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Type 2 diabetes affects 7000 young people in England and Wales, analysis shows




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Type 2 diabetes: 5000 patients to test feasibility of “remission service”




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Rammya Mathew: Liquid diets offer promise, but we still need upstream solutions




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Diabetes: precision approach will improve outcomes, says research director




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Dentists could help detect diabetes and cardiovascular disease during oral health checks




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Public health leaders slam Boris Johnson over “sin tax” review plan




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Quality of dietary fat and genetic risk of type 2 diabetes: individual participant data meta-analysis




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Obesity: raising price of sugary snacks may be more effective than soft drink tax




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Diabetes technology: specialists are blocking access for some patients, say experts




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Obesity: medical leaders call for end to “stigmatising” language




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Partha Kar: What will come after the covid-19 crisis?




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30 low-key acquisitions who could pay off big

Fans and analysts spend the entire offseason speculating where the top free agents could go, but sometimes an under-the-radar pickup can end up making a world of difference. As positional competitions begin to heat up at Spring Training camps this month, MLB.com's beat writers were asked to identify one potentially overlooked acquisition for each of the 30 clubs. Here's who they came up with.




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Bell lays out vision on first day of workouts

Wednesday marked the first time that manager David Bell got to address Reds players as a group when he spoke to pitchers and catchers ahead of their first workout of Spring Training. Bell put a lot of thought into what he wanted to tell them.




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Disco embraces fresh start after tough end to '18

Reds starting pitcher Anthony DeSclafani hated how his 2018 season ended and didn't need any motivation to make improvements over the winter.




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Reasons for optimism for each MLB club

On this opening week of Spring Training, all 30 Major League teams have one thing in common: optimism. Here's an optimism cheat sheet for each of them.




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Reds' Top 30 Prospects list

Who do the Reds have in the pipeline? Get scouting reports, video, stats, projected ETAs and more for Cincy's Top 30 Prospects on MLB Pipeline's Prospect Watch.




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Bell facing tough decisions for OF alignment

Reds manager David Bell has great corner outfield depth, but he doesn't have a regular center fielder. Determining who will get to play where and sorting out the log jam should be a challenge for Bell in his first season as a skipper in the big leagues.




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Commissioner excited for first OD in Cincy

Major League Baseball Commissioner Rob Manfred has never been to an Opening Day in Cincinnati. Manfred is excited to experience one for himself, now that he has the honor of being the grand marshal of the 100th Findlay Market Opening Day Parade on March 28.




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Why can’t vehicle registration be renewed online?

THE EDITOR, Madam: I arrived at the Constant Spring tax office at 6:05 a.m. on Monday, May 4 to renew my vehicle registration. At that hour, there were already 30 persons ahead of me. Persons related horror stories of spending up to five hours in...




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Letter of the Day | Discrimination and stigma hurt

THE EDITOR, Madam: The devastating news of Jodian Fearon’s death has resulted in public outrage and concern. The controversy and seemingly negligent actions of the hospitals involved have left many Jamaicans anxious about our health system and...




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An educator’s distress

THE EDITOR, Madam: I am an educator at the secondary level. I teach at a school that is located in the western part of Jamaica. I am writing this letter with a high level of distress. The Ministry of Education is asking for too much at this point...




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Re-registration process for persons with disabilities cumbersome

THE EDITOR, Madam: THE JAMAICA Council for Persons with Disabilities (JCPD) – an agency of the Ministry of Labour...




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Stop mismanaging our country

THE EDITOR, Madam: TO THE Jamaican Government: there are no trade laws that say you have to buy poison – foreign chicken, beef, produce and other agricultural staples are poisonous. They are chock-full of hormones, antibiotics, fillers, excess...




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Pandemic demands proper nutrition, exercise

THE EDITOR, Madam: On Wednesday at 8:30 a.m., while watching TVJ, I saw Get Moving home workout series. Very good, TVJ and the Ministry of Health, for bringing this workout programme into our homes. Minister Tufton was a participant; he truly...




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Letter of the Day | Tourism won’t be ‘business as usual’

THE EDITOR, Madam: With most things grinding to a halt worldwide, this pandemic has proven to be as much of an economic crisis as it is a health one. Many sectors have changed their day-to-day operations, with some allowing for greater flexibility...




