DiabetesPub Date : 2024-10-23DOI: 10.2337/db24-0119
Hossam Montaser, Sonja Leppänen, Eliisa Vähäkangas, Nils Bäck, Alicia Grace, Solja Eurola, Hazem Ibrahim, Väinö Lithovius, Samuel B. Stephens, Tom Barsby, Diego Balboa, Jonna Saarimäki-Vire, Timo Otonkoski
{"title":"IER3IP1 mutations cause neonatal diabetes due to impaired proinsulin trafficking","authors":"Hossam Montaser, Sonja Leppänen, Eliisa Vähäkangas, Nils Bäck, Alicia Grace, Solja Eurola, Hazem Ibrahim, Väinö Lithovius, Samuel B. Stephens, Tom Barsby, Diego Balboa, Jonna Saarimäki-Vire, Timo Otonkoski","doi":"10.2337/db24-0119","DOIUrl":"https://doi.org/10.2337/db24-0119","url":null,"abstract":"Immediate early response 3 interacting-protein 1 (IER3IP1) is an endoplasmic reticulum resident protein, highly expressed in pancreatic cells and the developing brain cortex. Homozygous mutations in IER3IP1 have been found in individuals with microcephaly and neonatal diabetes, yet the underlying mechanism causing beta cell failure remains unclear. Here, we utilized differentiation of genome edited-stem cells into pancreatic islet cells to elucidate the molecular basis of IER3IP1 neonatal diabetes. Using CRISPR-Cas9, we generated two distinct IER3IP1-mutant human embryonic stem cell lines: a homozygous knock-in model of a patient mutation (IER3IP1V21G), and a knockout model (IER3IP1-/-). While these mutant stem cell lines differentiated normally into definitive endoderm and pancreatic progenitors, we observed that IER3IP1-KO stem cell derived-islets (SC-islets) presented a significant decrease in beta cell numbers and elevated ER stress. Retention Using Selective Hooks (RUSH) assay revealed three-fold reduction in ER-to-Golgi trafficking of proinsulin in IER3IP1 mutant beta cells. Additionally, IER3IP1 mutant SC-islets implanted into immunocompromised mice displayed defective human insulin secretion, indicating the deleterious impact of IER3IP1 mutations on beta cell function. Our study provides valuable insights into the role of IER3IP1 in human beta cell biology and establishes a useful model to investigate ER-to-Golgi trafficking defects within beta cells.","PeriodicalId":11376,"journal":{"name":"Diabetes","volume":"3 1","pages":""},"PeriodicalIF":7.7,"publicationDate":"2024-10-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142488380","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
DiabetesPub Date : 2024-10-17DOI: 10.2337/db24-0262
Xing Xing, Siqi Xu, Yining Wang, Ziyuan Shen, Simin Wen, Yan Zhang, Guangfeng Ruan, Guoqi Cai
{"title":"Evaluating the causal effect of circulating proteome on the glycemic traits: Evidence from Mendelian randomization","authors":"Xing Xing, Siqi Xu, Yining Wang, Ziyuan Shen, Simin Wen, Yan Zhang, Guangfeng Ruan, Guoqi Cai","doi":"10.2337/db24-0262","DOIUrl":"https://doi.org/10.2337/db24-0262","url":null,"abstract":"Exploring the mechanisms underlying abnormal glycemic traits is important for deciphering type 2 diabetes and characterizing novel drug targets. This study aimed to decipher the causal associations of circulating proteins with fasting glucose (FG), 2-h glucose after an oral glucose challenge (2hGlu), fasting insulin (FI), and glycated hemoglobin (HbA1c) using large-scale proteome-wide Mendelian randomization (MR) analyses. Genetic data on plasma proteomes were obtained from ten proteomic genome-wide association studies (GWAS). Both cis- and cis+trans-protein quantitative trait loci (pQTLs) MR analyses were conducted. Bayesian colocalization, Steiger filtering analysis, assessment of protein-altering variants, and mapping expression quantitative trait loci to protein quantitative trait loci were performed to investigate the reliability of the MR findings. Protein-protein interaction, pathway enrichment analysis, and evaluation of drug targets were performed. Thirty-three proteins were identified with causal effects on FG, FI, or HbA1c but not 2hGlu in the cis-pQTLs analysis, and 93 proteins had causal effects on glycemic traits in the cis+trans-pQTLs analysis. Most proteins were either considered druggable or drug targets. In conclusion, many novel circulating protein biomarkers were identified to be causally associated with glycemic traits. These biomarkers enhance the understanding of molecular etiology and provide insights into the screening, monitoring, and treatment of diabetes.","PeriodicalId":11376,"journal":{"name":"Diabetes","volume":"11 1","pages":""},"PeriodicalIF":7.7,"publicationDate":"2024-10-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142448207","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
