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Tchitchek N, Binvignat M, Roux A, Pitoiset F, Dubois J, Marguerit G, Saadoun D, Cacoub P, Sellam J, Berenbaum F, Hartemann A, Amouyal C, Lorenzon R, Mariotti-Ferrandiz E, Rosenzwajg M, Klatzmann D. Deep immunophenotyping reveals that autoimmune and autoinflammatory disorders are spread along two immunological axes capturing disease inflammation levels and types. Ann Rheum Dis 2024; 83:638-650. [PMID: 38182406 DOI: 10.1136/ard-2023-225179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2023] [Accepted: 12/17/2023] [Indexed: 01/07/2024]
Abstract
OBJECTIVES Based on genetic associations, McGonagle and McDermott suggested a classification of autoimmune and autoinflammatory diseases as a continuum ranging from purely autoimmune to purely autoinflammatory diseases and comprising diseases with both components. We used deep immunophenotyping to identify immune cell populations and molecular targets characterising this continuum. METHODS We collected blood from 443 patients with one of 15 autoimmune or autoinflammatory diseases and 71 healthy volunteers. Deep phenotyping was performed using 13 flow cytometry panels characterising over 600 innate and adaptive cell populations. Unsupervised and supervised analyses were conducted to identify disease clusters with their common and specific cell parameters. RESULTS Unsupervised clustering categorised these diseases into five clusters. Principal component analysis deconvoluted this clustering into two immunological axes. The first axis was driven by the ratio of LAG3+ to ICOS+ in regulatory T lymphocytes (Tregs), and segregated diseases based on their inflammation levels. The second axis was driven by activated Tregs and type 3 innate lymphoid cells (ILC3s), and segregated diseases based on their types of affected tissues. We identified a signature of 23 cell populations that accurately characterised the five disease clusters. CONCLUSIONS We have refined the monodimensional continuum of autoimmune and autoinflammatory diseases as a continuum characterised by both disease inflammation levels and targeted tissues. Such classification should be helpful for defining therapies. Our results call for further investigations into the role of the LAG3+/ICOS+ balance in Tregs and the contribution of ILC3s in autoimmune and autoinflammatory diseases. TRIAL REGISTRATION NUMBER NCT02466217.
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Affiliation(s)
- Nicolas Tchitchek
- INSERM UMRS 959, Immunology-Immunopathology-Immunotherapy (i3), Sorbonne Université, Paris, France
- Clinical Investigation Center for Biotherapies (CIC-BTi) and Immunology-Inflammation-Infectiology and Dermatology Department (3iD), Assistance Publique-Hôpitaux de Paris, Hôpital Pitié-Salpêtrière-Charles Foix Hospital, Paris, France
| | - Marie Binvignat
- INSERM UMRS 959, Immunology-Immunopathology-Immunotherapy (i3), Sorbonne Université, Paris, France
- INSERM U938, Rheumatology Department, Saint-Antoine Hospital, AP-HP, Sorbonne Université, Paris, France
| | - Alexandra Roux
- INSERM UMRS 959, Immunology-Immunopathology-Immunotherapy (i3), Sorbonne Université, Paris, France
- Clinical Investigation Center for Biotherapies (CIC-BTi) and Immunology-Inflammation-Infectiology and Dermatology Department (3iD), Assistance Publique-Hôpitaux de Paris, Hôpital Pitié-Salpêtrière-Charles Foix Hospital, Paris, France
| | - Fabien Pitoiset
- INSERM UMRS 959, Immunology-Immunopathology-Immunotherapy (i3), Sorbonne Université, Paris, France
- Clinical Investigation Center for Biotherapies (CIC-BTi) and Immunology-Inflammation-Infectiology and Dermatology Department (3iD), Assistance Publique-Hôpitaux de Paris, Hôpital Pitié-Salpêtrière-Charles Foix Hospital, Paris, France
| | - Johanna Dubois
- INSERM UMRS 959, Immunology-Immunopathology-Immunotherapy (i3), Sorbonne Université, Paris, France
- Clinical Investigation Center for Biotherapies (CIC-BTi) and Immunology-Inflammation-Infectiology and Dermatology Department (3iD), Assistance Publique-Hôpitaux de Paris, Hôpital Pitié-Salpêtrière-Charles Foix Hospital, Paris, France
| | - Gwendolyn Marguerit
- INSERM UMRS 959, Immunology-Immunopathology-Immunotherapy (i3), Sorbonne Université, Paris, France
- Clinical Investigation Center for Biotherapies (CIC-BTi) and Immunology-Inflammation-Infectiology and Dermatology Department (3iD), Assistance Publique-Hôpitaux de Paris, Hôpital Pitié-Salpêtrière-Charles Foix Hospital, Paris, France
| | - David Saadoun
- INSERM UMRS 959, Immunology-Immunopathology-Immunotherapy (i3), Sorbonne Université, Paris, France
- Clinical Investigation Center for Biotherapies (CIC-BTi) and Immunology-Inflammation-Infectiology and Dermatology Department (3iD), Assistance Publique-Hôpitaux de Paris, Hôpital Pitié-Salpêtrière-Charles Foix Hospital, Paris, France
- Department of Internal Medicine and Clinical Immunology and Immunology-Inflammation-Infectiology and Dermatology Department (3iD), Reference Center for Autoinflammatory Disorders (CEREMAIA); Reference Center for Systemic Autoimmune Diseases, Paris, France
| | - Patrice Cacoub
- INSERM UMRS 959, Immunology-Immunopathology-Immunotherapy (i3), Sorbonne Université, Paris, France
- Clinical Investigation Center for Biotherapies (CIC-BTi) and Immunology-Inflammation-Infectiology and Dermatology Department (3iD), Assistance Publique-Hôpitaux de Paris, Hôpital Pitié-Salpêtrière-Charles Foix Hospital, Paris, France
- Department of Internal Medicine and Clinical Immunology and Immunology-Inflammation-Infectiology and Dermatology Department (3iD), Reference Center for Autoinflammatory Disorders (CEREMAIA); Reference Center for Systemic Autoimmune Diseases, Paris, France
| | - Jérémie Sellam
- INSERM U938, Rheumatology Department, Saint-Antoine Hospital, AP-HP, Sorbonne Université, Paris, France
