Unexpected adverse effect of metyrapone: A case report

PIK3R1 Mutations Cause Syndromic Insulin Resistance with Lipoatrophy

International audience; Short stature, hyperextensibility of joints and/or inguinal hernia, ocular depression, Rieger anomaly, and teething delay (SHORT) syndrome is a developmental disorder with an unknown genetic cause and hallmarks that include insulin resistance and lack of subcutaneous fat. We ascertained two unrelated individuals with SHORT syndrome, hypothesized that the observed phenotype was most likely due to de novo mutations in the same gene, and performed whole-exome sequencing in the two probands and their unaffected parents. We then confirmed our initial observations in four other subjects with SHORT syndrome from three families, as well as 14 unrelated subjects presenting wi…

Risque augmenté de ré-hospitalisation chez les personnes atteintes de diabète de type 1 et de schizophrénie

Introduction La morbidite et mortalite associees au diabete comme a la schizophrenie suggerent que leur combinaison puisse generer de graves problemes. L’objectif de l’etude etait d’estimer le risque de re-hospitalisation pour complications aigues du diabete et tentative de suicide a trois ans chez des personnes atteintes de diabete et de schizophrenie. Methodes A partir des donnees nationales d’hospitalisation, l’etude en population s’est interessee aux personnes âgees de 15 a 35 ans pour lesquelles une hospitalisation mentionnait un diabete de type 1, entre 2009 et 2012. Pour identifier les personnes atteintes de schizophrenie, un code correspondant a ete recherche pendant ou dans les deu…

Increased erythrocytes n-3 and n-6 polyunsaturated fatty acids is significantly associated with a lower prevalence of steatosis in patients with type 2 diabetes

Summary Background & aims Non-alcoholic fatty liver disease (NAFLD) is commonly associated with obesity, metabolic syndrome and type 2 diabetes. Although dietary fat contributes substantially to the accumulation of liver fat, the role of individual fatty acids in this accumulation is unclear. Objective In this study, we set out to determine whether liver fat content (LFC), was associated with red blood cell fatty acid (RBC-FA) composition in people with type 2 diabetes. Design, settings, and participants One hundred and sixty-two type 2 diabetic patients were included in this study. LFC was measured using 1H-MR Spectroscopy. RBC-FA composition was measured by gas chromatography. Results One…

Effet secondaire inattendu de la métyrapone : à propos d’un cas

Introduction L’hypercorticisme est une pathologie rare et l’utilisation de la metyrapone est peu frequente. Le surdosage en metyrapone se traduit habituellement par des symptomes gastro-intestinaux et une insuffisance surrenalienne aigue. Observation Un diagnostic d’hypercorticisme est realise chez un homme de 28 ans. Un traitement par metyrapone 250 mg deux fois par jour a debute pour controler l’hypercorticisme. Le patient est hospitalise pour une intoxication medicamenteuse volontaire avec 100 comprimes de metyrapone. Un diagnostic d’insuffisance surrenalienne aigue est pose devant des douleurs abdominales, des vomissements, une asthenie et une hypotension. Il ne presente pas de myalgies…

Liraglutide reduces plasma PCSK9 in patients with type 2 diabetes not treated with statins

Dyslipidaemia in type 2 diabetes mellitus (T2DM), which increases cardiovascular risk, includes abnormal metabolism of low-density lipoproteins (LDL). Our group has recently shown that liraglutide increases LDL catabolism in patients with T2DM and that it reduces the expression of PCSK9 (a major inhibitor of LDL-receptor expression) in vitro and in mice. This prompted us to study the effect of liraglutide on plasma PCSK9 level in patients with T2DM.We studied prospectively 82 patients with T2DM (51 without statins, 31 with statins). Plasma PCSK9 and plasma lipids were measured before and six months after the initiation of a treatment with liraglutide at a dose of 1.2 mg/day.Plasma PCSK9 was…

Nésidioblastose traitée par pasiréotide LAR : à propos d’un cas

Resume Une patiente de 56 ans, diabetique de type 2, presentait des episodes d’hypoglycemies, qui ont persiste apres arret du traitement antidiabetique. Une epreuve de jeune authentifie une hypoglycemie organique, a 0,34 g/L, insulinemie a 6 mUI/L, peptide C a 1,9 ng/mL (normes : 0,5–3,0 ng/mL) et proinsuline a 3,72, puis 4,5 pmol/L (normes : 1,28–3,84 pmol/L). Aucune lesion n’est retrouvee au scanner ou a l’echo-endoscopie. La scintigraphie a la somatostatine est negative. Ces elements font ainsi porter le diagnostic de nesidioblastose. Des traitements par diazoxide et octreotide sont successivement mis en place, sans succes. Sous pasireotide LAR, les hypoglycemies disparaissent, avec meme…

No Improvement of High-Density Lipoprotein (HDL) Vasorelaxant Effect Despite Increase in HDL Cholesterol Concentration in Type 2 Diabetic Patients Treated With Glitazones

Abstract Context: High-density lipoproteins (HDLs) from type 2 diabetic patients are unable to counteract the inhibitory effect of oxidized low-density lipoproteins (ox-LDLs) on vasorelaxation. We hypothesized that glitazones, which improve glycemic control and dyslipidemia, could correct this abnormality. Objectives and Design: We compared the ability of HDL from controls (n = 12) and from type 2 diabetic patients before and after 6 months of treatment with either rosiglitazone (n = 11) or pioglitazone (n = 8) to counteract the inhibitory effect of ox-LDL on vasodilatation of rabbit aorta rings. Results: Rosiglitazone induced a decrease in hemoglobin A1c (7.7% ± 1.1% vs 9.8% ± 1.0%, P = .0…