DiabetesPub Date : 2024-10-17DOI: 10.2337/db24-0451
Daniel B. Rosoff, Josephin Wagner, Jeesun Jung, Pal Pacher, Constantinos Christodoulides, George Davey Smith, David Ray, Falk W. Lohoff
{"title":"Multi-Omics Mendelian Randomization Study Investigating the Impact of PCSK9 and HMGCR Inhibition on Type 2 Diabetes Across Five Populations","authors":"Daniel B. Rosoff, Josephin Wagner, Jeesun Jung, Pal Pacher, Constantinos Christodoulides, George Davey Smith, David Ray, Falk W. Lohoff","doi":"10.2337/db24-0451","DOIUrl":"https://doi.org/10.2337/db24-0451","url":null,"abstract":"The prevalence of type 2 diabetes (T2D) varies among populations of different race/ethnicity. The influence of genetically-proxied lipoprotein cholesterol (LDL-C) lowering through proprotein convertase subtilisin/kexin 9 (PCSK9) and HMG-CoA Reductase (HMGCR) on T2D in non-European populations is not well established.A drug-target Mendelian randomization (MR) approach was used to assess the effects of PCSK9 and HMGCR inhibition on T2D risk and glycemic traits in five populations: East Asian (EAS), South Asian (SAS), Hispanic (HISP), African (AFR), and European (EUR). Our study did not find relationships between genetically-proxied PCSK9 inhibition and T2D risk in EAS (odds ratio [OR]=1.02, [0.95-1.10]), SAS (OR=1.05, [0.97-1.14]), HISP (OR=1.03, [0.94-1.12]), or EUR (OR=1.04, [0.98-1.11]). However, in AFR, primary analyses suggested an increased risk of T2D due to PCSK9 inhibition (OR=1.53, [1.058-2.22], P-value=0.024), although this was not supported in sensitivity analyses. Genetically-proxied HMGCR inhibition was associated with an increased risk of T2D in SAS (OR=1.44, [1.30-1.61], P-value=9.8×10−12), EAS (OR=1.36, [1.22-1.51], P-value=4.2×10−10), and EUR (OR=1.52, [1.21-1.90], P-value=3.3×10−4). These results were consistent across various sensitivity analyses, including colocalization, indicating a robust finding. The findings indicate a neutral impact of long-term PCSK9 inhibition on T2D and glycemic markers in most non-European populations, with a potential increased risk in AFR cohorts. By contrast, HMGCR inhibition increased the risk of T2D in South Asian, East Asian, and European cohorts, underscoring the need to consider diversity in genetic research on metabolic diseases.","PeriodicalId":11376,"journal":{"name":"Diabetes","volume":"232 1","pages":""},"PeriodicalIF":7.7,"publicationDate":"2024-10-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142448158","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
DiabetesPub Date : 2024-10-17DOI: 10.2337/db24-0493
Daniel Schwarz, Maxime Le Marois, Volker Sturm, Andreas S. Peters, Rémi Longuespée, Dominic Helm, Martin Schneider, Bastian Eichmüller, Asa S. Hidmark, Manuel Fischer, Zoltan Kender, Constantin Schwab, Ingrid Hausser, Joachim Weis, Susanna Dihlmann, Dittmar Böckler, Martin Bendszus, Sabine Heiland, Stephan Herzig, Peter P. Nawroth, Julia Szendroedi, Thomas Fleming
{"title":"Exploring Structural and Molecular Features of Sciatic Nerve Lesions in Diabetic Neuropathy: Unveiling Pathogenic Pathways and Targets","authors":"Daniel Schwarz, Maxime Le Marois, Volker Sturm, Andreas S. Peters, Rémi Longuespée, Dominic Helm, Martin Schneider, Bastian Eichmüller, Asa S. Hidmark, Manuel Fischer, Zoltan Kender, Constantin Schwab, Ingrid Hausser, Joachim Weis, Susanna Dihlmann, Dittmar Böckler, Martin Bendszus, Sabine Heiland, Stephan Herzig, Peter P. Nawroth, Julia Szendroedi, Thomas Fleming","doi":"10.2337/db24-0493","DOIUrl":"https://doi.org/10.2337/db24-0493","url":null,"abstract":"Lesioned fascicles (LF) in the sciatic nerves of individuals with diabetic neuropathy (DN) correlate with