Rationnel La normoglycémie à l’effort est recherchée par tout sportif. Matériels et méthodes L’objectif est la prévention de l’hypoglycémie ; les objectifs secondaires : adaptation du traitement, ...faisabilité, fiabilité. DT1 60 ans, durée diabète 15 ans, BMI 21, HbA1c 6,5 %, glucides 210 g OHC/jour, 1,5 l H20/ jour, pompe externe depuis 10 ans, débit basal jour 0,6 UI/h, nuit 0,8 UI/h, bolus 5 UI matin/4 UI midi/4 UI soir, multi-activités sportives. RTP (pompe + capteur de glycémie) pendant 10 jours, course cycliste en 5 étapes de 150 km/j, intensité 22 km/h (75 % FMT), météo et parcours connus. RTP avec glycémie en temps réel, flèches anticipant les variations, alarme préventive de l’hypoglycémie à 1 g, étalonnage avant repas, impression des résultats glycémiques et insuliniques enregistrés. Résultats Prévention de l’hypoglycémie : visualisation des flèches, de la glycémie en temps réel, mais alarmes mal reconnues. Le DT1 voit sa glycémie en roulant sans se piquer. Les données enregistrées analysées avec DT1 montre une insuline prandiale trop réduite, une absence d’hypoglycémies nocturnes retardées, La diminution des besoins insuliniques semble se stabiliser au 3e jour de la course et persister 24 h après. Moyenne sur 10 jours : glycémique capillaire = 1,41 ± 0,46 g, glycémique capteur 1,62 ± 0,6 g ; 28,4 UI insuline/jour : 17,3 UI basal-11,1 UI bolus ; glucides 270 g OHC/jour, 3 litres H2O/jour. Pour la faisabilité : port RTP pendant l effort, capteur changé par patient, pas d’incident, tracé journalier imprimable. Pour la fiabilité : mauvaise sensibilité dans l’hypoglycémie, léger « retard glycémique » du capteur sur le capillaire ; plus l’étalonnage est fréquent, plus la fiabilité des mesures est précise. Conclusion Pour ce DT1 cycliste entraîné et pour son diabétologue, RTP offre un nouvelle approche d’adaptation, plutôt rétroactive qu’instantanée pour l’instant. Un apprentissage plus long est nécessaire, surtout pour anticiper les hypoglycémies. RTP pourrait être indiqué chez le sportif DT1 pour une durée déterminée, mais doit être validé par une étude comparative.
Introduction Ce stage en immersion de 5 jours, avec un programme d’activité physique adaptée (APA) pluri quotidienne et d’éducation thérapeutique (utilisant le holter glycémique HG en temps réel) ...avait pour objectif d’améliorer équilibre et qualité de vie de diabétiques de type 2, en échec thérapeutique. Matériels et méthodes 11 DT2 et 1 entourage, 40–70 ans, obèses BMI 36,4 ± 21, Hba1c 7,9 ± 2%, traitement oral + ou – GLP1/insuline, aptes physiquement, niveau APA variable 20 questionnaire (Q) de Ricci Gagnon, motivés (Q), certains en rupture (Q SF 36) ; soignants : infirmière d’éducation, diabétologue, médecin du sport, professeur de gymnastique, Arthérapeute, patient expert. 5þjours à Base Nautique, lac de l’Ailette Alimentation standard de collectivité Livret de suivi personnalisé, 11 HG Anima Vibe réglés sans alarme, dossier médical, tensiomètre, ECG, défibrillateur, balance. Assurance du réseau. Visite et participation d’institutionnels. Résultats – AVANT: Modification recrutement 6 semaines (réseau de santé et pole prévention), 3 mois préparation APA. Tests de condition physique. Examen podologique – STAGE : 3 à 4 séances/jour APA dans durée, intensité et type de pratique. Éducation thérapeutique : individuelle : discussion glycémie avec soignant, HP en temps réel (profil glycémique quotidien, effet de APA, des glucides, du traitement), de groupe : APA, repas (choix commenté d aliments) arthérapie et échanges le soir. ADHÉSION globale : tous les DT2 participent APA, Effet du groupe Adaptation traitement, parfois quotidiennement Incidents mineurs : 1 hypoglycémie nocturne, 2 hypertensions et 1 passage en arythmie lente, pas incident locomoteur, ni podologique ; HG : bonne acceptabilité du DT2, faisabilité pendant APA et analyse glycémique performante – APRÈS : orientation APA post stage discutée, engagement individuel. Évaluation stage et HG. Conclusion L’APA prolongée et répétée peut être réalisée par DT2 motivés, préparés et accompagnés, sans incidents en particulier hypoglycémies, permettant le recul des « barrières APA » soigné et soignant. Bénéfices APA : à court terme : baisse glycémie et réduction du traitement, à long terme : évaluation prévue par réseau ADIAMO sur 1 an (poursuite APA, traitement, poids, Tension, HbA1c, Q SF 36). Message éducatif simple (diabète, diététique, APA). HG améliore connaissance glycémie DT2 Stage DT2 innovant, ludique. Expérience à diffuser. Cout à évaluer.