Application of the new eLIFT test for the non-invasive diagnosis of advanced liver fibrosis in people with type 2 diabetes

Pragmatic Diabetes Management in Nursing Homes: Individual Care Plan

Although the management of diabetes as a simple entity has been extensively developed, there is a dearth of evidence in elderly, frail patients with multiple comorbidities and polymedication. This population represents a large proportion of the residents of nursing homes (NHs). As a multidisciplinary group of French experts (geriatricians, endocrinologists, diabetologists, and general practitioners) with practical experience in this area, which is growing in magnitude throughout the world, we convened to compile pragmatic, simple advice on the management of elderly, frail diabetic patients. Given demands on NH personnel (manager, medical coordinator, nurses, and, at the front line of care p…

Quels sont les patients diabétiques de type 2 à risque d’interactions médicamenteuses ?

Prise en charge pragmatique du diabétique en EHPAD

Resume On estime a 20 a 30 % le pourcentage de residents en Etablissement d’Hebergement pour Personnes Âgees Dependantes (EHPAD) qui presentent un diabete sucre. Il s’agit souvent de patients lourds, fragiles, polypathologiques, parfois atteints de troubles cognitifs majeurs. A ces âges, et dans ce contexte, le controle strict du diabete passe au second plan par rapport a la prevention des risques de chute, de denutrition, de sarcopenie et de declin cognitif, ainsi qu’a la prevention des accidents metaboliques aigus. La redaction d’un Plan de Soins Personnalise permet de fixer les objectifs a atteindre pour un patient donne, d’adapter le traitement antidiabetique au cas par cas, et de preci…

No change in apolipoprotein AI metabolism when subcutaneous insulin infusion is replaced by intraperitoneal insulin infusion in type 1 diabetic patients.

In type 1 diabetic patients, the replacement of subcutaneous insulin infusion by intraperitoneal insulin infusion restores the normal physiological gradient between the portal vein and the peripheral circulation, which is likely to modify HDL metabolism. This stable isotope kinetic study was designed to compare HDL apolipoprotein (apo) AI metabolism in seven type 1 diabetic patients first treated by continuous subcutaneous insulin infusion by an external pump and then 3 months after the beginning of intraperitoneal insulin infusion by an implantable pump. Glycaemic control was comparable under subcutaneous and intraperitoneal insulin infusion (HbA1c=7.34+/-0.94% versus 7.24+/-1.00%, NS). HD…

3q27.3 microdeletional syndrome: a recognisable clinical entity associating dysmorphic features, marfanoid habitus, intellectual disability and psychosis with mood disorder.

Abstract: Background Since the advent of array-CGH, numerous new microdeletional syndromes have been delineated while others remain to be described. Although 3q29 subtelomeric deletion is a well-described syndrome, there is no report on 3q interstitial deletions. Methods We report for the first time seven patients with interstitial deletions at the 3q27.3q28 locus gathered through the Decipher database, and suggest this locus as a new microdeletional syndrome. Results The patients shared a recognisable facial dysmorphism and marfanoid habitus, associated with psychosis and mild to severe intellectual disability (ID). Most of the patients had no delay in gross psychomotor acquisition, but ha…

Personality types in individuals with type 1 and type 2 diabetes

Objective The Type A personality, characterized by impatience, strong career ambition and competitiveness, is associated with greater sensitivity to external stress. Type 1 diabetes (T1D) is an auto-immune disease, which is potentially influenced by stress, unlike type 2 diabetes (T2D). The aim of this study was to assess whether individuals with T1D and T2D exhibited significant differences on the Type A personality scale. We also assessed personality in patients with thyroid auto-immune diseases to validate potential links between auto-immune disease and Type A personality. Design and methods The Bortner questionnaire was used to assess Type A personality in 188 patients with T1D, 430 pa…

Type 1 diabetes is not associated with an increased prevalence of hepatic steatosis

Aim Non-alcoholic fatty liver disease (NAFLD) is commonly associated with Type 2 diabetes. Recently, it has been suggested that NAFLD is also frequently associated with Type 1 diabetes and diabetic complications. In this study, we set out to determine whether Type 1 diabetes was associated with liver fat content measured using magnetic resonance imaging. Methods One hundred and twenty-eight patients with Type 1 diabetes, 264 patients with Type 2 diabetes and 67 participants without diabetes were included in this study. Hepatic steatosis was defined as a liver fat content > 5.5%. Results People with Type 1 diabetes and controls were similar for age and BMI. Liver fat content was significantl…

Circulating Apelin is increased in patients with type 1 or type 2 diabetes and is associated with better glycaemic control

SummaryContext Apelin is an adipokine expressed in several tissues and it appears to be involved in energy metabolism. Objective The aim of this study was to determine serum apelin levels in a large cohort of patients with type 1 and type 2 diabetes and control subjects and to correlate the results with glycaemic control. Design and Participants One hundred and thirty patients with type 1 diabetes, 98 patients with type 2 diabetes and 162 controls were enrolled in the study. Apelin levels were measured by enzyme-linked immunosorbent assay. Results Serum apelin levels were significantly higher in type 1 and type 2 diabetic patients than in controls (P < 0·0001). Serum apelin levels were high…