| | - Francis Berenbaum
- INSERM U938, Rheumatology Department, Saint-Antoine Hospital, AP-HP, Sorbonne Université, Paris, France
| | - Agnès Hartemann
- INSERM UMRS 959, Immunology-Immunopathology-Immunotherapy (i3), Sorbonne Université, Paris, France
- Clinical Investigation Center for Biotherapies (CIC-BTi) and Immunology-Inflammation-Infectiology and Dermatology Department (3iD), Assistance Publique-Hôpitaux de Paris, Hôpital Pitié-Salpêtrière-Charles Foix Hospital, Paris, France
- Diabetology-Metabolism Department, AP-HP, Institut Hospitalo-Universitaire de Cardiometabolisme et Nutrition (ICAN), Pitié-Salpêtrière-Charles Foix Hospital, Sorbonne Université, Paris, France
| | - Chloé Amouyal
- INSERM UMRS 959, Immunology-Immunopathology-Immunotherapy (i3), Sorbonne Université, Paris, France
- Clinical Investigation Center for Biotherapies (CIC-BTi) and Immunology-Inflammation-Infectiology and Dermatology Department (3iD), Assistance Publique-Hôpitaux de Paris, Hôpital Pitié-Salpêtrière-Charles Foix Hospital, Paris, France
- Diabetology-Metabolism Department, AP-HP, Institut Hospitalo-Universitaire de Cardiometabolisme et Nutrition (ICAN), Pitié-Salpêtrière-Charles Foix Hospital, Sorbonne Université, Paris, France
| | - Roberta Lorenzon
- INSERM UMRS 959, Immunology-Immunopathology-Immunotherapy (i3), Sorbonne Université, Paris, France
- Clinical Investigation Center for Biotherapies (CIC-BTi) and Immunology-Inflammation-Infectiology and Dermatology Department (3iD), Assistance Publique-Hôpitaux de Paris, Hôpital Pitié-Salpêtrière-Charles Foix Hospital, Paris, France
| | - Encarnita Mariotti-Ferrandiz
- INSERM UMRS 959, Immunology-Immunopathology-Immunotherapy (i3), Sorbonne Université, Paris, France
- Clinical Investigation Center for Biotherapies (CIC-BTi) and Immunology-Inflammation-Infectiology and Dermatology Department (3iD), Assistance Publique-Hôpitaux de Paris, Hôpital Pitié-Salpêtrière-Charles Foix Hospital, Paris, France
- Institut Universitaire de France (IUF), Paris, France
| | - Michelle Rosenzwajg
- INSERM UMRS 959, Immunology-Immunopathology-Immunotherapy (i3), Sorbonne Université, Paris, France
- Clinical Investigation Center for Biotherapies (CIC-BTi) and Immunology-Inflammation-Infectiology and Dermatology Department (3iD), Assistance Publique-Hôpitaux de Paris, Hôpital Pitié-Salpêtrière-Charles Foix Hospital, Paris, France
| | - David Klatzmann
- INSERM UMRS 959, Immunology-Immunopathology-Immunotherapy (i3), Sorbonne Université, Paris, France
- Clinical Investigation Center for Biotherapies (CIC-BTi) and Immunology-Inflammation-Infectiology and Dermatology Department (3iD), Assistance Publique-Hôpitaux de Paris, Hôpital Pitié-Salpêtrière-Charles Foix Hospital, Paris, France
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2
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Denimal D, Ponnaiah M, Jeannin AC, Phan F, Hartemann A, Boussouar S, Charpentier E, Redheuil A, Foufelle F, Bourron O. Non-alcoholic fatty liver disease biomarkers estimate cardiovascular risk based on coronary artery calcium score in type 2 diabetes: a cross-sectional study with two independent cohorts. Cardiovasc Diabetol 2024; 23:69. [PMID: 38351039 PMCID: PMC10865592 DOI: 10.1186/s12933-024-02161-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Accepted: 02/08/2024] [Indexed: 02/16/2024] Open
Abstract
BACKGROUND Studies have demonstrated that coronary artery calcification on one hand and non-alcoholic fatty liver disease (NAFLD) on the other hand are strongly associated with cardiovascular events. However, it remains unclear whether NAFLD biomarkers could help estimate cardiovascular risk in individuals with type 2 diabetes (T2D). The primary objective of the present study was to investigate whether the biomarkers of NAFLD included in the FibroMax® panels are associated with the degree of coronary artery calcification in patients with T2D. METHODS A total of 157 and 460 patients with T2D were included from the DIACART and ACCoDiab cohorts, respectively. The coronary artery calcium score (CACS) was measured in both cohorts using computed tomography. FibroMax® panels (i.e., SteatoTest®, FibroTest®, NashTest®, and ActiTest®) were determined from blood samples as scores and stages in the DIACART cohort and as stages in the ACCoDiab cohort. RESULTS CACS significantly increased with the FibroTest® stages in both the DIACART and ACCoDiab cohorts (p-value for trend = 0.0009 and 0.0001, respectively). In DIACART, the FibroTest® score was positively correlated with CACS in univariate analysis (r = 0.293, p = 0.0002) and remained associated with CACS independently of the traditional cardiovascular risk factors included in the SCORE2-Diabetes model [β = 941 ± 425 (estimate ± standard error), p = 0.028]. In the ACCoDiab cohort, the FibroTest® F3-F4 stage was positively correlated with CACS in point-biserial analysis (rpbi = 0.104, p = 0.024) and remained associated with CACS after adjustment for the traditional cardiovascular risk factors included in the SCORE2-Diabetes model (β = 234 ± 97, p = 0.016). Finally, the prediction of CACS was improved by adding FibroTest® to the traditional cardiovascular risk factors included in the SCORE2-Diabetes model (goodness-of-fit of prediction models multiplied by 4.1 and 6.7 in the DIACART and ACCoDiab cohorts, respectively). In contrast, no significant relationship was found between FibroMax® panels other than FibroTest® and CACS in either cohort. CONCLUSIONS FibroTest® is independently and positively associated with the degree of coronary artery calcification in patients with T2D, suggesting that FibroTest® could be a relevant biomarker of coronary calcification and cardiovascular risk. TRIAL REGISTRATION ClinicalTrials.gov identifiers NCT02431234 and NCT03920683.