Subjects with diabetes are reported to have an increased risk of dementia and cognitive impairment. However, the underlying causes remain unknown. We investigated the longitudinal associations ...between midlife insulin secretion, glucose metabolism, and the subsequent development of Alzheimer disease (AD) and dementia.
The population-based Uppsala Longitudinal Study of Adult Men started 1970 when the 2,322 participants were 50 years old. Investigation at baseline included determinations of acute insulin response and glucose tolerance using the IV glucose tolerance test and Homeostasis Model Assessment insulin resistance index. During a median follow up of 32 years, 102 participants were diagnosed with AD, 57 with vascular dementia, and 394 with any dementia or cognitive impairment. Associations were analyzed using Cox proportional hazard models.
A low insulin response at baseline was associated with a higher cumulative risk of AD (hazard ratio for 1 SD decrease, 1.31; 95% CI, 1.10-1.56) also after adjustment for age, systolic blood pressure, body mass index, serum cholesterol, smoking, education level, and insulin resistance. This association was stronger in subjects without the APOE epsilon4 allele. Impaired glucose tolerance increased the risk of vascular dementia (hazard ratio for 1 SD decrease, 1.45; 95% CI, 1.05-2.00) but not AD. Impaired insulin secretion, glucose intolerance, and estimates of insulin resistance were all associated with higher risk of any dementia and cognitive impairment.
In this longitudinal study, impaired acute insulin response at midlife was associated with an increased risk of Alzheimer disease (AD) up to 35 years later suggesting a causal link between insulin metabolism and the pathogenesis of AD.
Abstract Background Despite considerable evolution in the quality of laboratory-based testing for detection of HCV, the availability of rapid, point-of-care tests may increase diagnoses by increasing ...opportunities for testing outside of traditional laboratory settings. Objectives We evaluated the performance of a new, rapid HCV test that can be used with venous blood, finger stick blood, serum, plasma, or oral fluid and compared it to FDA-approved laboratory methods. Study design HCV positive subjects as well as subjects at low risk for HCV were tested with the rapid test using all 5 specimen types and results compared to FDA-approved laboratory methods. In addition, performance was assessed in commercially available seroconversion panels. Results Sensitivity and specificity of the rapid test was equivalent to laboratory EIA and performance was comparable across all 5 specimen types. Conclusions The OraQuick® HCV Rapid Antibody Test appears suitable as an aid in the diagnosis of HCV infection.
Aims To assess the effects of orlistat vs. placebo, in combination with a weight management programme, on weight loss and metabolic control in obese patients with Type 2 diabetes.
Methods Patients ...treated with either metformin alone or metformin in combination with sulphonylurea were randomized to double‐blind treatment with orlistat or placebo (120 mg) three times daily, combined with a mildly reduced calorie diet and a weight management programme for 52 weeks. Changes in body weight, anthropometry, glycaemic control and lipid profile were assessed.
Results After 52 weeks, orlistat‐treated patients achieved an almost threefold greater reduction in weight compared with placebo recipients (−5.0% vs. −1.8%; P < 0.0001). The decrease in waist circumference was significantly greater with orlistat than placebo (−4.8 cm vs. −2.8 cm; P = 0.0022). Orlistat treatment was also associated with significantly greater reductions in haemoglobin A1c (−1.1% vs. −0.2%; P < 0.0001), fasting plasma glucose (−1.9 mmol/l vs. −0.3 mmol/l; P < 0.0001), total cholesterol (−0.2 mmol/l vs. 0.1 mmol/l; P = 0.03) and apolipoprotein B (−0.08 g/l vs. 0.01 g/l; P = 0.0085) and greater improvements in beta‐cell function (P = 0.031) and insulin resistance (P = 0.001) assessed using the homeostasis model assessment (HOMA). Similar results were obtained for subgroups of patients treated with metformin alone or metformin in combination with sulphonylurea. Orlistat treatment reduced the requirement for anti‐diabetic medication more than placebo.
Conclusions Orlistat, in combination with a reduced calorie diet and a weight management programme, promotes weight loss and clinically relevant improvements in glycaemic control and other cardiovascular risk factors in obese patients with Type 2 diabetes.
Due to the lack of available evidence on pediatric trauma care organization, no French national guideline has been developed. This survey aimed to describe the management of pediatric trauma patients ...in France.
In this cross-sectional survey, an electronic questionnaire (previously validated) was distributed to intensive care physicians from tertiary hospitals via the GFRUP (Groupe Francophone de Réanimation et Urgences Pédiatriques) mailing list.
