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Upper Gastrointestinal Motility And Glycaemic Control In Diabetes Mellitus
Funder
National Health and Medical Research Council
Funding Amount
$543,301.00
Summary
The application of novel techniques to evaluate gastrointestinal motor function has established that the rate at which the stomach empties is abnormally slow in ~50% of people who have insulin-dependent (type 1) or non-insulin dependent (type 2) diabetes. Delayed stomach emptying, which was thought to be an infrequent complication of diabetes, may contribute to a number of problems including symptoms such as nausea and bloating, and poor control of blood glucose concentrations. The blood glucose ....The application of novel techniques to evaluate gastrointestinal motor function has established that the rate at which the stomach empties is abnormally slow in ~50% of people who have insulin-dependent (type 1) or non-insulin dependent (type 2) diabetes. Delayed stomach emptying, which was thought to be an infrequent complication of diabetes, may contribute to a number of problems including symptoms such as nausea and bloating, and poor control of blood glucose concentrations. The blood glucose level itself also has a reversible effect on both stomach contractions and symptoms; when the blood glucose is abnormally high, the rate at which the stomach empties is slower, and symptoms, such as fullness, are greater. The rate of stomach emptying and the absorption of sugar from the intestine have a major influence on the rise in the blood glucose level after a meal. This is important because in people with diabetes it is desirable to maintain blood glucose levels as close as possible to normal to minimise the risk of complications such as eye and nerve damage. Specific modifications in diet and recently developed drugs which have actions similar to that of the hormone, glucagon-like peptide-1, may improve blood glucose control in type 2 diabetes by slowing the rate of gastric emptying. People with cystic fibrosis frequently develop diabetes which is often difficult to manage; this may result from abnormally rapid gastric emptying and impaired release of hormones. If so, pancreatic enzyme replacement, in the form of tablets, should prove effective. Our group has conducted research in this area for about 24 years and have performed the most comprehensive studies to date resulting in international recognition. The studies proposed in the current application represent a logical development from our previous work and have important implications for the management of diabetes.Read moreRead less
Effects Of Gastric Bypass And Banding For Obesity On Gastrointestinal Function, Body Weight, Glycaemia And Symptoms
Funder
National Health and Medical Research Council
Funding Amount
$444,086.00
Summary
The increasing incidence of obesity poses a significant impact on the health care system. Bariatric surgery not only achieves sustained weight loss but also reverses the associated complications. This proposal aims to examine the mechanisms that mediate weight loss, improvement in blood glucose control and symptoms after bariatric surgery. The results will provide insights into future development of minimally invasive interventions for the management of obesity and diabetes.
A Randomised Controlled Trial Of Normoglycaemia Versus Conventional Glycaemic Control In Intensive Care Unit Patients.
Funder
National Health and Medical Research Council
Funding Amount
$1,773,507.00
Summary
The concentration of sugar in the blood is often increased in patients in intensive care and patients with increased blood sugar levels are more likely to die. A recent study performed in a Belgian intensive care unit found that using high doses of insulin to lower blood sugars levels to normal increased the number of patients who survived. The chance of surviving to leave hospital was increased from 89% to 93%. Whilst the result is very encouraging, Intensive Care Specialists in Australia are u ....The concentration of sugar in the blood is often increased in patients in intensive care and patients with increased blood sugar levels are more likely to die. A recent study performed in a Belgian intensive care unit found that using high doses of insulin to lower blood sugars levels to normal increased the number of patients who survived. The chance of surviving to leave hospital was increased from 89% to 93%. Whilst the result is very encouraging, Intensive Care Specialists in Australia are unsure if the treatment would work in their patients because of differences in the types of patients found in intensive care