A low-carbohydrate high-fat diet initiated promptly after diagnosis provides clinical remission in three patients with type 1 diabetes

O29 Diminution du contenu en sphingosine-1-phosphate dans les lipoprotéines de haute densité (HDL) au cours du diabète de type 1

Introduction La fonctionnalite des HDL des patients diabetiques de type 1 (DT1) est alteree. Ces anomalies sont en partie attribuables a des modifications glycoxydatives mais pourraient egalement s'expliquer par des variations de la composition en phospholipides et sphingolipides a la surface des HDL, molecules qui jouent un role important dans les differentes fonctions des HDL. Patients et methodes Nous avons recrute 43 patients DT1 (âge : 44,3±16,1 ; 17 hommes, 19 femmes) et 36 sujets controles normolipidemiques (âge : 40,3±14,6 ; 18 hommes, 25 femmes). Nous avons etabli la composition en phospholipides et sphingolipides des HDL par chromatographie liquide couplee a la spectrometrie de ma…

Liver Fat Content in People with Pituitary Diseases: Influence of Serum IGF1 Levels

AbstractNon-alcoholic fatty liver disease (NAFLD) is commonly associated with obesity, metabolic syndrome, and type 2 diabetes. NAFLD is also seen in patients with endocrinopathies. However, the relationship between endocrine diseases and the development of NAFLD is not well known. In this study, we set out to determine whether liver fat content (LFC) was associated with IGF1 levels in people with pituitary diseases (PD). Eighty-nine patients with pituitary diseases and 74 healthy controls were included in this study. LFC was measured using MRI. Hepatic steatosis was defined as LFC&gt;5.5%. Patients with PD were older, and had a higher BMI than healthy controls. LFC was significantly higher…

Depression and obesity, data from a national administrative database study: Geographic evidence for an epidemiological overlap

BackgroundDepression and obesity are two major conditions with both psychological and somatic burdens. Some data suggest strong connections between depression and obesity and more particularly associated prevalence of both disorders. However, little is known about the geographical distribution of these two diseases. This study aimed to determine if there is spatial overlap between obesity and depression using data from the entire French territory.MethodsData for 5,627 geographic codes for metropolitan France were collected from the two national hospital databases (PMSI-MCO and RIM-P) for the year 2016. We identified people who were depressed, obese or both registered in the two public medic…

Intravoxel incoherent motion diffusion-weighted imaging in nonalcoholic fatty liver disease: a 3.0-T MR study.

International audience; PURPOSE: To compare pure molecular diffusion, D, perfusion-related diffusion, D*, and perfusion fraction, f, determined from diffusion-weighted (DW) magnetic resonance (MR) imaging on the basis of the intravoxel incoherent motion (IVIM) theory in patients with type 2 diabetes with and without liver steatosis. MATERIALS AND METHODS: This prospective study was approved by the appropriate ethics committee, and written informed consent was obtained from all patients. Between December 2009 and September 2011, 108 patients with type 2 diabetes (51 men, 57 women; mean age, 50 years) underwent 3.0-T single-voxel point-resolved proton MR spectroscopy of the liver (segment VII…

Diabetes is not associated with COVID-19-related mortality in older institutionalized people

Diabetes & Metabolism - Sous presse. Manuscrit accepte. Disponible en ligne depuis le mercredi 27 janvier 2021

Impact of the COVID‐19 Epidemic on hospitalization for diabetic foot ulcers during lockdown: A French nationwide population‐based study

AIMS/HYPOTHESIS: The aim of this study was to examine the impact of the COVID-19 epidemic on the hospitalization rates for diabetic foot ulcer (DFU), osteomyelitis and lower limb revascularization procedure in people with DFU. METHODS: This nationwide retrospective cohort study included hospital data on all people hospitalized in France for diabetes in weeks 2-43 in 2020, including the COVID-19 lockdown period, compared to same period in 2019. RESULTS: The number of hospitalizations for DFU decreased significantly in weeks 12-19 (during the lockdown) (p < 10-4 ). Hospitalization for foot osteomyelitis also decreased significantly in weeks 12-19 (p < 10-4 ). The trend was the same for lower …

Liraglutide Increases the Catabolism of Apolipoprotein B100–Containing Lipoproteins in Patients With Type 2 Diabetes and Reduces Proprotein Convertase Subtilisin/Kexin Type 9 Expression

OBJECTIVE Dyslipidemia observed in type 2 diabetes (T2D) is atherogenic. Important features of diabetic dyslipidemia are increased levels of triglyceride-rich lipoproteins and small dense LDL particles, which all have apolipoprotein B100 (apoB100) as a major apolipoprotein. This prompted us to study the effect of the GLP-1 agonist liraglutide on the metabolism of apoB100-containing lipoproteins. RESEARCH DESIGN AND METHODS We performed an in vivo kinetic study with stable isotopes (L-[1-13C]leucine) in 10 patients with T2D before and after 6 months of treatment with liraglutide (1.2 mg/day). We also evaluated in mice the effect of liraglutide on the expression of genes involved in apoB100-…

Successful Control of Hypoglycemia with Pasireotide LAR in a Patient with Inappropriate Insulin Secretion