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This week’s shutterbugs




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United against coronavirus through art - Government of India calls artists to participate in a unique art competition

The COVID-19 pandemic around the world has taken the world by storm, touching the lives of every human being on Earth. The global nature of the crisis has united us as human beings and tragedy and deaths in any country by COVID-19 worry us all....




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This week’s shutterbugs




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A walk down St Catherine’s history

Parish Histories of Jamaica Project, a publication by the JN Foundation in collaboration with the Department of History and Archaeology at The University of the West Indies, Mona, was launched recently. Jenny Jemmott of Department of History and...




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Curating the history of a people

Redlining a Holocaust is a rigorously researched oeuvre that establishes Dòwòti Désir as one of the most important figures in contemporary African thought. Redlining is an imaginative and monumental undertaking, a literary, visual, and oratorical...




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This week’s Shutterbugs




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Mitochondrial Proton Leak Regulated by Cyclophilin D Elevates Insulin Secretion in Islets at Nonstimulatory Glucose Levels

Fasting hyperinsulinemia precedes the development of type 2 diabetes. However, it is unclear whether fasting insulin hypersecretion is a primary driver of insulin resistance or a consequence of the progressive increase in fasting glycemia induced by insulin resistance in the prediabetic state. Herein, we have discovered a mechanism that specifically regulates non–glucose-stimulated insulin secretion (NGSIS) in pancreatic islets that is activated by nonesterified free fatty acids, the major fuel used by β-cells during fasting. We show that the mitochondrial permeability transition pore regulator cyclophilin D (CypD) promotes NGSIS, but not glucose-stimulated insulin secretion, by increasing mitochondrial proton leak. Islets from prediabetic obese mice show significantly higher CypD-dependent proton leak and NGSIS compared with lean mice. Proton leak–mediated NGSIS is conserved in human islets and is stimulated by exposure to nonesterified free fatty acids at concentrations observed in obese subjects. Mechanistically, proton leak activates islet NGSIS independently of mitochondrial ATP synthesis but ultimately requires closure of the KATP channel. In summary, we have described a novel nonesterified free fatty acid–stimulated pathway that selectively drives pancreatic islet NGSIS, which may be therapeutically exploited as an alternative way to halt fasting hyperinsulinemia and the progression of type 2 diabetes.




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The Novel Adipokine Gremlin 1 Antagonizes Insulin Action and Is Increased in Type 2 Diabetes and NAFLD/NASH

The BMP2/4 antagonist and novel adipokine Gremlin 1 is highly expressed in human adipose cells and increased in hypertrophic obesity. As a secreted antagonist, it inhibits the effect of BMP2/4 on adipose precursor cell commitment/differentiation. We examined mRNA levels of Gremlin 1 in key target tissues for insulin and also measured tissue and serum levels in several carefully phenotyped human cohorts. Gremlin 1 expression was high in adipose tissue, higher in visceral than in subcutaneous tissue, increased in obesity, and further increased in type 2 diabetes (T2D). A similar high expression was seen in liver biopsies, but expression was considerably lower in skeletal muscles. Serum levels were increased in obesity but most prominently in T2D. Transcriptional activation in both adipose tissue and liver as well as serum levels were strongly associated with markers of insulin resistance in vivo (euglycemic clamps and HOMA of insulin resistance), and the presence of nonalcoholic fatty liver disease (NAFLD) and nonalcoholic steatohepatitis (NASH). We also found Gremlin 1 to antagonize insulin signaling and action in human primary adipocytes, skeletal muscle, and liver cells. Thus, Gremlin 1 is a novel secreted insulin antagonist and biomarker as well as a potential therapeutic target in obesity and its complications T2D and NAFLD/NASH.




