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Yoshinori Kanemaru Department of Diabetes, Endocrinology and Nutrition, Graduate School of Medicine, Kyoto University, Kyoto, Japan

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Norio Harada Department of Diabetes, Endocrinology and Nutrition, Graduate School of Medicine, Kyoto University, Kyoto, Japan

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Satoko Shimazu-Kuwahara Department of Diabetes, Endocrinology and Nutrition, Graduate School of Medicine, Kyoto University, Kyoto, Japan
Preemptive Medicine and Lifestyle Related Disease Research Center, Kyoto University Hospital, Kyoto, Japan

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Shunsuke Yamane Department of Diabetes, Endocrinology and Nutrition, Graduate School of Medicine, Kyoto University, Kyoto, Japan

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Eri Ikeguchi Department of Diabetes, Endocrinology and Nutrition, Graduate School of Medicine, Kyoto University, Kyoto, Japan

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Yuki Murata Department of Diabetes, Endocrinology and Nutrition, Graduate School of Medicine, Kyoto University, Kyoto, Japan

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Sakura Kiyobayashi Department of Diabetes, Endocrinology and Nutrition, Graduate School of Medicine, Kyoto University, Kyoto, Japan

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Tomonobu Hatoko Department of Diabetes, Endocrinology and Nutrition, Graduate School of Medicine, Kyoto University, Kyoto, Japan

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Nobuya Inagaki Department of Diabetes, Endocrinology and Nutrition, Graduate School of Medicine, Kyoto University, Kyoto, Japan

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decline of activities of daily living (ADL) in elderly people and is also related to the high prevalence of medical disorders such as diabetes, hyperlipidemia, and hypertension ( Cheng et al . 2013 , Chang et al . 2017 ). It is therefore important for

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M E Cleasby Department of Veterinary Basic Sciences, Diabetes and Obesity Research Program, Faculty of Medicine, Department of Medicine, Faculty of Medicine, Royal Veterinary College, University of London, Royal College Street, London NW1 0TU, UK
Department of Veterinary Basic Sciences, Diabetes and Obesity Research Program, Faculty of Medicine, Department of Medicine, Faculty of Medicine, Royal Veterinary College, University of London, Royal College Street, London NW1 0TU, UK

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Q Lau Department of Veterinary Basic Sciences, Diabetes and Obesity Research Program, Faculty of Medicine, Department of Medicine, Faculty of Medicine, Royal Veterinary College, University of London, Royal College Street, London NW1 0TU, UK

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E Polkinghorne Department of Veterinary Basic Sciences, Diabetes and Obesity Research Program, Faculty of Medicine, Department of Medicine, Faculty of Medicine, Royal Veterinary College, University of London, Royal College Street, London NW1 0TU, UK

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S A Patel Department of Veterinary Basic Sciences, Diabetes and Obesity Research Program, Faculty of Medicine, Department of Medicine, Faculty of Medicine, Royal Veterinary College, University of London, Royal College Street, London NW1 0TU, UK

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S J Leslie Department of Veterinary Basic Sciences, Diabetes and Obesity Research Program, Faculty of Medicine, Department of Medicine, Faculty of Medicine, Royal Veterinary College, University of London, Royal College Street, London NW1 0TU, UK

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N Turner Department of Veterinary Basic Sciences, Diabetes and Obesity Research Program, Faculty of Medicine, Department of Medicine, Faculty of Medicine, Royal Veterinary College, University of London, Royal College Street, London NW1 0TU, UK
Department of Veterinary Basic Sciences, Diabetes and Obesity Research Program, Faculty of Medicine, Department of Medicine, Faculty of Medicine, Royal Veterinary College, University of London, Royal College Street, London NW1 0TU, UK

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G J Cooney Department of Veterinary Basic Sciences, Diabetes and Obesity Research Program, Faculty of Medicine, Department of Medicine, Faculty of Medicine, Royal Veterinary College, University of London, Royal College Street, London NW1 0TU, UK
Department of Veterinary Basic Sciences, Diabetes and Obesity Research Program, Faculty of Medicine, Department of Medicine, Faculty of Medicine, Royal Veterinary College, University of London, Royal College Street, London NW1 0TU, UK

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A Xu Department of Veterinary Basic Sciences, Diabetes and Obesity Research Program, Faculty of Medicine, Department of Medicine, Faculty of Medicine, Royal Veterinary College, University of London, Royal College Street, London NW1 0TU, UK