units in Australia, and because of other treatment given to the patients in the Belgian study. In particular the doctors in the Belgian unit studied only patients who had had operations and gave large amounts of intravenous sugar to their patients. This is not normally done in Australian Intensive Care Units and the safety of giving high dose insulin to patients not receiving large amounts of intravenous sugar is not known. This is of particular interest as reducing blood glucose to abnormally low levels can cause serious side effects and even result in permanent brain damage. The Australian and New Zealand Intensive Care Society proposes to conduct a new study involving 4,000 patients from intensive care units in Australia and New Zealand and will study all patients regardless of whether or not they have had an operation. These patients will be randomly assigned to receive insulin to control blood sugar levels to normal or to slightly above normal levels as has been tradition in intensive care units around the world. Outcome and serious side effects will be closely monitored. The results will be available within three years of starting the study, and these are likely to influence the treatment of the majority of patients admitted to intensive care units both in Australia and worldwide.Read moreRead less
Gastroduodenal Motility And Glycaemic Control In Diabetes Mellitus
Funder
National Health and Medical Research Council
Funding Amount
$393,750.00
Summary
The recent application of novel techniques to evaluate gastrointestinal motor function has established that the rate which the stomach empties food is abnormally slow in ~50% of people who have insulin-dependent (type 1) or non-insulin dependent (type 2) diabetes. Delayed stomach emptying was thought to be an infrequent complication in diabetes; much less common than damage to the eyes, kidneys or nerves. Abnormal stomach emptying may contribute to a number of problems in diabetes, including sym ....The recent application of novel techniques to evaluate gastrointestinal motor function has established that the rate which the stomach empties food is abnormally slow in ~50% of people who have insulin-dependent (type 1) or non-insulin dependent (type 2) diabetes. Delayed stomach emptying was thought to be an infrequent complication in diabetes; much less common than damage to the eyes, kidneys or nerves. Abnormal stomach emptying may contribute to a number of problems in diabetes, including symptoms such as nausea and bloating, and poor control of blood glucose concentrations. It is now recognised that the blood glucose level itself has a reversible effect on both stomach contractions and symptoms. For example, when the blood glucose is abnormally high (hyperglycaemia), the rate at which the stomach empties food into the intestine is slower and symptoms, such as fullness, are greater. The rate of stomach emptying and the absorption of glucose from the intestine affect the rise in the blood glucose level after a meal; this is an important issue because it is desirable to maintain blood glucose levels within the normal range to minimise the risk of both the development and progression of the complications of diabetes. In many people with diabetes eating a meal results in a substantial fall in blood pressure, which may cause fainting and falls. By slowing gastric emptying the magnitude of the fall in blood pressure is minimised. Our group has been the recipient of ongoing support from the NH and MRC for approximately 18 years to conduct research in this area. As a result we have performed the most comprehensive studies to date and developed new methods to evaluate stomach and intestinal function in people with diabetes, resulting in international recognition. The studies proposed in the current application represent a logical development from our previous work and have important implications for the management of diabetes.Read moreRead less
TELEPHONE COUNSELLING FOR MAINTENANCE OF PHYSICAL ACTIVITY, WEIGHT LOSS And GLYCAEMIC CONTROL IN TYPE 2 DIABETES
Funder
National Health and Medical Research Council
Funding Amount
$1,285,894.00
Summary
Regular exercise, a healthy diet and weight loss are key to managing type 2 diabetes, yet these are major challenges for most people with diabetes. This study will evaluate the impact of a telephone counselling program to assist people with type 2 diabetes to exercise, eat a healthy diet and lose weight, with the goal of helping them to sustain these changes over the long-term. It is expected that these lifestyle changes will also result in improved blood glucose control and quality of life.
