreas or experimentally with cells isolated from the pancreas of donor humans. Despite the success of these procedures, demand for human organs far exceeds supply, thus driving the search for suitable alternatives. Pigs are physiologically similar to humans, and insulin-producing cells can be easily isolated from the fetal pig pancreas as islet-like ce ....The ideal treatment for insulin-dependent diabetes is the replacement of insulin-producing cells. Currently, this is carried out using a whole pancreas or experimentally with cells isolated from the pancreas of donor humans. Despite the success of these procedures, demand for human organs far exceeds supply, thus driving the search for suitable alternatives. Pigs are physiologically similar to humans, and insulin-producing cells can be easily isolated from the fetal pig pancreas as islet-like cell clusters; 8% of the cells in the cluster produce insulin and the remaining cells develop this capability after transplantation. Transplantation requires chronic immunosuppression with drugs which increase the risk of infection and cancer. To many people with diabetes, the side effects will be greater than the potential benefit. Placing cells inside microcapsules made of a biologically inert material may prevent graft rejection without chronic immunosuppression. The Investigators have demonstrated that encapsulated insulin-producing pig cells survive and function when transplanted into diabetic immunodeficient mice, but not when xenografted into immunocompetent mice. It is hypothesised that this is due to an immunological or inflammatory response by the host in response to the shedding of molecules by the encapsulated pig cells. A pre-clinical model to test the efficacy of encapsulated insulin-producing pig cells is the humanized mouse. It is hypothesized that transient administration of anti-rejection drugs will be needed to allow the survival of pig cells xenografted into these mice and normalization of BGL once diabetes has been induced. The aims of this study are: 1. To assess the nature of the host response when encapsulated insulin-producing fetal pig cells are transplanted into diabetic BALB-c mice. 2. To normalize blood glucose levels (BGL) in diabetic humanized mice transplanted with encapsulated insulin-producing fetal pig cells.Read moreRead less
Biochemical Basis Of Islet Beta-cell Compensation And Failure In Normal Pregnancy And Gestational Diabetes Mellitus
Funder
National Health and Medical Research Council
Funding Amount
$480,828.00
Summary
The factors causing the current world-wide crisis of rapidly rising diabetes prevalence remain poorly understood. Of potential major importance, however, is the hypothesis that abnormalities in the maternal metabolic environment, as occur in gestational diabetes (GDM) (diabetes that develops in pregnancy), result in abnormal development of metabolic systems in the baby resulting in higher risk of adult onset diabetes in the babies. Therefore, it is of importance to understand the mechanisms caus ....The factors causing the current world-wide crisis of rapidly rising diabetes prevalence remain poorly understood. Of potential major importance, however, is the hypothesis that abnormalities in the maternal metabolic environment, as occur in gestational diabetes (GDM) (diabetes that develops in pregnancy), result in abnormal development of metabolic systems in the baby resulting in higher risk of adult onset diabetes in the babies. Therefore, it is of importance to understand the mechanisms causing GDM, such that effective measures can be developed to counter this passing on of diabetes risk from mother to baby. It is known that a key factor causing GDM is failure of maternal pancreatic islet beta-cells to compensate for increased demands for insulin production in pregnancy. Poorly understood, however, are the cellular mechanisms of islet beta-cell compensation in normal pregnancy and failure of this compensation in GDM pregnancy. We have recently shown that there is a pathway of fat metabolism (triglyceride- free fatty acid cycle) within the islet beta-cell that has an important role in amplyfing insulin secretion necessary to maintain normal blood glucose and protecting the islets from failure in obese rats. The major focus of this project is to test the hypothesis that this pathway has a key role in the adaptation of pancreatic islets to normal pregnancy and its dysfunction contributes to the causation of GDM. Of great interest from preliminary findings is that a master regulator of glucose and fat metabolism, PGC1alpha, is markedly reduced in islets during normal pregnancy. Studies will also be directed to PGC1alpha's role in islet adaptation to pregnancy and failure in GDM. We expect that successful completion of this project will lead to the development of highly targeted counter measures to prevent GDM and to slow and reverse the current epidemic of diabetes.Read moreRead less