As diabetic retinopathy (DR) can occur even in well-controlled patients with type 2 diabetes (T2D), our study sought to determine whether it might be related to ‘glucose memory’ by evaluating ...patients’ HbA1c over previous years and their skin autofluorescence (SAF).
In 334 patients with T2D and HbA1c levels≤8%, their available values of HbA1c from previous years were collected, and their SAF measured by an advanced glycation end-product (AGE) reader. Binary logistic regression analysis was then used to correlate DR with previously recorded HbA1c levels and to SAF, with adjustment for DR risk factors age, gender, BMI, duration of diabetes, arterial hypertension, diabetic kidney disease (DKD), blood lipid levels and statin treatment.
Our patients were mostly men (58.4%) aged 63±10years, with a duration of diabetes of 13±10years and HbA1c=7.1±0.7%. Of these patients, 84 (25.1%) had DR, which was associated with longer duration of diabetes and greater prevalence of DKD. A total of 605 HbA1c values from previous years were collected for time periods −4±3 months (n=255), −16±4months (n=152), −30±4months (n=93) and −62±26 months (n=105). After adjustment, the association between DR and having an HbA1c higher than the median was significant only for the oldest previous HbA1c values: OR=6.75, 95% CI: 1.90–23.90. Moreover, SAF values were higher in those with DR 2.95±0.67 arbitrary units (AU) vs 2.65±0.65 AU with no DR (P<0.01) and were also associated with the oldest previous HbA1c values (P<0.01).
Our study found that 25.1% of our well-controlled T2D patients had DR, which was related to both their HbA1c levels from 5years prior to study admission and their SAF values, a marker of glucose memory.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UILJ, UL, UM, UPCLJ, UPUK, ZAGLJ, ZRSKP
BackgroundKetoacidosis is a severe metabolic complication mainly reported in diabetic patients. Therapeutic fasting is a millennial worldwide practice, believed to improve a large panel of health ...conditions, but its efficiency and safety profile have not yet been established. We report here a case of euglycemic ketoacidosis in a non-diabetic woman.Case descriptionA 51-year-old woman without a history of excessive alcohol use or medical history, except for a depressive disorder, was admitted in the emergency room for altered general status, deep asthenia, muscular weakness, articular pain, nausea, vomiting, and consciousness disorders. She was practicing during the previous 48 h a therapeutic fasting following a progressive restrictive diet for 4 d. She was diagnosed with ketoacidosis and hospitalized in the intensive care unit. Her laboratory test results indicated pH 7.28, bicarbonate 7 mmol/L, significant ketone bodies, glycemia 8.9 mmol/L without glycosuria, and negative blood alcohol assessment. Glycated hemoglobin was 5.5%, and blood glucose never went above 9 mmol/L. Serum concentrations of free fatty acids were high at 1.13 mmol/L (normal range: 0.13–0.45). Plasma insulin and peptide C were in the normal ranges. Comprehensive plasma and urinary biochemistry panels, including energetic substrates, and chromatography of amino acids and organic acids did not indicate any energetic or metabolic deficiency. The ketoacidosis regressed, and the overall outcome was favorable after intravenous glucose infusion for 48 h, without insulin requirement.ConclusionsThis report is the first case, to our knowledge, of euglycemic ketoacidosis thought to be induced by therapeutic fasting in a non-diabetic patient. Practitioners should be aware of this complication of fasting.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UILJ, UL, UM, UPCLJ, UPUK, ZAGLJ, ZRSKP