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E W Kraegen Department of Veterinary Basic Sciences, Diabetes and Obesity Research Program, Faculty of Medicine, Department of Medicine, Faculty of Medicine, Royal Veterinary College, University of London, Royal College Street, London NW1 0TU, UK
Department of Veterinary Basic Sciences, Diabetes and Obesity Research Program, Faculty of Medicine, Department of Medicine, Faculty of Medicine, Royal Veterinary College, University of London, Royal College Street, London NW1 0TU, UK

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Introduction Resistance of skeletal muscle to the action of insulin is an essential pre-requisite for the development of type 2 diabetes and is frequently associated with obesity ( Zimmet et al . 2001 ). This insulin resistance has been

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S Khan Centre for Cardiovascular Science, Queen’s Medical Research Institute, University of Edinburgh, Edinburgh, UK

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D E W Livingstone Centre for Cardiovascular Science, Queen’s Medical Research Institute, University of Edinburgh, Edinburgh, UK
Centre for Discovery Brain Science, University of Edinburgh, Hugh Robson Building, Edinburgh, UK

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A Zielinska College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK

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C L Doig Department of Biosciences, School of Science & Technology, Nottingham Trent University, Nottingham, UK

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D F Cobice Centre for Cardiovascular Science, Queen’s Medical Research Institute, University of Edinburgh, Edinburgh, UK

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C L Esteves Centre for Cardiovascular Science, Queen’s Medical Research Institute, University of Edinburgh, Edinburgh, UK

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J T Y Man Centre for Cardiovascular Science, Queen’s Medical Research Institute, University of Edinburgh, Edinburgh, UK

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N Z M Homer Mass Spectrometry Core Laboratory, Edinburgh Clinical Research Facility, Queen’s Medical Research Institute, University of Edinburgh, Edinburgh, UK

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J R Seckl Centre for Cardiovascular Science, Queen’s Medical Research Institute, University of Edinburgh, Edinburgh, UK

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C L MacKay SIRCAMS, School of Chemistry, University of Edinburgh, Joseph Black Building, King's Buildings, Edinburgh, UK

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S P Webster Centre for Cardiovascular Science, Queen’s Medical Research Institute, University of Edinburgh, Edinburgh, UK

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G G Lavery Department of Biosciences, School of Science & Technology, Nottingham Trent University, Nottingham, UK

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K E Chapman Centre for Cardiovascular Science, Queen’s Medical Research Institute, University of Edinburgh, Edinburgh, UK

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B R Walker Centre for Cardiovascular Science, Queen’s Medical Research Institute, University of Edinburgh, Edinburgh, UK
Clinical & Translational Research Institute, Newcastle University, International Centre for Life, Central Parkway, Newcastle upon Tyne, UK

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R Andrew Centre for Cardiovascular Science, Queen’s Medical Research Institute, University of Edinburgh, Edinburgh, UK
Mass Spectrometry Core Laboratory, Edinburgh Clinical Research Facility, Queen’s Medical Research Institute, University of Edinburgh, Edinburgh, UK

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effects including type 2 diabetes, hypertension, visceral obesity, myopathy, mood disturbances and cognitive deficits, and 11βHSD1 has therefore emerged as a drug target to reduce active glucocorticoid levels ( Hughes et al. 2008 ) in a tissue

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Graham W Aberdeen Departments of Obstetrics, Gynecology, Reproductive Sciences and Physiology, University of Maryland School of Medicine, Baltimore, Maryland, USA

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Jeffery S Babischkin Departments of Obstetrics, Gynecology, Reproductive Sciences and Physiology, University of Maryland School of Medicine, Baltimore, Maryland, USA

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Gerald J Pepe Department of Physiological Sciences, Eastern Virginia Medical School, Norfolk, Virginia, USA

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Eugene D Albrecht Departments of Obstetrics, Gynecology, Reproductive Sciences and Physiology, University of Maryland School of Medicine, Baltimore, Maryland, USA

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Introduction There is a prevalent increase in the incidence of type 2 diabetes mellitus (T2DM), particularly in the younger generation, in the USA ( Cowie et al. 2018 , Lin et al. 2020 ). However, little is known about the cause of this

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Michael Merkhassine Loftus Laboratory, Department of Clinical Sciences, Cornell University, College of Veterinary Medicine, Ithaca, New York, USA
VCA Colonial Animal Hospital, Ithaca, New York, USA

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Reilly W Coch Loftus Laboratory, Department of Clinical Sciences, Cornell University, College of Veterinary Medicine, Ithaca, New York, USA
Weill Cornell College of Medicine, New York, New York, USA

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Carol E Frederick Loftus Laboratory, Department of Clinical Sciences, Cornell University, College of Veterinary Medicine, Ithaca, New York, USA