clinical symptom severity. This study aimed to characterize the structural and molecular composition of these lesions to better understand DN pathogenesis. Sciatic nerves from amputees with and without type 2 diabetes (T2D) were examined using ex vivo magnetic resonance neurography, in vitro imaging, and proteomic analysis. Lesions were only found in T2D donors and exhibited significant structural abnormalities, including axonal degeneration, demyelination, and impaired blood nerve barrier (BNB). While non-lesioned fascicles from T2D donors showed activation of neuroprotective pathways, lesioned fascicles lacked this response and instead displayed increased complement activation via the classical pathway. The detection of liver-derived acute-phase proteins suggests that BNB disruption facilitates harmful inter-organ communication between the liver and nerves. These findings reveal key molecular mechanisms contributing to DN and highlight potential targets for therapeutic intervention.","PeriodicalId":11376,"journal":{"name":"Diabetes","volume":"232 1","pages":""},"PeriodicalIF":7.7,"publicationDate":"2024-10-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142448106","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
DiabetesPub Date : 2024-10-17DOI: 10.2337/dbi24-0011
Jonathan N. Flak
{"title":"Functionally Separate Populations of Ventromedial Hypothalamic Neurons in Obesity and Diabetes","authors":"Jonathan N. Flak","doi":"10.2337/dbi24-0011","DOIUrl":"https://doi.org/10.2337/dbi24-0011","url":null,"abstract":"The Ventromedial hypothalamic nucleus (VMN) maintains healthy metabolic function through several important roles. Collectively, homeostasis is maintained via intermingled cells within the VMN that raise blood glucose, lower blood glucose, and stimulate energy expenditure when needed. This perspective discusses the defining factors for the VMN cell types that govern distinct functions induced by the VMN, particularly in relation to energy balance and blood glucose levels. Special attention is given to distinct features of VMN cells responsible for these processes. Finally, these topics are reviewed in the context of research funded by the Pathway to Stop Diabetes initiative, highlighting key findings and current unresolved questions for future investigations.","PeriodicalId":11376,"journal":{"name":"Diabetes","volume":"31 1","pages":""},"PeriodicalIF":7.7,"publicationDate":"2024-10-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142448202","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
DiabetesPub Date : 2024-10-17DOI: 10.2337/db24-0166
Giuseppina T. Russo, Antonio Nicolucci, Giuseppe Lucisano, Maria Chiara Rossi, Antonio Ceriello, Francesco Prattichizzo, Valeria Manicardi, Alberto Rocca, Paolo Di Bartolo, Salvatore De Cosmo, Graziano Di Cianni, Riccardo Candido
{"title":"When does metabolic memory start? Insights from the AMD Annals Initiative on stringent HbA1c targets.","authors":"Giuseppina T. Russo, Antonio Nicolucci, Giuseppe Lucisano, Maria Chiara Rossi, Antonio Ceriello, Francesco Prattichizzo, Valeria Manicardi, Alberto Rocca, Paolo Di Bartolo, Salvatore De Cosmo, Graziano Di Cianni, Riccardo Candido","doi":"10.2337/db24-0166","DOIUrl":"https://doi.org/10.2337/db24-0166","url":null,"abstract":"Early, intensive glycemic control in T2D patients is associated with long-term benefits on cardiovascular disease (CVD) development. Evidence on benefits of achieving HbA1c targets close to normal values is scant. Subjects with newly-diagnosed T2D, without CVD at baseline, were identified in an Italian clinical registry (N=251,339). We adopted three definitions of early exposure periods (0–1, 0–2 and 0–3 years). Mean HbA1c was categorized into HbA1c < 5.7%, 5.7-6.4%, 6.5-7.0%, 7.1-8.0%, and >8.0%. The outcome was the incidence of major cardiovascular events. After a mean follow-up of 4.6±2.9 years, at multivariate Cox regression analysis, compared with mean HbA1c <5.7% during the first year after diagnosis, the increase in the risk of CVD was 24%, 42%, 49% and 56% for patients with HbA1c of 5.7%-6.4%, 6.5%-7.0%, 7.1%-8.0%, and >8.0%, respectively. The same trend was documented in all exposure periods. In conclusion, our data support that an early achievement of stringent targets of HbA1c <5.7% is worthy for CVD prevention.","PeriodicalId":11376,"journal":{"name":"Diabetes","volume":"2021 1","pages":""},"PeriodicalIF":7.7,"publicationDate":"2024-10-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142448161","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