Introduction Inappropriate insulin secretion could be due to several diseases. Nesidioblastosis is characterized by diffuse hyperplasia of pancreatic beta cells, causing organic hypoglycemia. No pancreatic lesions are found on the imaging of patients with this condition. Diazoxide is used as a first-line treatment but can be poorly tolerated because of its side effects, and therapeutic failure is possible. Somatostatin analogues have limited efficacy because of their poor affinity to somatostatin (SST) receptors. Pasireotide is a somatostatin analogue with a much higher affinity to SST receptors, especially SST5, and it could thus be more efficient for treating nesidioblastosis-related hypo…

Early cardiovascular events in women with a history of gestational diabetes mellitus

International audience; Background: The effect of gestational diabetes mellitus (GDM) on cardiovascular diseases (CVD) is not assessed within the first 10 years postpartum, regardless of subsequent diabetes. The aim of this study was to determine the risk of CVD events related to GDM within 7 years of postpartum.Methods: This nationwide population-based study of deliveries in 2007 and 2008 with a follow-up of 7 years was based on data from the French medico-administrative database. Two groups were formed: women with a history of GDM and women without GDM or previous diabetes. CVD included angina pectoris, myocardial infarction, stroke, heart bypass surgery, coronary angioplasty, carotid end…

Précocité des pathologies cardiovasculaires chez les femmes ayant un antécédent de diabète gestationnel

Introduction La precocite de dysfonctions cardiaques et du syndrome metabolique apres une grossesse marquee par un diabete gestationnel (DG) est un sujet d’actualite. L’objectif de l’etude etait de determiner, a partir des donnees hospitalieres, l’association entre antecedent de DG et maladies cardiovasculaires (MCV) dans les six annees du post-partum. Methodes Cette etude concerne l’ensemble des accouchements reperes dans la base nationale du PMSI en 2007 et 2008. Parmi ces femmes, ont ete distinguees celles ayant presente un DG au cours de leur grossesse (en 2007 ou 2008), et celles sans DG. Ces femmes ont ete suivies via le chainage des resumes PMSI, jusqu’en 2013. Une analyse par regres…

Association entre hospitalisation pour acidocétose et risque d’hospitalisation pour tentatives de suicide parmi les personnes atteintes de diabète de type 1

Introduction L’objectif de notre etude etait d’estimer l’association entre un antecedent d’hospitalisation pour acidocetose ou coma hyperglycemique et une hospitalisation pour tentative de suicide chez des personnes atteintes d’un diabete de type 1. Methodes Le principe de cette cohorte retrospective en population etait d’explorer les donnees hospitalieres des personnes ayant presente une hospitalisation mentionnant un diabete de type 1, en France, en 2008. Elles ont ete identifiees a partir d’un code diagnostique de diabete enregistre en diagnostic principal, associe ou relie. Pour eviter d’inclure des personnes atteintes de diabete de type 2, seules les personnes âgees de 18 a 35 ans ont …

Chronic Hyperinsulinemia Does Not Increase the Production Rate of High-Density Lipoprotein Apolipoprotein AI

Objective— In vitro studies showed that insulin stimulates the production of apolipoprotein AI (apoAI). Thus, we hypothesized that chronic hyperinsulinemia could contribute to the increase in the production of high-density lipoprotein apoAI that is observed in metabolic syndrome. Approach and Results— We performed an in vivo kinetic study with stable isotope in 7 patients with insulinoma who showed hyperinsulinemia but no insulin resistance, 8 patients with insulin resistance, and 16 controls. Insulinemia was 3.1× ( P &lt;0.01) higher in patients with insulinoma or insulin resistance than in controls in the fasting state and, respectively, 3.5× and 2.6× ( P &lt;0.05) higher in the fed stat…

Type A competitiveness traits correlate with downregulation of c-Fos expression in patients with type 1 diabetes.

International audience; AimType A personality has been associated with increased survival in people with type 1 diabetes (T1D). Systemic low-grade inflammation may play a critical role, as suggested in recent reports, although the links between the inflammatory circulating transcriptome and Type A remain unknown. This prompted our exploration of the potential associations between Type A personality and c-Fos gene expression, a candidate gene closely linked to inflammatory processes, in T1D.MethodsType A personality was assessed by Bortner questionnaire in patients with T1D, and two subscales – ‘speed’ and ‘competitiveness’ – were used to measure these specific dimensions of Type A. Expressi…

Fewer Type A personality traits in type 2 diabetes patients with diabetic foot ulcer.

Abstract Aim Type A personality—characterized by time urgency, strong drive, and a need for achievement and competitiveness—has been shown to be associated with reduced mortality in patients with diabetes. However, it is not known whether a Type A personality might protect against diabetic foot ulcer (DFU). This prompted our present analysis of the association between Type A personality and DFU. Methods The Bortner Scale questionnaire was used to assess Type A personality in 386 patients with type 2 diabetes (T2D), including 104 patients also presenting with, and 282 presenting without, DFU. Additional questionnaires were used to assess perceived stress and depression. Results Type A Bortne…

Whole-exome sequencing identifies the first French MODY 6 family with a new mutation in the NEUROD1 gene

Abstract Aim The aim of the present study was to identify the affected gene in a French family with maturity-onset diabetes of the young (MODY) using whole-exome sequencing (WES). Methods WES was performed in one patient with MODY, and candidate variants were confirmed in members of the immediate family by Sanger sequencing. Results In the proband, a new heterozygous missense mutation (c.340A>C) was identified in the NEUROD1 gene by WES analysis and confirmed by Sanger sequencing. Additional Sanger sequencing of the proband's sister and mother revealed the same heterozygous mutation. The proband and his sister displayed typical clinical characteristics of MODY, while their mother had the sa…