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Lipokine 5-PAHSA Is Regulated by Adipose Triglyceride Lipase and Primes Adipocytes for De Novo Lipogenesis in Mice

Branched esters of palmitic acid and hydroxystearic acid (PAHSA) are anti-inflammatory and antidiabetic lipokines that connect glucose and lipid metabolism. We aimed to characterize involvement of the 5-PAHSA regioisomer in the adaptive metabolic response of white adipose tissue (WAT) to cold exposure (CE) in mice, exploring the cross talk between glucose utilization and lipid metabolism. CE promoted local production of 5- and 9-PAHSAs in WAT. Metabolic labeling of de novo lipogenesis (DNL) using 2H2O revealed that 5-PAHSA potentiated the effects of CE and stimulated triacylglycerol (TAG)/fatty acid (FA) cycling in WAT through impacting lipogenesis and lipolysis. Adipocyte lipolytic products were altered by 5-PAHSA through selective FA re-esterification. The impaired lipolysis in global adipose triglyceride lipase (ATGL) knockout mice reduced free PAHSA levels and uncovered a metabolite reservoir of TAG-bound PAHSAs (TAG estolides) in WAT. Utilization of 13C isotope tracers and dynamic metabolomics documented that 5-PAHSA primes adipocytes for glucose metabolism in a different way from insulin, promoting DNL and impeding TAG synthesis. In summary, our data reveal new cellular and physiological mechanisms underlying the beneficial effects of 5-PAHSA and its relation to insulin action in adipocytes and independently confirm a PAHSA metabolite reservoir linked to ATGL-mediated lipolysis.




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Perivascular Adipose Tissue Controls Insulin-Stimulated Perfusion, Mitochondrial Protein Expression, and Glucose Uptake in Muscle Through Adipomuscular Arterioles

Insulin-mediated microvascular recruitment (IMVR) regulates delivery of insulin and glucose to insulin-sensitive tissues. We have previously proposed that perivascular adipose tissue (PVAT) controls vascular function through outside-to-inside communication and through vessel-to-vessel, or "vasocrine," signaling. However, direct experimental evidence supporting a role of local PVAT in regulating IMVR and insulin sensitivity in vivo is lacking. Here, we studied muscles with and without PVAT in mice using combined contrast-enhanced ultrasonography and intravital microscopy to measure IMVR and gracilis artery diameter at baseline and during the hyperinsulinemic-euglycemic clamp. We show, using microsurgical removal of PVAT from the muscle microcirculation, that local PVAT depots regulate insulin-stimulated muscle perfusion and glucose uptake in vivo. We discovered direct microvascular connections between PVAT and the distal muscle microcirculation, or adipomuscular arterioles, the removal of which abolished IMVR. Local removal of intramuscular PVAT altered protein clusters in the connected muscle, including upregulation of a cluster featuring Hsp90ab1 and Hsp70 and downregulation of a cluster of mitochondrial protein components of complexes III, IV, and V. These data highlight the importance of PVAT in vascular and metabolic physiology and are likely relevant for obesity and diabetes.




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A Single Bout of One-Legged Exercise to Local Exhaustion Decreases Insulin Action in Nonexercised Muscle Leading to Decreased Whole-Body Insulin Action

A single bout of exercise enhances insulin action in the exercised muscle. However, not all human studies find that this translates into increased whole-body insulin action, suggesting that insulin action in rested muscle or other organs may be decreased by exercise. To investigate this, eight healthy men underwent a euglycemic-hyperinsulinemic clamp on 2 separate days: one day with prior one-legged knee-extensor exercise to local exhaustion (~2.5 h) and another day without exercise. Whole-body glucose disposal was ~18% lower on the exercise day as compared with the resting day due to decreased (~37%) insulin-stimulated glucose uptake in the nonexercised muscle. Insulin signaling at the level of Akt2 was impaired in the nonexercised muscle on the exercise day, suggesting that decreased insulin action in nonexercised muscle may reduce GLUT4 translocation in response to insulin. Thus, the effect of a single bout of exercise on whole-body insulin action depends on the balance between local effects increasing and systemic effects decreasing insulin action. Physiologically, this mechanism may serve to direct glucose into the muscles in need of glycogen replenishment. For insulin-treated patients, this complex relationship may explain the difficulties in predicting the adequate insulin dose for maintaining glucose homeostasis following physical activity.