DiabetesPub Date : 2024-10-17DOI: 10.2337/db24-0652
Jingyi Lu, Jiaying Ni, Hang Su, Xingxing He, Wei Lu, Wei Zhu, Yufei Wang, Xiaojing Ma, Yuqian Bao, Jian Zhou
{"title":"1-hour postload glucose is a more sensitive marker of impaired β-cell function than 2-hour postload glucose","authors":"Jingyi Lu, Jiaying Ni, Hang Su, Xingxing He, Wei Lu, Wei Zhu, Yufei Wang, Xiaojing Ma, Yuqian Bao, Jian Zhou","doi":"10.2337/db24-0652","DOIUrl":"https://doi.org/10.2337/db24-0652","url":null,"abstract":"There is evidence that 1-h plasma glucose (PG) during the 75-g oral glucose tolerance test (OGTT) is superior to 2-h PG in predicting diabetes. We aimed to investigate the characteristics of insulin sensitivity and β-cell function behind this observation. After age, sex and BMI matching, 496 subjects selected from 3965 non-diabetic individuals at high risk of type 2 diabetes in a tertiary medical center were categorized into four groups in a 1:1:1:1 ratio based on OGTT results: 1) 1 h < 8.6 mmol/L and 2 h < 7.8 mmol/L (normal glucose tolerance [NGT] /1h-normal); 2) 1 h ≥ 8.6 mmol/L and 2 h < 7.8 mmol/L (NGT/1h-high); 3) 1 h < 8.6 mmol/L and 2 h ≥ 7.8 mmol/L (impaired glucose tolerance [IGT]/1h-normal); and 4) 1 h ≥ 8.6 mmol/L and 2 h ≥ 7.8 mmol/L (IGT/1h-high). Compared with subjects with IGT/1h-normal, those with NGT/1h-high exhibited similar extent of insulin resistance but lower early-phase insulin secretion. Additionally, participants with NGT/1h-high had lower disposition index at both 0-30 min and 0-120 min than those with IGT/1h-normal. The fitted regression line relating PG to log-transformed disposition index (0-30 min and 0-120 min) was significantly steeper for 1-h than 2-h PG. In conclusion, 1-h PG seemed to be more sensitive to the deterioration in β-cell function than 2-h PG. The use of 1-h PG may identify individuals at high risk of type 2 diabetes at an earlier stage","PeriodicalId":11376,"journal":{"name":"Diabetes","volume":"24 1","pages":""},"PeriodicalIF":7.7,"publicationDate":"2024-10-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142448201","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
DiabetesPub Date : 2024-10-14DOI: 10.2337/dbi24-0002
Bryan Portillo, Eunsang Hwang, Jason Ajwani, Kyle Grose, Linh Lieu, Briana Wallace, Anita Kabahizi, Joel K. Elmquist, Kevin W. Williams
{"title":"NMDA Receptors in POMC Neurons Connect Exercise With Insulin Sensitivity","authors":"Bryan Portillo, Eunsang Hwang, Jason Ajwani, Kyle Grose, Linh Lieu, Briana Wallace, Anita Kabahizi, Joel K. Elmquist, Kevin W. Williams","doi":"10.2337/dbi24-0002","DOIUrl":"https://doi.org/10.2337/dbi24-0002","url":null,"abstract":"Increased arcuate proopiomelanocortin (POMC) neuron activity improves glucose metabolism and reduces appetite, facilitating weight loss. We recently showed that arcuate POMC neurons are activated by exercise. However, the role of excitatory glutamatergic input in these neurons and the metabolic outcomes of exercise remains undefined. To investigate this, we developed a mouse model with NMDA receptors (NMDARs) selectively deleted from POMC neurons of adult mice. We performed metabolic assessments, including the monitoring of body weight, body composition analysis, and glucometabolic tolerance tests. We also examined the metabolic outcomes of these mice in response to exercise, including changes in arcuate POMC neuronal activity and insulin sensitivity. Loss of NMDARs in POMC neurons failed to alter body weight or body composition. Notably, however, we did observe a marked impairment in glucose tolerance and insulin sensitivity. Additionally, exercise resulted in activation of arcuate POMC neurons and a sustained improvement in insulin sensitivity, an