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Affiliation(s)
- Damien Denimal
- Center for Translational and Molecular Medicine, INSERM UMR 1231, Dijon, France
- Department of Clinical Biochemistry, Dijon Bourgogne University Hospital, Dijon, France
| | | | - Anne-Caroline Jeannin
- Sorbonne Université, Paris, France
- Department of Diabetology, Assistance Publique‑Hôpitaux de Paris (APHP), Pitié-Salpêtrière Hospital, 47‑83 Boulevard de l'Hôpital, Paris, France
| | - Franck Phan
- Sorbonne Université, Paris, France
- Centre de Recherche des Cordeliers, INSERM UMR_S 1138, Paris, France
- Department of Diabetology, Assistance Publique‑Hôpitaux de Paris (APHP), Pitié-Salpêtrière Hospital, 47‑83 Boulevard de l'Hôpital, Paris, France
| | - Agnès Hartemann
- Centre de Recherche des Cordeliers, INSERM UMR_S 1138, Paris, France
- Department of Diabetology, Assistance Publique‑Hôpitaux de Paris (APHP), Pitié-Salpêtrière Hospital, 47‑83 Boulevard de l'Hôpital, Paris, France
| | - Samia Boussouar
- Institute of Cardiometabolism and Nutrition (ICAN), Paris, France
- Laboratoire d'Imagerie Biomédicale INSERM_1146, CNRS_7371, Paris, France
- ICT Cardiovascular and Thoracic Imaging Unit, Assistance Publique‑Hôpitaux de Paris (APHP), Pitié Salpêtrière University Hospital, Paris, France
| | - Etienne Charpentier
- Institute of Cardiometabolism and Nutrition (ICAN), Paris, France
- Laboratoire d'Imagerie Biomédicale INSERM_1146, CNRS_7371, Paris, France
- ICT Cardiovascular and Thoracic Imaging Unit, Assistance Publique‑Hôpitaux de Paris (APHP), Pitié Salpêtrière University Hospital, Paris, France
| | - Alban Redheuil
- Institute of Cardiometabolism and Nutrition (ICAN), Paris, France
- Laboratoire d'Imagerie Biomédicale INSERM_1146, CNRS_7371, Paris, France
- ICT Cardiovascular and Thoracic Imaging Unit, Assistance Publique‑Hôpitaux de Paris (APHP), Pitié Salpêtrière University Hospital, Paris, France
| | - Fabienne Foufelle
- Centre de Recherche des Cordeliers, INSERM UMR_S 1138, Paris, France
| | - Olivier Bourron
- Sorbonne Université, Paris, France.
- Centre de Recherche des Cordeliers, INSERM UMR_S 1138, Paris, France.
- Department of Diabetology, Assistance Publique‑Hôpitaux de Paris (APHP), Pitié-Salpêtrière Hospital, 47‑83 Boulevard de l'Hôpital, Paris, France.