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Bariatric Surgery Rapidly Decreases Cardiac Dietary Fatty Acid Partitioning and Hepatic Insulin Resistance Through Increased Intra-abdominal Adipose Tissue Storage and Reduced Spillover in Type 2 Diabetes

Reduced storage of dietary fatty acids (DFAs) in abdominal adipose tissues with enhanced cardiac partitioning has been shown in subjects with type 2 diabetes (T2D) and prediabetes. We measured DFA metabolism and organ partitioning using positron emission tomography with oral and intravenous long-chain fatty acid and glucose tracers during a standard liquid meal in 12 obese subjects with T2D before and 8–12 days after bariatric surgery (sleeve gastrectomy or sleeve gastrectomy and biliopancreatic diversion with duodenal switch). Bariatric surgery reduced cardiac DFA uptake from a median (standard uptake value [SUV]) 1.75 (interquartile range 1.39–2.57) before to 1.09 (1.04–1.53) after surgery (P = 0.01) and systemic DFA spillover from 56.7 mmol before to 24.7 mmol over 6 h after meal intake after surgery (P = 0.01), with a significant increase in intra-abdominal adipose tissue DFA uptake from 0.15 (0.04–0.31] before to 0.49 (0.20–0.59) SUV after surgery (P = 0.008). Hepatic insulin resistance was significantly reduced in close association with increased DFA storage in intra-abdominal adipose tissues (r = –0.79, P = 0.05) and reduced DFA spillover (r = 0.76, P = 0.01). We conclude that bariatric surgery in subjects with T2D rapidly reduces cardiac DFA partitioning and hepatic insulin resistance at least in part through increased intra-abdominal DFA storage and reduced spillover.




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PI3K{delta} as a Novel Therapeutic Target in Pathological Angiogenesis

Diabetic retinopathy is the most common microvascular complication of diabetes, and in the advanced diabetic retinopathy appear vitreal fibrovascular membranes that consist of a variety of cells, including vascular endothelial cells (ECs). New therapeutic approaches for this diabetic complication are urgently needed. Here, we report that in cultured human retinal microvascular ECs, high glucose induced expression of p110, which was also expressed in ECs of fibrovascular membranes from patients with diabetes. This catalytic subunit of a receptor-regulated PI3K isoform is known to be highly enriched in leukocytes. Using genetic and pharmacological approaches, we show that p110 activity in cultured ECs controls Akt activation, cell proliferation, migration, and tube formation induced by vascular endothelial growth factor, basic fibroblast growth factor, and epidermal growth factor. Using a mouse model of oxygen-induced retinopathy, p110 inactivation was found to attenuate pathological retinal angiogenesis. p110 inhibitors have been approved for use in human B-cell malignancies. Our data suggest that antagonizing p110 constitutes a previously unappreciated therapeutic opportunity for diabetic retinopathy.




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Acyl-ghrelin Is Permissive for the Normal Counterregulatory Response to Insulin-Induced Hypoglycemia

Insulin-induced hypoglycemia leads to far-ranging negative consequences in patients with diabetes. Components of the counterregulatory response (CRR) system that help minimize and reverse hypoglycemia and coordination between those components are well studied but not yet fully characterized. Here, we tested the hypothesis that acyl-ghrelin, a hormone that defends against hypoglycemia in a preclinical starvation model, is permissive for the normal CRR to insulin-induced hypoglycemia. Ghrelin knockout (KO) mice and wild-type (WT) littermates underwent an insulin bolus-induced hypoglycemia test and a low-dose hyperinsulinemic-hypoglycemic clamp procedure. Clamps also were performed in ghrelin-KO mice and C57BL/6N mice administered the growth hormone secretagogue receptor agonist HM01 or vehicle. Results show that hypoglycemia, as induced by an insulin bolus, was more pronounced and prolonged in ghrelin-KO mice, supporting previous studies suggesting increased insulin sensitivity upon ghrelin deletion. Furthermore, during hyperinsulinemic-hypoglycemic clamps, ghrelin-KO mice required a 10-fold higher glucose infusion rate (GIR) and exhibited less robust corticosterone and growth hormone responses. Conversely, HM01 administration, which reduced the GIR required by ghrelin-KO mice during the clamps, increased plasma corticosterone and growth hormone. Thus, our data suggest that endogenously produced acyl-ghrelin not only influences insulin sensitivity but also is permissive for the normal CRR to insulin-induced hypoglycemia.