Impact pronostique de la concentration de 3-hydroxymyristate sur la survie des patients atteints de cirrhose alcoolique ou virale

Etat de la question Le role de l’endotoxemie liee a la translocation bacterienne sur l’aggravation de la cirrhose fait l’objet de nombreuses etudes, mais son impact sur la mortalite au cours de la cirrhose est mal connu. Le but de ce travail etait d’etudier l’impact de la concentration sanguine de 3-hydroxymyristate (3-HM) total (composant specifique des lipopolysaccharides, endotoxine), sur le risque de deces et de complications des malades cirrhotiques. Materiel et methodes Au total, 593 patients atteints de cirrhose alcoolique ou virale, sans carcinome hepatocellulaire ont ete inclus entre 2008 et 2012 dans six centres hospitalo-universitaires francais. Le dosage de 3-HM total, libre et …

Frequent and severe hypoglycaemia detected with continuous glucose monitoring in older institutionalised patients with diabetes.

AbstractBackgroundLittle is known about the prevalence of hypoglycaemia in older people with diabetes. However, the HbA1c goal is ≥8% for institutionalised patients with treatments that can cause hypoglycaemia.PurposeWe aimed to assess the prevalence of hypoglycaemia with continuous glucose monitoring and to evaluate the link with HbA1C in older institutionalised patients with diabetes taking potentially hypoglycaemia-inducing drugs.DesignProspective, multicentre study carried out in six geriatric care centres in the Côte d’Or region of France between January 2019 and July 2020.Settings, subjects and methodsA FreeStyle Libre Pro® (FSLP) was worn for up to 14 days in blinded mode in 42 patie…

Glycemic Variability Assessment with a 14-Day Continuous Glucose Monitoring System: When and How Long to Measure MAGE (Mean Amplitude of Glucose Excursion) for Optimal Reliability?

Mean amplitude of glucose excursion (MAGE) is considered as the “gold standard” for assessing the short-term within-day glycemic variability (GV), which is an important component of overall glycemic control. A 14-day continuous glucose monitoring system is now widely used and allows easier assessment of GV. However, it is still unknown whether MAGE, usually calculated on a 48-hour period is identical whatever the time during the 14-day lifespan of the sensor and whether a longer time period might give additional information. We evaluated in 68 patients with type 1 diabetes, MAGE during three 2-day periods (day1-day3; day6-day8; day11-day13) and during periods of 3 days and 4 days. MAGE cal…

Effets de la corticothérapie systémique sur le métabolisme des HDL

Resume La prise exogene de glucocorticoides (GC) est responsable de nombreux effets secondaires, notamment metaboliques. Les effets sur le metabolisme lipidique ne se limitent pas aux triglycerides, mais concernent egalement les HDL. Meme si les donnees disponibles sont peu nombreuses, elles montrent que les GC entrainent une augmentation des taux plasmatiques de HDL-cholesterol et de la taille des particules HDL, independante de l’effet anti-inflammatoire des GC. Les mecanismes sous-jacents a ces augmentations restent actuellement meconnus. Alors que les patients traites par GC presentent une augmentation de la morbidite cardiovasculaire et que l’alteration de la fonctionnalite des HDL est…

Visceral fat area as a new independent predictive factor of survival in patients with metastatic renal cell carcinoma treated with antiangiogenic agents.

Abstract Purpose. A better identification of patients who are more likely to benefit from vascular endothelial growth factor–targeted therapy is warranted in metastatic renal cell carcinoma (mRCC). As adipose tissue releases angiogenic factors, we determined whether parameters such as visceral fat area (VFA) were associated with outcome in these patients. Experimental Design. In 113 patients with mRCC who received antiangiogenic agents (bevacizumab, sunitinib, or sorafenib) (n = 64) or cytokines (n = 49) as first-line treatment, we used computed tomography to measure VFA and subcutaneous fat area (SFA). We evaluated associations linking body mass index (BMI), SFA, and VFA to time to progres…

Liver methylene fraction by dual- and triple-echo gradient-echo imaging at 3.0T: Correlation with proton MR spectroscopy and estimation of robustness after SPIO administration

Purpose To assess the systematic errors in liver methylene fraction (LMF) resulting from fat–fat interference effects with dual- and triple-echo gradient-recalled-echo Dual/Triple GRE) sequences and to test the robustness of these sequences after iron overloading. Materials and Methods Forty type-2 diabetic patients underwent LMF measurement by 3.0T 1H magnetic resonance spectroscopy (corrected for T1 and T2 decays) as the reference standard and liver fat fraction (%Fat) measurement by four Dual/Triple GRE sequences with 20° and 60° flip angle (α), corrected for T1 recovery. The same four sequences were repeated in eight patients after ferumoxide injection. Corrections for systematic errors…

Comparison of classification methods that combine clinical data and high-dimensional mass spectrometry data

Background The identification of new diagnostic or prognostic biomarkers is one of the main aims of clinical cancer research. Technologies like mass spectrometry are commonly being used in proteomic research. Mass spectrometry signals show the proteomic profiles of the individuals under study at a given time. These profiles correspond to the recording of a large number of proteins, much larger than the number of individuals. These variables come in addition to or to complete classical clinical variables. The objective of this study is to evaluate and compare the predictive ability of new and existing models combining mass spectrometry data and classical clinical variables. This study was co…

Glycated albumin with loss of fatty acid binding capacity contributes to enhanced arachidonate oxygenation and platelet hyperactivity: relevance in patients with type 2 diabetes.