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Phan F, Halbron M, Jacqueminet S, Popelier M, Soliman H, Coffin B, Hartemann A, Amouyal C. Improved dyspeptic symptoms of type 1 diabetes adults with gastroparesis on hybrid closed loop system: A case series. Diabetes Metab 2023; 49:101471. [PMID: 37657737 DOI: 10.1016/j.diabet.2023.101471] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Revised: 07/15/2023] [Accepted: 08/19/2023] [Indexed: 09/03/2023]
Affiliation(s)
- Franck Phan
- Sorbonne Université, Paris, France; Assistance Publique-Hôpitaux de Paris (APHP), Diabetology Department, La Pitié Salpêtrière-Charles Foix University Hospital, Paris, France; Centre de Recherche des Cordeliers, INSERM, UMR_S 1138, Paris, France; Institute of Cardiometabolism and Nutrition ICAN, Paris, France
| | - Marine Halbron
- Sorbonne Université, Paris, France; Assistance Publique-Hôpitaux de Paris (APHP), Diabetology Department, La Pitié Salpêtrière-Charles Foix University Hospital, Paris, France; Institute of Cardiometabolism and Nutrition ICAN, Paris, France
| | - Sophie Jacqueminet
- Sorbonne Université, Paris, France; Assistance Publique-Hôpitaux de Paris (APHP), Diabetology Department, La Pitié Salpêtrière-Charles Foix University Hospital, Paris, France; Institute of Cardiometabolism and Nutrition ICAN, Paris, France
| | - Marc Popelier
- Sorbonne Université, Paris, France; Assistance Publique-Hôpitaux de Paris (APHP), Diabetology Department, La Pitié Salpêtrière-Charles Foix University Hospital, Paris, France; Institute of Cardiometabolism and Nutrition ICAN, Paris, France
| | - Heithem Soliman
- INSERM, UMR 1149, Université de Paris-Cité, équipe PIMS, Paris, France; Assistance Publique-Hôpitaux de Paris (APHP), DMU Esprit, Gastroenterology Unit, Louis Mourier Hospital, Colombes, France; Université Paris Cité, Paris, France
| | - Benoit Coffin
- INSERM, UMR 1149, Université de Paris-Cité, équipe PIMS, Paris, France; Assistance Publique-Hôpitaux de Paris (APHP), DMU Esprit, Gastroenterology Unit, Louis Mourier Hospital, Colombes, France; Université Paris Cité, Paris, France
| | - Agnès Hartemann
- Sorbonne Université, Paris, France; Assistance Publique-Hôpitaux de Paris (APHP), Diabetology Department, La Pitié Salpêtrière-Charles Foix University Hospital, Paris, France; Centre de Recherche des Cordeliers, INSERM, UMR_S 1138, Paris, France; Institute of Cardiometabolism and Nutrition ICAN, Paris, France
| | - Chloé Amouyal
- Sorbonne Université, Paris, France; Assistance Publique-Hôpitaux de Paris (APHP), Diabetology Department, La Pitié Salpêtrière-Charles Foix University Hospital, Paris, France; Institute of Cardiometabolism and Nutrition ICAN, Paris, France; Nutrition and Obesities: Systemic Approaches (NutriOmics) Research Unit, INSERM, UMRS U1269, Paris, France.
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4
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Feron F, Amouyal C, Hartemann A, Van GH, Bourron O, Dierick-Gallet A, Michaux C, Santos MD, Baudot M, Devaux G, Taboureau O, Andreelli F. The short-term prognosis of diabetic foot ulceration is independent of nutritional status at admission. J Wound Care 2023; 32:312-317. [PMID: 37094929 DOI: 10.12968/jowc.2023.32.5.312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/26/2023]
Abstract
Diabetic foot ulcers are one of the complications of diabetes. Malnutrition is one of the risk factors for wounds but, on the other hand, diabetic foot ulceration may promote malnutrition. In this single-centre retrospective study we evaluated the frequency of malnutrition at first admission and the severity of foot ulceration. We demonstrated that malnutrition at admission correlated with duration of hospitalisation and with death rate rather than with the risk of amputation. Our data challenged the concept that protein-energy deficiency may worsen the prognosis of diabetic foot ulcers. Nevertheless, it is still important to screen nutritional status at baseline and during the follow-up in order to start specific nutritional support therapy as soon as possible in order to reduce morbidity/mortality related to malnutrition.
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Affiliation(s)
- Florine Feron
- Diabetology-Metabolism Department, Sorbonne University, APHP, University Hospital Institute of Cardiometabolism and Nutrition (ICAN), Pitié-Salpêtrière-Charles Foix Hospital, F75013, Paris, France
| | - Chloé Amouyal
- Diabetology-Metabolism Department, Sorbonne University, APHP, University Hospital Institute of Cardiometabolism and Nutrition (ICAN), Pitié-Salpêtrière-Charles Foix Hospital, F75013, Paris, France
| | - Agnès Hartemann
- Diabetology-Metabolism Department, Sorbonne University, APHP, University Hospital Institute of Cardiometabolism and Nutrition (ICAN), Pitié-Salpêtrière-Charles Foix Hospital, F75013, Paris, France
| | - Georges Ha Van
- Diabetology-Metabolism Department, Sorbonne University, APHP, University Hospital Institute of Cardiometabolism and Nutrition (ICAN), Pitié-Salpêtrière-Charles Foix Hospital, F75013, Paris, France
| | - Olivier Bourron
- Diabetology-Metabolism Department, Sorbonne University, APHP, University Hospital Institute of Cardiometabolism and Nutrition (ICAN), Pitié-Salpêtrière-Charles Foix Hospital, F75013, Paris, France
| | - Anne Dierick-Gallet