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Lucinda L Bennett Loftus Laboratory, Department of Clinical Sciences, Cornell University, College of Veterinary Medicine, Ithaca, New York, USA

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Seth A Peng Loftus Laboratory, Department of Clinical Sciences, Cornell University, College of Veterinary Medicine, Ithaca, New York, USA
Fate Therapeutics, San Diego, California, USA

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Benjamin Morse Loftus Laboratory, Department of Clinical Sciences, Cornell University, College of Veterinary Medicine, Ithaca, New York, USA

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Bethany P Cummings Center for Alimentary and Metabolic Science, Department of Surgery, School of Medicine, University of California, Davis, Sacramento, California, USA
Department of Molecular Biosciences, School of Veterinary Medicine, University of California, Davis, Davis, California, USA

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John P Loftus Loftus Laboratory, Department of Clinical Sciences, Cornell University, College of Veterinary Medicine, Ithaca, New York, USA

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as an antidote for hypoglycemia caused by exogenous insulin administration ( Datte et al. 2016 , Harris et al. 2020 ). Elevated glucagon levels are seen in virtually all forms of diabetes mellitus (DM), α-cell hyperplasia, and, most dramatically

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Eun Young Lee
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Shuji Kaneko Department of Medical Physiology, Department of Molecular Pharmacology, Department of Pharmacology and Toxicology, Division of Molecular and Metabolic Medicine, Drug Development Center, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba 260-8670, Japan

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Promsuk Jutabha Department of Medical Physiology, Department of Molecular Pharmacology, Department of Pharmacology and Toxicology, Division of Molecular and Metabolic Medicine, Drug Development Center, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba 260-8670, Japan

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Xilin Zhang
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Susumu Seino Department of Medical Physiology, Department of Molecular Pharmacology, Department of Pharmacology and Toxicology, Division of Molecular and Metabolic Medicine, Drug Development Center, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba 260-8670, Japan

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Takahito Jomori Department of Medical Physiology, Department of Molecular Pharmacology, Department of Pharmacology and Toxicology, Division of Molecular and Metabolic Medicine, Drug Development Center, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba 260-8670, Japan

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Naohiko Anzai Department of Medical Physiology, Department of Molecular Pharmacology, Department of Pharmacology and Toxicology, Division of Molecular and Metabolic Medicine, Drug Development Center, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba 260-8670, Japan

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Takashi Miki
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type 2 diabetes mellitus (T2DM; Cho et al . 2014 ). GLP1-targeted anti-diabetic agents comprise GLP1 mimetics and inhibitors of dipeptidyl peptidase 4 that enhance GLP1 action by inhibiting the rapid inactivation of the hormone endogenously secreted

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Nami Kim Department of Anatomy, Department of Medicine, Integrated Metabolomics Research Group, Department of Life Science, Korea University College of Medicine, Seoul 136-701, South Korea
Department of Anatomy, Department of Medicine, Integrated Metabolomics Research Group, Department of Life Science, Korea University College of Medicine, Seoul 136-701, South Korea

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Jung Ok Lee Department of Anatomy, Department of Medicine, Integrated Metabolomics Research Group, Department of Life Science, Korea University College of Medicine, Seoul 136-701, South Korea

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Hye Jeong Lee Department of Anatomy, Department of Medicine, Integrated Metabolomics Research Group, Department of Life Science, Korea University College of Medicine, Seoul 136-701, South Korea

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Yong Woo Lee Department of Anatomy, Department of Medicine, Integrated Metabolomics Research Group, Department of Life Science, Korea University College of Medicine, Seoul 136-701, South Korea

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Hyung Ip Kim Department of Anatomy, Department of Medicine, Integrated Metabolomics Research Group, Department of Life Science, Korea University College of Medicine, Seoul 136-701, South Korea

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Su Jin Kim Department of Anatomy, Department of Medicine, Integrated Metabolomics Research Group, Department of Life Science, Korea University College of Medicine, Seoul 136-701, South Korea

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Sun Hwa Park Department of Anatomy, Department of Medicine, Integrated Metabolomics Research Group, Department of Life Science, Korea University College of Medicine, Seoul 136-701, South Korea

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Chul Su Lee Department of Anatomy, Department of Medicine, Integrated Metabolomics Research Group, Department of Life Science, Korea University College of Medicine, Seoul 136-701, South Korea

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Sun Woo Ryoo Department of Anatomy, Department of Medicine, Integrated Metabolomics Research Group, Department of Life Science, Korea University College of Medicine, Seoul 136-701, South Korea