High plasma concentrations of nonesterified fatty acids (NEFAs), transported bound to serum albumin, are associated with type 2 diabetes (T2D). The effects of albumin on platelet function were investigated in vitro. Modifications of albumin, such as those due to glycoxidation, were found in patients with T2D, and the consequences of these modifications on biological mechanisms related to NEFA handling were investigated. Mass spectrometry profiles of albumin from patients with T2D differed from those from healthy control subjects. Diabetic albumin showed impaired NEFA binding capacity, and both structural and functional alterations could be reproduced in vitro by incubating native albumin wi…

Analyse géographique de la prévalence de l’obésité et de la dépression à partir des bases du Programme de médicalisation des systèmes d’information et du RIM-P

Introduction La prise en charge de l’obesite et de la depression represente un poids consequent et en augmentation pour le systeme de soins. Plusieurs etudes ont montre que ces deux pathologies partagent des mecanismes physiopathologiques communs. Par ailleurs, aux Etats-Unis, la repartition spatiale des zones de forte prevalence des deux pathologies presente des similitudes. Cette repartition etant meconnue en France, nous avons cherche si les deux pathologies touchaient les memes territoires. Methodes Nous avons identifie dans le PMSI-MCO les patients presentant un diagnostic d’obesite ou un diagnostic principal de depression. A partir du RIM-P, nous avons identifie les patients presentan…

Diabète de type 2 chez le sujet âgé : quelles spécificités ?

Type 2 diabetes, whose prevalence has increased among elderly aged over 75 years, has a number of specific features which differ from that in young people: heterogeneous population, association with other cardiovascular risk factors and several comorbidities, different therapeutic constraints and risks, and lower life expectancy. By using a standardized geriatric assessment it is possible to determine therapeutic and glycemic goals for each patient. In the elderly, main complications of diabetes are hypoglycemia and foot lesions. In order to avoid malnutrition, lifestyle and dietary rules should not be too strict. Recommendations for the prescription of oral antidiabetic agents are the same…

GLP-1 receptor agonists in NAFLD.

IF 4.101; International audience; Non-alcoholic fatty liver disease (NAFLD) is very common in patients with type 2 diabetes (T2D), with approximately two-thirds having a diagnosis of the disease. Currently, the only validated treatment for NAFLD is weight loss. A number of studies of animal models and human trials have evaluated the effects of glucagon-like peptide-1 receptor agonists (GLP-1RAs) on liver fat content and suggest that the treatment could represent a new alternative for NAFLD management. In this review, our focus is on the main studies regarding the effects of GLP-1RAs on NAFLD. Also, the mechanisms that might explain their beneficial effects on liver diseases are analyzed.

Specific enrichment of 2-arachidonoyl-lysophosphatidylcholine in carotid atheroma plaque from type 2 diabetic patients

IF 3.942; International audience; Background and aims: Diabetic patients are at high risk of stroke and coronary artery disease. Recent data suggest that arachidonic acid metabolism is altered in diabetic conditions and that these alterations contribute to accelerated atherosclerosis. Little is known about how these alterations affect the metabolism and the proportions of different lipid species within the atherosclerotic plaque. The aim of our study was to perform a targeted lipidomic analysis of human atherosclerotic lesions, with a specific focus on PUFA-containing lipid species, to reveal differences in the fatty-acid composition of plaque in diabetic patients compared with non-diabetic…

Distinct patterns of heparin affinity chromatography VLDL1 and VLDL2 subfractions in the different dyslipidaemias

Very low density lipoprotein (VLDL) 1 and 2 were fractionated by heparin affinity chromatography into a bound and an unbound fraction and the different subfractions were quantified in 17 normolipidaemic (NL), 13 hypercholesterolaemic (HC), 10 hypertriglyceridaemic (HTG) and 11 combined hyperlipidaemic subjects (CHL). Unbound VLDL1 and VLDL2 were, respectively, 1.9- and 2.2-fold richer in triglycerides than bound VLDL1 and VLDL2. In HTG and CHL the concentration of all the VLDL subfractions was increased and plasma triglyceride level was correlated to unbound VLDL1 and to bound VLDL1 (respectively, r=0.86 (p<0.001) and r=0.77 (p<0.01) in HTG and r=0.73 (p<0.001) and r=0.62 (p<0.05) in CHL). …

Increased Risk of Rehospitalization for Acute Diabetes Complications and Suicide Attempts in Patients With Type 1 Diabetes and Comorbid Schizophrenia

OBJECTIVE The aim of this large retrospective cohort study was to estimate the supplementary morbidity and mortality risks conferred by the co-occurrence of schizophrenia among young people with type 1 diabetes. RESEARCH DESIGN AND METHODS This nationwide population-based study included individuals aged 15–35 years hospitalized in France for type 1 diabetes from 2009 to 2012 with or without schizophrenia. For assessment of the occurrence of rehospitalization for acute diabetes complications, suicide attempts, and hospital mortality, multivariate logistic regressions and survival analysis adjusted for age, sex, and Charlson comorbidity index scores were performed. The association between ho…

Are older patients with diabetes still being overtreated in French long-term care homes?