- Diabetology-Metabolism Department, Sorbonne University, APHP, University Hospital Institute of Cardiometabolism and Nutrition (ICAN), Pitié-Salpêtrière-Charles Foix Hospital, F75013, Paris, France
| | - Caroline Michaux
- Diabetology-Metabolism Department, Sorbonne University, APHP, University Hospital Institute of Cardiometabolism and Nutrition (ICAN), Pitié-Salpêtrière-Charles Foix Hospital, F75013, Paris, France
| | - Maude Dos Santos
- Diabetology-Metabolism Department, Sorbonne University, APHP, University Hospital Institute of Cardiometabolism and Nutrition (ICAN), Pitié-Salpêtrière-Charles Foix Hospital, F75013, Paris, France
| | - Magali Baudot
- Diabetology-Metabolism Department, Sorbonne University, APHP, University Hospital Institute of Cardiometabolism and Nutrition (ICAN), Pitié-Salpêtrière-Charles Foix Hospital, F75013, Paris, France
| | - Gaelle Devaux
- Diabetology-Metabolism Department, Sorbonne University, APHP, University Hospital Institute of Cardiometabolism and Nutrition (ICAN), Pitié-Salpêtrière-Charles Foix Hospital, F75013, Paris, France
| | - Olivier Taboureau
- Université de Paris, BFA, Team CMPLI, Inserm U1133, CNRS UMR 8251, Paris, France
| | - Fabrizio Andreelli
- Diabetology-Metabolism Department, Sorbonne University, APHP, University Hospital Institute of Cardiometabolism and Nutrition (ICAN), Pitié-Salpêtrière-Charles Foix Hospital, F75013, Paris, France
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5
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Diedisheim M, Pecquet C, Julla JB, Carlier A, Potier L, Hartemann A, Jacqueminet S, Vidal-Trecan T, Gautier JF, Dubois Laforgue D, Fagherazzi G, Roussel R, Larger E, Sola-Gazagnes A, Riveline JP. Prevalence and Description of the Skin Reactions Associated with Adhesives in Diabetes Technology Devices in an Adult Population: Results of the CUTADIAB Study. Diabetes Technol Ther 2023; 25:279-286. [PMID: 36763338 DOI: 10.1089/dia.2022.0513] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
Abstract
Objective: The use of continuous glucose monitoring (CGM) systems and continuous subcutaneous insulin infusion (CSII) devices adhering to the skin can lead to skin reactions. The objective was to determine the prevalence and consequences of skin reactions at CGM or CSII sites in a large unbiased population. Research Design and Methods: This is a cross-sectional multicenter study. All adult patients with diabetes seen in consultation over a period of 7 months and using or having used a system with skin adhesives (in the last 10 years) were included and filled out a self-assessment questionnaire. Results: Among 851 patients, skin reaction was reported in 28% with CGM and 29% with CSII. Patients reporting reactions were more frequently women using CGM and CSII, and CGM users had type 1 more often than type 2 diabetes (P < 0.001). Manifestations were similar for reactions to CGM and CSII: redness and pruritus in 70%-75% of patients with reactions, pain in 20%-25%, and vesicles and desquamation in 12%-15%. Manifestations occurred within the first 24 h of first use in 22%-24% of patients with reactions to CGM and CSII, but after more than 6 months in 38% and 47% of patients with reactions to CGM and CSII, respectively. Device use was definitively stopped in 12% of patients with reactions to CGM (3.2% of all users) and 7% with reactions to CSII (2.1% of all users). Conclusions: Skin reactions were common, with similar presentations in CGM and CSII users. Manifestations suggested skin irritation rather than allergies. These reactions rarely led to the definitive discontinuation of the use of the device.
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Affiliation(s)
- Marc Diedisheim
- Diabetology Department, Cochin Hospital, APHP, Paris, France
- Institut Necker Enfants Malades (INEM), INSERM U1151, CNRS UMR 8253, Université Paris Cité, IMMEDIAB Laboratory, Paris, France
| | | | - Jean-Baptiste Julla
- Institut Necker Enfants Malades (INEM), INSERM U1151, CNRS UMR 8253, Université Paris Cité, IMMEDIAB Laboratory, Paris, France
- Diabetology and Endocrinology Department, Lariboisière Hospital, Féderation de Diabétologie, APHP, Paris, France
| | - Aurelie Carlier
- Diabetology Department, Bichat Hospital, APHP, Paris, France
| | - Louis Potier
- Institut Necker Enfants Malades (INEM), INSERM U1151, CNRS UMR 8253, Université Paris Cité, IMMEDIAB Laboratory, Paris, France
- Diabetology Department, Bichat Hospital, APHP, Paris, France
| | - Agnès Hartemann
- Diabetology Department, Pitié-Salpêtrière Hospital, APHP, Paris, France
| | | | - Tiphaine Vidal-Trecan
- Diabetology and Endocrinology Department, Lariboisière Hospital, Féderation de Diabétologie, APHP, Paris, France
| | - Jean-François Gautier
- Institut Necker Enfants Malades (INEM), INSERM U1151, CNRS UMR 8253, Université Paris Cité, IMMEDIAB Laboratory, Paris, France
- Diabetology and Endocrinology Department, Lariboisière Hospital, Féderation de Diabétologie, APHP, Paris, France
| | | | - Guy Fagherazzi
- Deep Digital Phenotyping Research Unit, Luxembourg Institute of Health, Strassen, Luxembourg
| | - Ronan Roussel
- Diabetology Department, Bichat Hospital, APHP, Paris, France
| | - Etienne Larger
- Diabetology Department, Cochin Hospital, APHP, Paris, France
| | | | - Jean-Pierre Riveline
- Institut Necker Enfants Malades (INEM), INSERM U1151, CNRS UMR 8253, Université Paris Cité, IMMEDIAB Laboratory, Paris, France
- Diabetology and Endocrinology Department, Lariboisière Hospital, Féderation de Diabétologie, APHP, Paris, France