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Fossil Fuels Expert Roundtable: Managing Disputes and Arbitrations Involving the Extractive Sector in Africa

Invitation Only Research Event

30 September 2014 - 5:00pm to 6:30pm

Chatham House, London

Event participants

Paula Hodges QC, Partner; Head, Global Arbitration Practice, Herbert Smith Freehills
Stéphane Brabant, Partner; Chairman, Africa Practice Group, Herbert Smith Freehills

Disputes between international companies and national governments commonly arise in the extractive industry where high expectations from producer countries often run alongside emotive issues of ‘ownership’ and ‘exploitation’. In 2013, Chatham House published the report Conflict and Coexistence in the Extractives Industries, examining the rising occurrence of long-running and expensive company-government disputes. Continuing the conversation, the speakers will share their personal insights regarding doing business in Africa's oil and gas sector and preparing for crisis situations. They will outline why they believe the effective management of any crisis is critical to achieving an early settlement and why arbitration is the best formal mechanism for resolving disputes in Africa. They will also discuss what the preconditions of success are, and how companies must adjust to new commercial and political realities when engaging with national companies. 

Attendance at this event is by invitation only.

Owen Grafham

Manager, Energy, Environment and Resources Programme
+44 (0)20 7957 5708




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Addressing Resource Conflicts: Working Towards More Effective Resolution of Natural Resource Disputes

Invitation Only Research Event

26 June 2014 - 9:00am to 5:00pm

Chatham House, London

Disputes over resources are a persistent challenge to international peace and security. Natural resources (such as oil, natural gas, minerals, timber and water) are a major source of national income for many countries and, alongside land, are essential to the livelihoods of many millions of people. There is a growing recognition among researchers and decision-makers that in many fragile states disputes over these resources have fed into, and underpinned, violent conflict and instability. 

Although international engagement in national resource disputes is not always desirable or feasible, where it is necessary and possible to support, supplement (or even substitute) national dispute resolution processes it is important to think through the parameters of such action: Who gets involved? With what financial resources? When does an intervention begin? How do they act? 

This one-day roundtable will bring together around 30 experts from policy, academia and business to discuss these questions and more.

The event will be held under the Chatham House Rule. Attendance is by invitation only.

Event attributes

Chatham House Rule

Owen Grafham

Manager, Energy, Environment and Resources Programme
+44 (0)20 7957 5708




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Legal Aquisition of CITES Timber: Lessons from the Congo Basin

Invitation Only Research Event

26 February 2015 - 10:30am to 27 February 2015 - 4:30pm

Chatham House, London

This event will focus on the trade in Pericopsis elata (Afrormosia/Assamela) harvested in West and Central Africa, and will be co-chaired by Emmanuel Heuse, FLEGT facilitator in the Democratic Republic of Congo.

This workshop is supported by the Climate and Land Use Alliance, the UK Department of International Development and the European Union Action to Fight Environmental Crime.

Attendance at this event is by invitation only.

Adelaide Glover

Digital Coordinator, Energy, Environment and Resources Programme




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The Marikana Killings and Labour Dispute Resolution in South Africa: Implications of an Inquiry

Research Event

4 August 2015 - 4:00pm to 5:00pm

Chatham House, London

Event participants

Toby Fisher, Barrister, Landmark Chambers; Representative of the South African Human Rights Commission, Marikana Commission of Inquiry
Gary White, Director of Operations, Ineqe Group; Expert Witness on Policing, Marikana Commission of Inquiry
Chair: Muzong Kodi, Associate Fellow, Africa Programme

The Marikana Commission of inquiry was appointed by South Africa’s President Jacob Zuma following more than 40 deaths (with many others left injured) after police opened fire on striking miners at Marikana in August 2012.

The massacre was reported as the worst use of lethal force by the South African Police Service since 1994, and brought issues of labour dispute resolution, public-order policing and accountability into stark relief.

Speakers will discuss the Commission's recently-published report and its potential impact on industrial stakeholders, as well as the wider consequences for South Africa.