Abstract Background Diabetes management has not been evaluated in French nursing homes (NHs) for 10 years. Objectives The present study aimed to compare the management of diabetes with guidelines in older patients living in NHs. Design Observational, retrospective and multicentre study carried out in 13 NH in the Cote d’Or region of France. Settings and subjects Between January and June 2018, all NH residents older than 65 years and known to have diabetes (n = 148) were included. Methods Epidemiological, clinical and biological data and diabetes characteristics were collected from the medical records. Results The average glycated haemoglobin (HbA1C) was 7.2 ± 1.2%. In total, 51% of patients…

Potential influence of Type A personality on plasma C-reactive protein levels in people with diabetes

IF 4.693; Aim. Type A personality, although classically known as a factor linked to increased vascular risk, has recently been associated with increased survival in patients with diabetes. As low-grade inflammation predicts a poor outcome, the present study explored the potential associations between Type A and plasma levels of C-reactive protein (CRP) in diabetes. Methods. Type A personality was assessed by the Bortner questionnaire in people with diabetes. The association between Type A and plasma CRP levels was examined by multivariable linear regression, and structural equation modelling (SEM) was performed to determine the impact of the major clinical, biological and psychological conf…

''Assessment of the use of hypolipidemic agents (HAs), mainly statins, in elderly subjects aged 80 years and more in Burgundy: Analysis of 13,211 patients''

Manckoundia, Patrick | Lorenzini, Mathieu | Disson-Dautriche, Anne | Petit, Jean-Michel | Lorcerie, Bernard | Debost, Emmanuel | Menu, Didier | Pfitzenmeyer, Pierre; International audience; ''Only few studies have investigated the use of HA in elderly subjects and there are no data in very elderly subjects. We assessed the prescription of HA and analyzed the relationship between such prescriptions and frailty markers among persons aged 80 and more in an observational study. We recorded the prescriptions for 13,211 patients aged 80-109 years and affiliated to the "Mutualite-Sociale-Agricole (MSA)'' of Burgundy over a 1-month period. The prescription of a HA among all included patients, and t…

Effets secondaires thyroïdiens sous immunothérapie anti-PD1 : évaluation des facteurs de survenue

Objectifs L’utilisation des immunotherapies anti-PD1 dans le traitement des cancers de la peau et du poumon, s’accompagne d’effets secondaires auto-immuns thyroidiens. L’objectif de cette etude etait de determiner leur frequence et d’identifier les facteurs favorisant leur survenue. Methodes Etude retrospective chez 196 patients traites pour un melanome malin ou un cancer bronchique non a petites cellules (CBNPC) par pembrolizumab ou par nivolumab, entre juillet 2014 et fevrier 2018. Quarante-quatre patients ont ete exclus de l’etude (34 pour antecedents de dysthyroidie et 18 par manque de donnees). Les dysthyroidies sous anti-PD1 ont ete differenciees des modifications de TSH par surcharge…

Dépistage précoce du diabète après une grossesse marquée par un diabète gestationnel

Introduction Les femmes ayant presente un diabete gestationnel (DG) ont ulterieurement un risque eleve de diabete de type 2 (DT2). Le taux de depistage du DT2 apres un antecedent de DG est estime entre 3,4 et 92,6 % selon les etudes. L’objectif de notre etude etait de decrire le depistage precoce du DT2 apres une grossesse marquee par un DG entre 2007 et 2013. Methodes L’etude s’est interessee aux femmes ayant presente un DG a partir de l’echantillon generaliste des beneficiaires des donnees de l’assurance maladie obligatoire. Dans les donnees hospitalieres, les accouchements ont ete reperes a partir des codes Z37 de la CIM-10 et le diabete gestationnel a partir du code O24.4. Les examens d…

Liraglutide Reduces Postprandial Hyperlipidemia by Increasing ApoB48 (Apolipoprotein B48) Catabolism and by Reducing ApoB48 Production in Patients With Type 2 Diabetes Mellitus

Objective— Treatment with liraglutide, a GLP-1 (glucagon-like peptide-1) agonist, has been shown to reduce postprandial lipidemia, an important feature of diabetic dyslipidemia. However, the underlying mechanisms for this effect remain unknown. This prompted us to study the effect of liraglutide on the metabolism of ApoB48 (apolipoprotein B48). Approach and Results— We performed an in vivo kinetic study with stable isotopes (D 8 -valine) in the fed state in 10 patients with type 2 diabetes mellitus before treatment and 6 months after the initiation of treatment with liraglutide (1.2 mg/d). We also evaluated, in mice, the effect of a 1-week liraglutide treatment on postload triglycerides an…

CO-74: Altérations majeures du sphingophospholipidome des lipoprotéines de haute densité (HDL) de patients avec syndrome métabolique et glycémie normale

Rationnel Les phospholipides et sphingolipides jouent un role primordial dans la fonctionnalite et le role anti-atherogene des HDL. Ces proprietes sont alterees chez les patients porteurs d'un syndrome metabolique avant meme l'apparition d'une hyperglycemie. Nous avons donc recherche si les HDL de ces patients presentaient des anomalies de leur sphingophospholipidome. Patients et Methodes Par chromatographie liquide couplee a la spectrometrie de masse en tandem, nous avons quantifie 80 especes moleculaires des principales classes de phospholipides et sphingolipides des HDL2 et HDL3, chez 26 patients avec un syndrome metabolique et une glycemie a jeun nor-male (14 hommes, 12 femmes, âge moye…