Gastric Motility And Blood Glucose Control In Diabetes Mellitus
Funder
National Health and Medical Research Council
Funding Amount
$354,947.00
Summary
The recent application of novel techniques to evaluate gastrointestinal motor function has established that the rate of which the stomach empties food is slow in up to 50% of people who have insulin-dependent (type 1) or non-insulin dependent (type 2) diabetes. Delayed stomach emptying was thought to be an infrequent complication in diabetes; much less common than damage to the eyes, kidneys or nerves. It is now recognised that disordered stomach emptying may contribute to a number of problems i ....The recent application of novel techniques to evaluate gastrointestinal motor function has established that the rate of which the stomach empties food is slow in up to 50% of people who have insulin-dependent (type 1) or non-insulin dependent (type 2) diabetes. Delayed stomach emptying was thought to be an infrequent complication in diabetes; much less common than damage to the eyes, kidneys or nerves. It is now recognised that disordered stomach emptying may contribute to a number of problems in diabetes, e.g. symptoms such as nausea and bloating and poor control of blood glucose concentrations. In some people symptoms are disabling and affect quality of life adversely. The effects of stomach emptying on blood glucose control is likely to be important, as it is desirable to maintain blood glucose levels within the normal range to minimise the risk of both the development and progression of complications of diabetes. In many people with diabetes, particularly older people with type 2 diabetes, there is a fall in blood pressure after a meal which may result in fainting and falls. The magnitude of the fall in blood pressure is determined by the rate at which the stomach empties; faster emptying results in a greater fall in blood pressure. In the past both slow stomach emptying and symptoms were assumed to result from irreversible nerve damage, however it is now recognised that the blood glucose level itself has a reversible effect on both stomach contractions and symptoms. Our group has been the recipient of ongoing support from the NH and MRC for approximately 15 years to conduct research in this area. As a result we have performed the most comprehensive studies to date and developed new methods to evaluate stomach function in people with diabetes, resulting in international recognition. The studies proposed in this current application represent a logical development from our previous work and have important implications for the management of diabetes.Read moreRead less
Upper Gastrointestinal Function And Glycaemic Control In Diabetes Mellitus
Funder
National Health and Medical Research Council
Funding Amount
$780,872.00
Summary
There is now increasing recognition that the stomach and intestines, by regulating the absorption of nutrients into the body and by releasing hormones that enhance insulin secretion, play a central role in the control of blood glucose in diabetes mellitus. We seek to understand the nature and causes of disturbed gut function in diabetes, so that we can optimise dietary and drug strategies to prevent and treat this condition.
Mechanisms Of Hypoglycaemic Damage In Developing Brain- A Protective Role For The Insulin-like Growth Factor System
Funder
National Health and Medical Research Council
Funding Amount
$408,055.00
Summary
The developing brain in the newborn infant or young child is vulnerable to many damaging influences. It is highly dependent on its essential fuel, glucose. Hypoglycemia, or lack of glucose availability, is therefore among the most damaging insults to the young brain, potentially leading to learning difficulties, developmental delay, cerebral palsy or epilepsy. Babies born premature or very small are at risk, as are those exposed to excessive insulin, such as infants of diabetic mothers. Children ....The developing brain in the newborn infant or young child is vulnerable to many damaging influences. It is highly dependent on its essential fuel, glucose. Hypoglycemia, or lack of glucose availability, is therefore among the most damaging insults to the young brain, potentially leading to learning difficulties, developmental delay, cerebral palsy or epilepsy. Babies born premature or very small are at risk, as are those exposed to excessive insulin, such as infants of diabetic mothers. Children with diabetes are also at risk, when their therapy with insulin may at times be excessive, leading to hypoglycaemia and impaired glucose availability for the brain. This proposal is examining at the cellular level the mechanisms involved in loss of brain cells in the face of glucose starvation in these various conditions. We are using several in vitro models where we can grow segments of developing mouse brain or human nerve cells in a dish, compared to studies with mice subjected to low blood glucose (hypoglycemia). After establishing that our laboratory models are representative of the whole animal, we will explore the cellular mechanisms involved in neuronal death following hypoglycaemia, particularly the interaction between the insulin-like growth factor (IGF) and other cell survival genes. We will also examine the possibility that treatment with IGF will reduce the loss of nerves in the brain after an episode of hypoglycemia. This may offer new and effective early treatment for this damaging brain injury in both newborn babies and children with insulin-dependent diabetes.Read moreRead less