Department/project

Christopher Vandome

Research Fellow, Africa Programme
+44 (0) 20 7314 3669




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The Resource Curse Revisited

4 August 2015

A new paper finds that while natural resources may provide low-income countries with a significant development opportunity, the prevailing extractives-led growth agenda is in urgent need of re-evaluation.

Professor Paul Stevens

Distinguished Fellow, Energy, Environment and Resources Programme

Glada Lahn

Senior Research Fellow, Energy, Environment and Resources Programme

Jaakko Kooroshy, Former Research Fellow, Energy, Environment and Resources Department, Chatham House (2011–14)

20150804ResourceCurse2.jpg

Hoping to make a little money from Sudan's ocean of black gold, a woman sells tea to roughnecks at an oil rig near Bentiu, Sudan. Photo by Getty Images.

Summary

  • This paper challenges the view that the ‘resource curse’ – for which so many academics found evidence in previous decades – has now been laid to rest.
  • During the commodities boom of the past decade, a number of influential policy and corporate institutions have encouraged poor countries to capitalize on below-ground resources for economic growth and development. The key assumption is that improved management of the extractives sector will enable it to spearhead positive national development and avoid resource curse effects such as declining global competitiveness in the rest of the economy and a widening wealth gap. This assumption continues to influence governance advice and country investment choices.
  • The extractives-led growth agenda promoted by donors and international advisers in multilateral banks, consultancies and some development agencies has tended to reinforce domestic, government and investor pressures to pursue a ‘fast-track’ approach to extractives projects. This appears logical, given the obvious benefits of foreign-investment inflows and export revenues for countries suffering from poverty, lack of infrastructure and high levels of indebtedness.
  • However, there is an urgent need to re-evaluate whether the policy advice stemming from this agenda can serve as an antidote to the negative effects identified in the resource-curse literature. First, there is often a mismatch between governance advice given and the capacity of countries to follow it. Second, the global context has changed: exporters are suffering as a result of the current downturn in commodity prices, while reliance on the sale of high-carbon fuels is challenged by the global shift to lower-carbon technologies and energy efficiency.
  • Extractive revenues should not be viewed as income to be consumed, but as representing a reshuffling of the national portfolio of assets. Converting extractive resources below ground into cash above ground raises key questions about how this cash can be deployed to create productive assets for the future which do not rely on depletable resources.
  • Diversification of the economy away from the resource sector over an appropriate timeframe remains a key priority. In many cases, this will require slower development of projects to allow time for institutional capacity in government and the private sector to develop.
  • More economic and governance capacity needs to be in place before investment begins in a project, to enable investment and eventual revenues to generate real benefits to the rest of the economy, as well as appropriate, sustainable diversification.




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This is the D-backs prospect to watch in camp

The countdown to pitchers and catchers reporting is down to single digits for all 30 MLB clubs, but as exciting as it is to see the return of Major League stars, it's also a time to dream about the next wave of baseball talent.




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Inbox: Is D-backs' closer Holland or Bradley?

With Greg Holland now signed, will he be the closer or is that still going to be Archie Bradley? Beat reporter Steve Gilbert answers this question and more from fans as Spring Training approaches.




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30 low-key acquisitions who could pay off big

Fans and analysts spend the entire offseason speculating where the top free agents could go, but sometimes an under-the-radar pickup can end up making a world of difference. As positional competitions begin to heat up at Spring Training camps this month, MLB.com's beat writers were asked to identify one potentially overlooked acquisition for each of the 30 clubs. Here's who they came up with.




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Kelly already knows his way around ST facility

Yes, catcher Carson Kelly is new to the D-backs this spring, but this wasn't the first time he's gotten to see what the inside of Salt River Fields looks like.




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Greinke discusses commitment to D-backs

Despite a stiff neck, which he says came on a recent airplane flight, D-backs ace Zack Greinke said Saturday that he feels much better physically than he did last year when he reported to Spring Training. Here are five takeaways from Greinke's Saturday session with reporters.




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D-backs' Top 30 prospects list

Who do the D-backs have in the pipeline? Get scouting reports, video, stats, projected ETAs and more for Arizona's Top 30 Prospects on MLBPipeline.com's Prospect Watch.