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6
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Diedisheim M, Dancoisne E, Gautier JF, Larger E, Cosson E, Fève B, Chanson P, Czernichow S, Tatulashvili S, Raffin-Sanson ML, Sallah K, Bourgeon M, Ajzenberg C, Hartemann A, Daniel C, Moreau T, Roussel R, Potier L. Response to Letter to the Editor From Woolcott and Castilla-Bancayán: "Diabetes Increases Severe COVID-19 Outcomes Primarily in Younger Adults". J Clin Endocrinol Metab 2021; 106:e5277-e5278. [PMID: 34370033 PMCID: PMC8385935 DOI: 10.1210/clinem/dgab583] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Indexed: 11/19/2022]
Affiliation(s)
- Marc Diedisheim
- Cordeliers Research Centre, ImMeDiab team,
INSERM, Université de Paris, 75006 Paris, France
- Hôpital Cochin, APHP, Diabetology
Department, 75014 Paris, France
| | - Etienne Dancoisne
- Assistance Publique-Hôpitaux de Paris, DSI WIND, Web
Innovation Données, 75012 Paris, France
- Hôpital Bichat - Claude-Bernard, APHP, URC
PNVS, CIC-EC 1425, INSERM, 75018 Paris, France
| | - Jean-François Gautier
- Cordeliers Research Centre, ImMeDiab team,
INSERM, Université de Paris, 75006 Paris, France
- GH Lariboisiere Fernand-Widal, APHP, Department of
Diabetes and Endocrinology, 75010 Paris, France
| | - Etienne Larger
- Hôpital Cochin, APHP, Diabetology
Department, 75014 Paris, France
| | - Emmanuel Cosson
- Hospital Avicenne, APHP, Department of
Endocrinology-Diabetology-Nutrition, CRNH-IdF, CINFO, 93000
Bobigny, France
- Université Sorbonne Paris Cité, UMR U557 INSERM/U11125
INRAE, Unité de Recherche Epidémiologique Nutritionnelle, 93000
Bobigny, France
| | - Bruno Fève
- Hôpital Saint-Antoine, APHP, Department of
Endocrinology-Diabetology, 75012 Paris, France
- Institut Hospitalo-Universitaire ICAN, 75013
Paris, France
- Sorbonne Université, INSERM, UMR_S938, CRMR
PRISIS, 75012 Paris, France
| | - Philippe Chanson
- 11Hôpital Bicêtre, APHP, Service d’Endocrinologie et des
Maladies de la Reproduction 94270 Le Kremlin-Bicetre, France
- 12Université Paris-Saclay, INSERM, Physiologie et
Physiopathologie Endocriniennes, 94270 Le Kremlin-Bicetre,
France
| | - Sébastien Czernichow
- Hôpital Européen Georges Pompidou, APHP, Service de
Nutrition, Centre Spécialisé Obésité, 75015 Paris, France
- Université de Paris, INSERM, UMR1153,
Epidemiology and Biostatistics Sorbonne Paris Cité Centre (CRESS), 75015 Paris,
France
| | - Sopio Tatulashvili
- Hospital Avicenne, APHP, Department of
Endocrinology-Diabetology-Nutrition, CRNH-IdF, CINFO, 93000
Bobigny, France
- Université Sorbonne Paris Cité, UMR U557 INSERM/U11125
INRAE, Unité de Recherche Epidémiologique Nutritionnelle, 93000
Bobigny, France
| | - Marie-Laure Raffin-Sanson
- Hospital Ambroise Paré, APHP, Service d'Endocrinologie
Diabétologie et Nutrition, 92100 Boulogne-Billancourt,
France
- Université de Versailles
Saint-Quentin-en-Yvelines, 78000 Versailles, France
| | - Kankoé Sallah
- Hôpital Bichat - Claude-Bernard, APHP, URC
PNVS, CIC-EC 1425, INSERM, 75018 Paris, France
| | - Muriel Bourgeon
- Hôpital Antoine-Béclère, APHP, Service de Médecine
Interne, 92140 Clamart, France
| | | | - Agnès Hartemann
- Hôpital Pitié Salpêtrière, APHP, Diabetology
Department, 75013Paris, France
| | - Christel Daniel
- Assistance Publique-Hôpitaux de Paris, DSI WIND, Web
Innovation Données, 75012 Paris, France
- Sorbonne Université, University Paris 13, Sorbonne Paris
Cité, INSERM UMR_S 1142, 75006 Paris, France
| | - Thomas Moreau
- Université Paris-Saclay, INRIA, CEA, 91120
Palaiseau, France
| | - Ronan Roussel
- Cordeliers Research Centre, ImMeDiab team,
INSERM, Université de Paris, 75006 Paris, France
- Hôpital Bichat - Claude-Bernard, APHP, Department of
Diabetology, 75018 Paris, France
| | - Louis Potier
- Cordeliers Research Centre, ImMeDiab team,
INSERM, Université de Paris, 75006 Paris, France
- Hôpital Bichat - Claude-Bernard, APHP, Department of
Diabetology, 75018 Paris, France
- Corresponding author: Dr Louis Potier, Diabetology, Endocrinology
and Nutrition Department, Bichat Hospital, APHP, 46 rue Henri Huchard 75018
Paris, tel: + 33 (0) 1 40 25 73 01,
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7
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Madhukar R, Jagadeesh AT, Moey MYY, Vaglio M, Badilini F, Leban M, Hartemann A, Dureau P, Funck-Brentano C, Bourron O, Salem JE. Association of thyroid-stimulating hormone with corrected QT interval variation: A prospective cohort study among patients with type 2 diabetes. Arch Cardiovasc Dis 2021; 114:656-666. [PMID: 34544648 DOI: 10.1016/j.acvd.2021.06.