Hamilton Health Sciences Corp.

Cardiovascular mortality is particularly high and increasing in patients with chronic kidney disease, with vascular calcification (VC) as a major pathophysiologic feature. VC is a highly regulated biological process similar to bone formation involving osteogenic transdifferentiation of vascular smooth muscle cells (VSMCs). We have previously demonstrated that loss of T-cell death-associated gene 51 (TDAG51) expression leads to an attenuation of medial VC. We now show a significant induction of circulating levels of growth differentiation factor 10 (GDF10) in TDAG51^-/- mice, which was of interest due to its established role as an inhibitor of osteoblast differentiation. The objective of this study was to examine the role of GDF10 in the osteogenic transdifferentiation of VSMCs. Using primary mouse and human VSMCs, as well as ex vivo aortic ring cultures, we demonstrated that treatment with recombinant human (rh) GDF10 mitigated phosphate-mediated hydroxyapatite (HA) mineral deposition. Furthermore, ex vivo aortic rings from GDF10^-/- mice exhibited increased HA deposition compared to C57BL/6J controls. To explain our observations, we identified that rhGDF10 treatment reduced protein expression of runt-related transcription factor 2, a key driver of osteogenic transdifferentiation of VSMCs and VC. In support of these findings, in vivo treatment with rhGDF10 attenuated VD₃-induced VC. Furthermore, we demonstrated an increase in circulating GDF10 in patients with chronic kidney disease with clinically defined severe VC, as assessed by coronary artery calcium score. Thus, our studies identify GDF10 as a novel inhibitor of mineral deposition and as such, may represent a potential novel biomarker and therapeutic target for the detection and management of VC.

In the past decade, diabetes health coaching, also referred to as diabetes coaching, has emerged as a patient-centered intervention to help individuals with type 2 diabetes gain independence with self-management. This study explores the perceived experience of receiving telephone-based diabetes health coaching among adults living with type 2 diabetes.

A qualitative exploration with an interpretive descriptive design was carried out. Participants from the intervention group of a larger randomized controlled trial who had received a telephone-based diabetes coaching intervention throughout 1 year were invited to participate in a telephone interview with open-ended questions.

Twelve participants were interviewed, and four major themes emerged: 1) adapting to ongoing challenges with type 2 diabetes, reflecting how coaching helped individuals integrate diabetes into their daily lives by addressing misconceptions, improving knowledge, encouraging awareness, and easing the transition from oral medication to insulin injections; 2) heightened mindfulness of diabetes-related wellness, capturing the greater attention participants gave to their overall well-being and self-management behaviors; 3) behavior change guided by the participant, highlighting the differences in participants’ motivation, readiness to make changes, and external factors that influenced their ability to make self-management behavior changes; and 4) valuing a supportive relationship, illustrating that most participants felt that the unique coach-client relationship was reliable, holistic, nonjudgmental, and encouraging.

Participants found diabetes coaching to be positive and highlighted the various ways it was able to support their ability to manage diabetes.