effect that was abrogated in mice deficient for NMDARs in POMC neurons when compared with their respective sedentary controls. This underscores an important link among exercise, hypothalamic neuron function, and metabolic health. Moreover, this highlights an underappreciated role of hypothalamic POMC neurons in mediating beneficial effects of exercise on glucose metabolism.","PeriodicalId":11376,"journal":{"name":"Diabetes","volume":"32 1","pages":""},"PeriodicalIF":7.7,"publicationDate":"2024-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142440216","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
DiabetesPub Date : 2024-10-14DOI: 10.2337/dbi24-0004
Kristy L. Townsend
{"title":"One Nervous System: Critical Links Between Central and Peripheral Nervous System Health and Implications for Obesity and Diabetes","authors":"Kristy L. Townsend","doi":"10.2337/dbi24-0004","DOIUrl":"https://doi.org/10.2337/dbi24-0004","url":null,"abstract":"There are key differences between the central nervous system (CNS) (brain and spinal cord) and peripheral nervous system (PNS), such as glial cell types, whether there is protection by the blood-brain barrier, modes of synaptic connections, etc. However, there are many more similarities between these two arms of the nervous system, including neuronal structure and function, neuroimmune and neurovascular interactions, and, perhaps most essentially, the balance between neural plasticity (including processes like neuron survival, neurite outgrowth, synapse formation, gliogenesis) and neurodegeneration (neuronal death, peripheral neuropathies like axonopathy and demyelination). This article brings together current research evidence on shared mechanisms of nervous system health and disease between the CNS and PNS, particularly with metabolic diseases like obesity and diabetes. This evidence supports the claim that the two arms of the nervous system are critically linked and that previously understudied conditions of central neurodegeneration or peripheral neurodegeneration may actually be manifesting across the entire nervous system at the same time, through shared genetic and cellular mechanisms. This topic has been critically underexplored due to the research silos between studies of the brain and studies of peripheral nerves and an overemphasis on the brain in neuroscience as a field of study. There are likely shared and linked mechanisms for how neurons stay healthy versus undergo damage and disease among this one nervous system in the body—providing new opportunities for understanding neurological disease etiology and future development of neuroprotective therapeutics.","PeriodicalId":11376,"journal":{"name":"Diabetes","volume":"103 1","pages":""},"PeriodicalIF":7.7,"publicationDate":"2024-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142440218","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
DiabetesPub Date : 2024-10-14DOI: 10.2337/dbi24-0001
Zaman Mirzadeh, Chelsea Faber
{"title":"Brain Defense of Glycemia in Health and Diabetes","authors":"Zaman Mirzadeh, Chelsea Faber","doi":"10.2337/dbi24-0001","DOIUrl":"https://doi.org/10.2337/dbi24-0001","url":null,"abstract":"The brain coordinates the homeostatic defense of multiple metabolic variables, including blood glucose levels, in the context of ever-changing external and internal environments. The biologically defended level of glycemia (BDLG) is the net result of brain modulation of insulin-dependent mechanisms in cooperation with the islet, and insulin-independent mechanisms through direct innervation and neuroendocrine control of glucose effector tissues. In this article, we highlight evidence from animal and human studies to develop a framework for the brain’s core homeostatic functions—sensory/afferent, integration/processing, and motor/efferent—that contribute to the normal BDLG in health and its elevation in diabetes.","PeriodicalId":11376,"journal":{"name":"Diabetes","volume":"9 1","pages":""},"PeriodicalIF":7.7,"publicationDate":"2024-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142440217","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}