We collected 37 responses from 28 centers with available data, representing 100% of French level-1 pediatric trauma centers. Most of the pediatric centers (n = 21, 75%) had a written local protocol on pediatric trauma care. In most centers (n = 17, 61%), patients with severe trauma could be admitted in various locations, including the adult or pediatric emergency department or the intensive care unit. Usually, the location of the trauma room depended on the patients’ age and/or severity of trauma. In 12 centers in which trauma could be managed by adult physicians (n = 12/18, 70%), a physician with pediatric expertise (anesthesiologist or intensive care physician) could be called according to the patient's age or severity of trauma. The cut-off patient age for considering pediatric expertise was mainly 3–5 years (n = 10, 83%).
Although most French level-1 pediatric trauma centers have a local protocol for pediatric trauma management, organization is very heterogeneous in France. Guidelines should focus on collaboration between professionals and hospital facilities in order to improve outcomes of children with trauma.
Intraportal transplantation of pancreatic islets offers improved glycaemic control and insulin independence in type 1 diabetes mellitus, but intraportal thrombosis remains a possible complication. ...The thrombotic reaction may explain why graft loss occurs and islets from more than one donor are needed, since contact between human islets and ABO-compatible blood in vitro triggers a thrombotic reaction that damages the islets. We investigated the possible mechanism and treatment of such thrombotic reactions.
Coagulation activation and islet damage were monitored in four patients undergoing clinical islet transplantation according to a modified Edmonton protocol. Expression of tissue factor (TF) in the islet preparations was investigated by immunohistochemistry, immunoprecipitation, electron microscopy, and RT-PCR. To assess TF activity in purified islets, human islets were mixed with non-anticoagulated ABO-compatible blood in tubing loops coated with heparin.
Coagulation activation and subsequent release of insulin were found consistently after clinical islet transplantation, even in the absence of signs of intraportal thrombosis. The endocrine, but not the exocrine, cells of the pancreas were found to synthesise and secrete active TF. The clotting reaction triggered by pancreatic islets in vitro could be abrogated by blocking the active site of TF with specific antibodies or site-inactivated factor Vila, a candidate drug for inhibition of TF activity in vivo.
Blockade of TF represents a new therapeutic approach that might increase the success of islet transplantation in patients with type 1 diabetes, in terms of both the risk of intraportal thrombosis and the need for islets from more than one donor.
Better risk prediction and new molecular targets are key priorities in type 2 diabetes (T2D) research. Little is known about the role of the urine metabolome in predicting the risk of T2D. We aimed ...to use non-targeted urine metabolomics to discover biomarkers and improve risk prediction for T2D. Urine samples from two community cohorts of 1,424 adults were analyzed by ultra-performance liquid chromatography/mass spectrometry (UPLC-MS). In a discovery/replication design, three out of 62 annotated metabolites were associated with prevalent T2D, notably lower urine levels of 3-hydroxyundecanoyl-carnitine. In participants without diabetes at baseline, LASSO regression in the training set selected six metabolites that improved prediction of T2D beyond established risk factors risk over up to 12 years' follow-up in the test sample, from C-statistic 0.866 to 0.892. Our results in one of the largest non-targeted urinary metabolomics study to date demonstrate the role of the urine metabolome in identifying at-risk persons for T2D and suggest urine 3-hydroxyundecanoyl-carnitine as a biomarker candidate.
The association between CHD and insulin sensitivity (Si) measured by the euglycaemic insulin clamp has not been examined previously. Earlier studies found a relationship between CHD and elevated ...plasma insulin, an analysis that may have been confounded by co-determination of proinsulin, which has evolved as a stronger predictor of CHD. The aim was to determine the longitudinal relationships between Si, intact proinsulin, 32-33 split proinsulin, specific insulin and subsequent CHD.
This was a population-based cohort study of 815 men in Uppsala, Sweden, aged 70 years at baseline with a follow-up of up to 10 years. Baseline insulin sensitivity was determined by euglycaemic insulin clamp. Fasting proinsulin, 32-33 split proinsulin and specific insulin concentrations were analysed using specific two-site immunometric assays. CHD was taken as diagnosed, if stated (in the event of death) on the Cause of Death Registry, or for subjects hospitalised for the first time with CHD, if CHD was recorded in the Hospital-Discharge Registry. The associations were analysed using Cox's proportional hazards, presented as hazard ratios (HRs) with their 95% CIs for a one-SD increase in the predictor.
In multivariate analysis, Si (HR:0.80, CI:0.65-0.97) adjusted for serum cholesterol, systolic blood pressure, fasting plasma glucose, BMI and smoking predicted CHD. Intact proinsulin (HR:1.18, CI:1.01-1.38), adjusted as the model above, predicted CHD, whereas 32-33 split proinsulin (HR:1.13, CI:0.95-1.35) or specific insulin (HR:1.07, CI:0.89-1.30) did not.
Insulin resistance measured by the euglycaemic insulin clamp predicts subsequent CHD in elderly men. Proinsulin provides a better prediction of CHD than insulin.
PDF