AIMS: As diabetic retinopathy (DR) can occur even in well-controlled patients with type 2 diabetes (T2D), our study sought to determine whether it might be related to 'glucose memory' by evaluating ...patients' HbA1c over previous years and their skin autofluorescence (SAF). METHODS: In 334 patients with T2D and HbA1c levels≤8%, their available values of HbA1c from previous years were collected, and their SAF measured by an advanced glycation end-product (AGE) reader. Binary logistic regression analysis was then used to correlate DR with previously recorded HbA1c levels and to SAF, with adjustment for DR risk factors age, gender, BMI, duration of diabetes, arterial hypertension, diabetic kidney disease (DKD), blood lipid levels and statin treatment. RESULTS: Our patients were mostly men (58.4%) aged 63±10years, with a duration of diabetes of 13±10years and HbA1c=7.1±0.7%. Of these patients, 84 (25.1%) had DR, which was associated with longer duration of diabetes and greater prevalence of DKD. A total of 605 HbA1c values from previous years were collected for time periods -4±3 months (n=255), -16±4months (n=152), -30±4months (n=93) and -62±26 months (n=105). After adjustment, the association between DR and having an HbA1c higher than the median was significant only for the oldest previous HbA1c values: OR=6.75, 95% CI: 1.90-23.90. Moreover, SAF values were higher in those with DR 2.95±0.67 arbitrary units (AU) vs 2.65±0.65 AU with no DR (P<0.01) and were also associated with the oldest previous HbA1c values (P<0.01). CONCLUSION: Our study found that 25.1% of our well-controlled T2D patients had DR, which was related to both their HbA1c levels from 5years prior to study admission and their SAF values, a marker of glucose memory.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UILJ, UL, UM, UPCLJ, UPUK, ZAGLJ, ZRSKP
L’hypoalbuminémie est associée à des complications du diabète, telles que les hypoglycémies, les cétoses, la sarcopénie, la neuropathie périphérique, les maux perforant, la néphropathie diabétique ou ...encore associée à des taux de mortalité plus élevés chez les patients hospitalisés ou atteints de coronaropathie. L’albumine sérique est généralement considérée comme un marqueur de l’état nutritionnel, avec un intérêt particulier pour les sujets en perte de poids involontaire : dans leur cas, les récentes recommandations des sociétés françaises de nutrition la considèrent comme un marqueur de dénutrition sévère lorsque l’albumine est inférieure à 30g/L. La diminution de l’albumine sérique peut, néanmoins, résulter d’autres causes : diminution de la synthèse hépatique dans la cirrhose, augmentation des pertes sous forme d’albuminurie, et fuite interstitielle due à une augmentation de la perméabilité vasculaire dans les états inflammatoires, qui peuvent toutes se produire chez les sujets diabétiques. La question de savoir si le diabète peut, par lui-même, favoriser l’hypoalbuminémie semble plus discutable : le diabète de type 2 le plus fréquent peut, en effet, être prédit à partir de l’hyperalbuminémie. La synthèse d’albumine répond normalement à l’insuline dans le diabète de type 2, mais elle diminue en cas de carence en insuline, ce qui peut être traité. Dans un diabète mal contrôlé, la glycation de l’albumine peut également modifier sa vitesse d’échappement du plasma. Nous ne savons pas si les taux d’albumine diffèrent selon le type, la durée, les complications et le contrôle du diabète, ce qui semble intéressant pour les cliniciens qui prennent en charge des patients non contrôlés et en perte de poids. Dans notre étude, nous avons mesuré les niveaux d’albumine plasmatique chez ces patients présentant une perte de poids récente et un diabète non contrôlé, puis analysé ses associations avec les caractéristiques de leur diabète, en tenant compte de l’ampleur de la perte de poids, de l’inflammation, de l’état hépatique et rénal.
Le taux d’albumine plasmatique a été dosé chez des sujets hospitalisés dans notre service de diabétologie de 2010 à 2019 pour une perte de poids inattendue. Tous ont subi un entretien et un examen clinique, une recherche de cancer par scanner et ont été contrôlés pour des complications diabétiques chroniques. Par régression binaire multivariée, nous avons analysé les déterminants de l’hypoalbuminémie (< 38g/L) ou de la dénutrition sévère (perte de poids et albumine<30g/L).