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Revised: 05/31/2021] [Accepted: 06/14/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND Patients with type 2 diabetes mellitus (T2DM) have a prolonged QT interval and are at high risk of sudden cardiac death. A prolonged QT interval, indicative of impaired ventricular repolarization, is a risk factor for lethal ventricular arrhythmias, such as torsades-de-pointes (TdP). AIMS To identify key clinical and biochemical covariates associated with Fridericia's corrected QT interval (QTcF) among euthyroid patients with T2DM, and to describe the temporal relationship between these factors and QTcF. METHODS We performed prospective, clinical, biochemical and electrocardiographic measurements among patients with T2DM enrolled in the DIACART study at Pitié-Salpêtrière Hospital, at T1 (baseline) and T2 (follow-up), with a median interval of 2.55 years. RESULTS Mean age (63.9±8.5 years), sex (22.35% women), drugs with known risk of TdP according to the CredibleMeds website (Cred-drugsTdP) and serum thyroid-stimulating hormone (TSH) concentrations correlated with QTcF in univariate analysis at both T1 and T2. In multivariable analysis, all these covariates except age were significantly associated with QTcF at both T1 (women: standardized β=0.24±0.07, P=0.001; Cred-drugsTdP: β=0.19±0.07, P=0.007; TSH concentration: β=0.18±0.07, P=0.01) and T2 (women: β=0.25±0.08, P=0.002; Cred-drugsTdP: β=0.25±0.08, P=0.001; TSH concentration: β=0.19±0.08, P=0.01). Furthermore, variation in QTcF over the years was associated with variation in TSH concentration (r=0.24, P=0.007) and changes in use of Cred-drugsTdP (r=0.2, P=0.02). CONCLUSIONS Serum TSH concentration and its variation were associated with QTcF and its variation, even after correcting for the main determinants of QTcF. Interventional optimization of TSH concentration in T2DM warrants further investigation to establish its impact on the risk of TdP and sudden cardiac death.
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Affiliation(s)
- Rashmi Madhukar
- Kasturba Medical College, Manipal Academy of Higher Education, Manipal, Karnataka 576104, India; Department of Pharmacology and Clinical Investigation Centre (CIC-1901), Pitié-Salpêtrière Hospital, AP-HP, Sorbonne Université, inserm, 75013 Paris, France
| | - Akshay T Jagadeesh
- Kasturba Medical College, Manipal Academy of Higher Education, Manipal, Karnataka 576104, India; Department of Pharmacology and Clinical Investigation Centre (CIC-1901), Pitié-Salpêtrière Hospital, AP-HP, Sorbonne Université, inserm, 75013 Paris, France
| | - Melissa Yen Yen Moey
- Department of Cardiovascular Sciences, East Carolina University, Greenville; and Vidant Medical Center, Greenville, NC 27834, USA
| | | | | | - Monique Leban
- Department of Biology, Pitié-Salpêtrière Hospital, AP-HP, Sorbonne Université, 75013 Paris, France
| | - Agnès Hartemann
- Department of Diabetology, Pitié-Salpêtrière Hospital, AP-HP, Sorbonne University, inserm, 75013 Paris, France
| | - Pauline Dureau
- Department of Pharmacology and Clinical Investigation Centre (CIC-1901), Pitié-Salpêtrière Hospital, AP-HP, Sorbonne Université, inserm, 75013 Paris, France
| | - Christian Funck-Brentano
- Department of Pharmacology and Clinical Investigation Centre (CIC-1901), Pitié-Salpêtrière Hospital, AP-HP, Sorbonne Université, inserm, 75013 Paris, France
| | - Olivier Bourron
- Department of Diabetology, Pitié-Salpêtrière Hospital, AP-HP, Sorbonne University, inserm, 75013 Paris, France
| | - Joe-Elie Salem
- Department of Pharmacology and Clinical Investigation Centre (CIC-1901), Pitié-Salpêtrière Hospital, AP-HP, Sorbonne Université, inserm, 75013 Paris, France; Departments of Medicine and Pharmacology, Cardio-Oncology Program, Vanderbilt University Medical Center, Nashville, TN 37232, USA.
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8
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Diedisheim M, Dancoisne E, Gautier JF, Larger E, Cosson E, Fève B, Chanson P, Czernichow S, Tatulashvili S, Raffin-Sanson ML, Bourgeon M, Ajzenberg C, Hartemann A, Daniel C, Moreau T, Roussel R, Potier L. Diabetes Increases Severe COVID-19 Outcomes Primarily in Younger Adults. J Clin Endocrinol Metab 2021; 106:e3364-e3368. [PMID: 34406396 PMCID: PMC8195170 DOI: 10.1210/clinem/dgab393] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Indexed: 01/24/2023]
Abstract
CONTEXT Diabetes is reported as a risk factor for severe coronavirus disease 2019 (COVID-19), but whether this risk is similar in all categories of age remains unclear. OBJECTIVE To investigate the risk of severe COVID-19 outcomes in hospitalized patients with and without diabetes according to age categories. DESIGN SETTING AND PARTICIPANTS We conducted a retrospective observational cohort study of 6314 consecutive patients hospitalized for COVID-19 between February and 30 June 2020 in the Paris metropolitan area, France; follow-up was recorded until 30 September 2020. MAIN OUTCOME MEASURE(S) The main outcome was a composite outcome of mortality and orotracheal intubation in subjects with diabetes compared with subjects without diabetes, after adjustment for confounding variables and according to age categories. RESULTS Diabetes was recorded in 39% of subjects. Main outcome was higher in patients with diabetes, independently of confounding variables (hazard ratio [HR] 1.13 [1.03-1.24]) and increased with age in individuals without diabetes, from 23% for those <50 to 35% for those >80 years but reached a plateau after 70 years in those with diabetes. In direct comparison between patients with and without diabetes, diabetes-associated risk was inversely proportional to age, highest in <50 years and similar after 70 years. Similarly, mortality was higher in patients with diabetes (26%) than in those without diabetes (22%, P < 0.001), but adjusted HR for diabetes was significant only in patients younger than age 50 years (HR 1.81 [1.14-2.87]). CONCLUSIONS Diabetes should be considered as an independent risk factor for the severity of COVID-19 in young adults more so than in older adults, especially for individuals younger than 70 years.