Characteristics of new patient referrals to specialised diabetic foot units across Europe and factors influencing delays

Objective: Foot ulcers are a common complication of diabetes and are associated with an increase in lower limb amputation and death. Early referral to a specialised unit is recommended. The aim of this study was to assess the characteristics of new-patient referrals to specialised diabetes foot care units across Europe and to determine the factors involved in delayed referral. Method: In this prospective observational study, consecutive patients with a new foot ulcer presenting to nine diabetic foot centres in five European countries (France, Germany, Italy, Spain and the UK) were included. Results: Some 25% of the 332 patients included had presented with a foot ulcer &gt;3 months before re…

Prognostic Impact of 3-HM Concentration in Patients with Alcoholic or Viral Cirrhosis

The role of endotoxemia related to intestinal bacterial translocation in worsening liver disease is the subject of many studies, but its impact on cirrhosis mortality has not been well evaluated. In this study, 3-hydroxymyristate (3-HM) (specific lipid of lipopolysaccharides) was directly quantified by an innovative patented assay with the aim of assessing the impact on cirrhosis mortality. The 3-HM concentration was measured in 593 patients with alcoholic or viral cirrhosis in stable clinical condition. A Cox hazards regression model was used to evaluate association between 3-HM and its fractions bound or nor bound to lipoprotein and the mortality. The 3-HM concentration was increased in p…

Type A personality is not associated with poor glycaemic control: Data from cross-sectional and longitudinal surveys of people with type 1 or type 2 diabetes.

Diabetes & Metabolism - In Press.Proof corrected by the author Available online since lundi 8 aout 2016

Thyroïdites : où en est-on en 2019 ?

Thyroiditis is a frequent and mostly benign disease that can sometimes disrupt the thyroid balance. Their diagnosis, as well as their aetiology, is a necessary step in the management of the patients. Painful thyroiditis includes acute thyroiditis of infectious origin and subacute thyroiditis. The first one can be treated by antibiotics or antifungals depending on the germ found. The second one will be treated with non-steroidal anti-inflammatory drugs or corticosteroids. In cases of Hashimoto's thyroiditis with overt hypothyroidism, replacement therapy with L-thyroxine will be adapted to the TSH level. As amiodarone treatment provides dysthyroidism, the thyroid status should be monitored re…

Particularités des diabètes associés aux maladies hépatiques

Resume Le diabete est frequemment associe a des maladies chroniques du foie et, notamment, l’infection par le virus de l’hepatite C, la cirrhose, et la steatose metabolique. La particularite des pathologies hepatiques au cours du diabete doit inciter les cliniciens a adapter leurs objectifs de traitements et de surveillance aux differentes situations cliniques. Ces differentes pathologies hepatiques peuvent impliquer une prise en charge differente sur le plan nutritionnel, sur la surveillance de l’equilibre glycemique, et sur l’utilisation des therapeutiques antidiabetiques.

Qualité de la surveillance de l’hémoglobine glyquée après un infarctus cérébral, un accident ischémique transitoire ou une hémorragie intra-cérébrale chez des patients diabétiques : une étude nationale

Introduction Chez les patients diabetiques, l’equilibre glycemique est un element cle de la prevention des accidents neuro-vasculaires, notamment de la recidive d’un infarctus cerebral (IC) et d’un accident ischemique transitoire (AIT). Notre etude s’interesse a l’association entre la survenue d’un IC, d’un AIT ou d’une hemorragie intra-cerebrale (HIC) et la realisation d’un suivi de l’HbA1c acceptable ou optimal selon les recommandations actuelles. Methodes Les patients diabetiques victimes d’un IC, d’un AIT ou d’une HIC en 2011 (exposes) ont ete identifies a partir des donnees du systeme national d’information interregimes de l’assurance maladie (Sniiram), et compares a un groupe de patie…

Increased body fat mass reduces the association between fructosamine and glycated hemoglobin in obese type 2 diabetes patients

Abstract Obesity is increasing in patients with type 2 diabetes. A possible reduced association between fructosamine and glycated hemoglobin (HbA1c) in obese individuals has been previously discussed, but this has never been specifically evaluated in type 2 diabetes, and the potential influence of body fat mass and fat distribution has never been studied. We studied 112 type 2 diabetes patients with assessment of fat mass, liver fat and fat distribution. Patients with body mass index (BMI) above the median (34.9 kg/m2), versus BMI below the median, had a correlation coefficient between fructosamine and HbA1c significantly reduced (r = 0.358 vs r = 0.765). In the whole population, fructosami…

Obesity, type 2 diabetes and risk of digestive cancer.

The frequency of obesity has been increasing worldwide for 20 years. Many epidemiological studies support a correlation between obesity and increased risk of cancer, particularly digestive cancers in both genders, and gynaecological cancer in women. Currently, about 5% of cancers could be directly related to overweight. Carcinogenesis mechanisms induced by obesity involve insulin resistance, adipokine and angiogenic factor secretions, and inflammation. Experimental and clinical evidence suggest that insulin resistance plays a major role in carcinogenesis. Insulin and non-protein banded IGF-1, whose levels are increased in type 2 diabetes, stimulate cellular growth and inhibit apoptosis. Abn…