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Geum-Sook Hwang Department of Anatomy, Department of Medicine, Integrated Metabolomics Research Group, Department of Life Science, Korea University College of Medicine, Seoul 136-701, South Korea
Department of Anatomy, Department of Medicine, Integrated Metabolomics Research Group, Department of Life Science, Korea University College of Medicine, Seoul 136-701, South Korea

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Hyeon Soo Kim Department of Anatomy, Department of Medicine, Integrated Metabolomics Research Group, Department of Life Science, Korea University College of Medicine, Seoul 136-701, South Korea

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and diabetes. Contraction of the skeletal muscles stimulates GLUT4 translocation in an insulin-independent manner ( Lund et al . 1995 ). Because glucose uptake during muscle contraction occurs in the absence of insulin, it is suggested that insulin

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Maayan Vatarescu The Department of Clinical Biochemistry and Pharmacology, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
The National Institute of Biotechnology in the Negev (NIBN), Ben-Gurion University, Beer-Sheva, Israel

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Sapir Bechor The Department of Clinical Biochemistry and Pharmacology, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
The National Institute of Biotechnology in the Negev (NIBN), Ben-Gurion University, Beer-Sheva, Israel

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Yulia Haim The Department of Clinical Biochemistry and Pharmacology, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
The National Institute of Biotechnology in the Negev (NIBN), Ben-Gurion University, Beer-Sheva, Israel

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Tal Pecht The Department of Clinical Biochemistry and Pharmacology, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
The National Institute of Biotechnology in the Negev (NIBN), Ben-Gurion University, Beer-Sheva, Israel

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Tanya Tarnovscki The Department of Clinical Biochemistry and Pharmacology, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel

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Noa Slutsky The Department of Clinical Biochemistry and Pharmacology, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel

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Ori Nov The Department of Clinical Biochemistry and Pharmacology, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel

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Hagit Shapiro The Department of Clinical Biochemistry and Pharmacology, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel

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Avishai Shemesh The Shraga Segal Department of Microbiology, Immunology and Genetics, Ben-Gurion University, Beer-Sheva, Israel

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Angel Porgador The Shraga Segal Department of Microbiology, Immunology and Genetics, Ben-Gurion University, Beer-Sheva, Israel

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Nava Bashan The Department of Clinical Biochemistry and Pharmacology, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel

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Assaf Rudich The Department of Clinical Biochemistry and Pharmacology, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
The National Institute of Biotechnology in the Negev (NIBN), Ben-Gurion University, Beer-Sheva, Israel

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mechanisms ( Cho 2014 ). Clearly, resolution of obesity itself is not required for this metabolic improvement, which in some patients even results in remission of preoperative overt type 2 diabetes. Moreover, when inducing weight loss in HFF mice, dysglycemia

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Sian J S Simpson Department of Diabetes, School of Life Course Sciences, Faculty of Life Science and Medicine, King’s College London, London, UK

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Lorna I F Smith Department of Diabetes, School of Life Course Sciences, Faculty of Life Science and Medicine, King’s College London, London, UK

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Peter M Jones Department of Diabetes, School of Life Course Sciences, Faculty of Life Science and Medicine, King’s College London, London, UK

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James E Bowe Department of Diabetes, School of Life Course Sciences, Faculty of Life Science and Medicine, King’s College London, London, UK

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functional β-cell mass and enhanced insulin secretory responses ( Baeyens et al . 2016 ). Failure of the β-cell to adapt to the maternal metabolic load can lead to maternal glucose intolerance and, eventually, to overt gestational diabetes ( Zhang et al

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I J Bujalska
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L L Gathercole
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J W Tomlinson
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C Darimont Division of Medical Sciences, Nestle Research Center, Pfizer Global Research and Development, The Medical School, Institute of Biomedical Research, University of Birmingham, Edgbaston, Birmingham B15 2TT, UK

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J Ermolieff Division of Medical Sciences, Nestle Research Center, Pfizer Global Research and Development, The Medical School, Institute of Biomedical Research, University of Birmingham, Edgbaston, Birmingham B15 2TT, UK

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A N Fanjul Division of Medical Sciences, Nestle Research Center, Pfizer Global Research and Development, The Medical School, Institute of Biomedical Research, University of Birmingham, Edgbaston, Birmingham B15 2TT, UK

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P A Rejto Division of Medical Sciences, Nestle Research Center, Pfizer Global Research and Development, The Medical School, Institute of Biomedical Research, University of Birmingham, Edgbaston, Birmingham B15 2TT, UK

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P M Stewart
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Introduction Glucocorticoid excess (Cushing's syndrome) causes visceral obesity, insulin resistance, diabetes mellitus, dyslipidaemia, hypertension and premature vascular mortality; as such it represents an excellent paradigm for patients with the

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