Les 334 sujets étaient principalement des hommes (60,5 %), âgés de 59±12 ans. Ils avaient récemment perdu −3,8kg/3 mois (IQR : −5,0, −1,5). La plupart des diabètes étaient de type 2 : 78,7 % (type 1 : 15,3 %, type 3, pancréatique : 6,0 %), avec une durée de diabète de 5 ans (IQR : 0–13), mal contrôlés : HBA1c 10,5±2,8 %. L’albuminémie moyenne était de 37,6±5,1g/L (médiane : 38,5g/L, IQR : 34,8–41,1). L’hypoalbuminémie était présente chez 151 sujets (45,2 %), liée à l’âge, au sexe féminin, à la cirrhose hépatique, à la protéine C-réactive, à l’HbA1c (HR : 4,3, 95 %CI : 2,0–9,2 pour HbA1c>12,4 %), et à une durée élevée du diabète (HR : 2,0, 95 %CI : 1,0–4,6 pour durée>13 ans). Une dénutrition sévère était présente chez 26 sujets (7,8 %), également liée à la protéine C-réactive, à l’HbA1c, à une durée élevée du diabète et au diabète pancréatique (HR : 2,2, 95 %CI : 1,1–4,3). Le taux d’albumine était significativement plus bas (−2g/L) chez les sujets atteints de rétinopathie et de neuropathie diabétiques. Après ajustement pour l’âge, le sexe, la durée du diabète et l’HbA1c, l’hypoalbuminémie (< 38g/L) était liée à la neuropathie (HR : 2,3, 95 %CI : 1,3–3,9).
Chez les sujets diabétiques hospitalisés pour perte de poids, l’hypoalbuminémie et la dénutrition sévère sont liées à un diabète ancien, mal contrôlé, notamment pancréatique, et à une neuropathie diabétique.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UILJ, UL, UM, UPCLJ, UPUK, ZAGLJ, ZRSKP
AimsDoes Diabetic Retinopathy (DR) relate to a previous dramatic reduction of HbA1c in Type 2 Diabetes (T2D)?MethodsIn patients hospitalized for T2D, we collected HbA1c values from previous years, ...and we defined “Rapid declinors” by a more than −3% reduction between two consecutive HbA1c, and “sustained moderate declinors” by HbA1c declining less than −3%. We analyzed the relation between DR and previous HbA1c courses, adjusted for other risk factors.ResultsOur 680 patients had a mean HbA1c at 8.7 ± 1.7% at admission and 8.7 ± 1.8 to 9.0 ± 2.2% during previous years (1500 HbA1C values collected), and 24% had a DR. A previous rapid decline of HbA1c occurred in 13.5% of subjects and related to DR (OR = 1.86, 95%CI:1.02–3.40), especially proliferative (OR = 2.64, 95%CI:1.02–6.80), after adjustment for age, gender, body mass index, arterial hypertension and diabetic kidney disease, blood lipids and statin treatment, duration of diabetes and mean previous HbA1c. A previous moderate reduction of HbA1c as occurred in 28.3% other subjects was not related to DR.ConclusionsIn subjects hospitalized for T2D, a previous rapid decline of HbA1c was related to proliferative DR, whereas a sustained moderate decline appeared to be safe.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UILJ, UL, UM, UPCLJ, UPUK, ZAGLJ, ZRSKP
Alimentazione e diabete: dietetica pratica Rigalleau, V.; Foussard, N.; Larroumet, A. ...
EMC - AKOS - Trattato di Medicina,
06/2024, Volume:
26, Issue:
2
Journal Article
Il diabete mellito è un sintomo di diverse malattie e la prescrizione dietetica dipende dalla loro diagnosi: tipo di diabete, stato nutrizionale, diagnosi educativa. Il diabete di tipo 1 viene ...trattato con insulina, che richiede la regolarizzazione dell’assunzione di carboidrati o addirittura il suo controllo all’interno di una terapia insulinica funzionale. Il diabete di tipo 2 complica l’eccesso di peso che richiede il controllo dell’apporto calorico e la promozione dell’attività fisica. Al contrario, il diabete di tipo 3c (pancreatico) è accompagnato da una cattiva digestione che espone alla malnutrizione e l’assunzione di cibo non deve essere limitata. La nefropatia porta a moderare l’apporto di proteine e sodio. I risultati insoddisfacenti della gestione del diabete di tipo 2 possono portare a cambiamenti nelle priorità: alimentazione mediterranea e riduzione dell’apporto di carboidrati e/o degli indici glicemici.
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