Is insulin resistance in mice lacking neuronal nitric oxide synthase related to an alpha-adrenergic mechanism?
insulin resistance in nNOS null mice was not related to defective insulin stimulation of skeletal muscle perfusion and substrate delivery or insulin signaling in the skeletal muscle cell, but to a sympathetic alpha-adrenergic mechanism.
The projects identified issues that required change to meet population need. Clinicians were allowed to innovate in an environment working together with commissioners, patients and public health colleagues. Communication and the development of clinical leadership led to the development of an infrastructure to define care pathways and decision points in the patient's journey.