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Affiliation(s)
- Marc Diedisheim
- Cordeliers Research Centre, ImMeDiab team, INSERM, Université de Paris, Paris, France
- Hospital Cochin, APHP, Diabetology Department, Paris, France. Université de Paris, Paris, France
| | - Etienne Dancoisne
- Assistance Publique-Hôpitaux de Paris, DSI WIND, Web Innovation Données, Paris, France
- Hôpital Bichat - Claude-Bernard, Clinical Research Unit, France
| | - Jean-François Gautier
- Cordeliers Research Centre, ImMeDiab team, INSERM, Université de Paris, Paris, France
- GH Lariboisiere Fernand-Widal, AP-HP, Department of Diabetes and Endocrinology, Paris, France. Cordeliers Research Centre, INSERM, ImMeDiab team, Paris, France
| | - Etienne Larger
- Hospital Cochin, APHP, Diabetology Department, Paris, France. Université de Paris, Paris, France
| | - Emmanuel Cosson
- Hospital Avicenne, APHP, Department of Endocrinology-Diabetology-Nutrition, CRNH-IdF, CINFO, Bobigny, France
- Université Sorbonne Paris Cité, UMR U557 INSERM/U11125 INRAE, Unité de Recherche Epidémiologique Nutritionnelle, Bobigny, France
| | - Bruno Fève
- Hôpital Saint-Antoine, Department of Endocrinology-Diabetology, APHP, Institut Hospitalo-Universitaire ICAN, Paris, France. Sorbonne Université, INSERM, UMR_S938, CRMR PRISIS, Paris, France
| | - Philippe Chanson
- Hôpital Bicêtre, APHP, Service d’Endocrinologie et des Maladies de la Reproduction Le Kremlin-Bicetre, France. Université Paris-Saclay, Inserm, Physiologie et Physiopathologie Endocriniennes, Le Kremlin-Bicetre, France
| | - Sébastien Czernichow
- Hôpital Européen Georges Pompidou Cancérologie, Service de Nutrition, Centre Spécialisé Obésité, Paris, France. Université de Paris, INSERM, UMR1153, Epidemiology and Biostatistics Sorbonne Paris Cité Centre (CRESS), Paris, France
| | - Sopio Tatulashvili
- Hospital Avicenne, AP-HP, Department of Endocrinology-Diabetology-Nutrition Bobigny, France. Université Sorbonne Paris Cité, Epidemiology and Biostatistics Research Center, Nutritional Epidemiology Research Team (EREN), Inserm U1153, INRA U1125 Bobigny, France
| | - Marie-Laure Raffin-Sanson
- Hospital Ambroise Paré, APHP, Service d'Endocrinologie Diabétologie et Nutrition, Boulogne-Billancourt, France. Université de Versailles Saint-Quentin-en-Yvelines Versailles, France
| | - Muriel Bourgeon
- Hôpital Antoine-Béclère, APHP, Service de Médecine Interne, Clamart, France
| | | | - Agnès Hartemann
- Sorbonne Université, Institute of Cardiometabolism and Nutrition ICAN, Paris, France. University Hospital Pitié Salpêtrière, APHP, Diabetes Department, Paris, France
| | - Christel Daniel
- Assistance Publique-Hôpitaux de Paris, DSI WIND, Web Innovation Données, Paris, France
- Sorbonne Université, University Paris 13, Sorbonne Paris Cité, INSERM UMR_S 1142, Paris, France
| | - Thomas Moreau
- Université Paris-Saclay, Inria, CEA, Palaiseau, France
| | - Ronan Roussel
- Cordeliers Research Centre, ImMeDiab team, INSERM, Université de Paris, Paris, France
- Hôpital Bichat - Claude-Bernard, APHP, Department of Diabetology, Paris, France
| | - Louis Potier
- Cordeliers Research Centre, ImMeDiab team, INSERM, Université de Paris, Paris, France
- Hôpital Bichat - Claude-Bernard, APHP, Department of Diabetology, Paris, France
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9
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Phan F, Bourron O, Laroche S, Jeannin AC, Hartemann A. Euglycaemic diabetic ketosis decompensation under dapagliflozin in a patient with MODY3. Diabetes Metab 2021; 47:101248. [PMID: 33731293 DOI: 10.1016/j.diabet.2021.101248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Revised: 02/12/2021] [Accepted: 03/01/2021] [Indexed: 10/21/2022]
Affiliation(s)
- F Phan
- Sorbonne University; Assistance Publique-Hôpitaux de Paris (APHP), Diabetology Department, La Pitié Salpêtrière-Charles Foix University Hospital, Paris, France; INSERM, UMR_S 1138, Centre de Recherche des Cordeliers, Paris 06; Institute of Cardiometabolism and Nutrition ICAN, Paris, France.
| | - O Bourron
- Sorbonne University; Assistance Publique-Hôpitaux de Paris (APHP), Diabetology Department, La Pitié Salpêtrière-Charles Foix University Hospital, Paris, France; INSERM, UMR_S 1138, Centre de Recherche des Cordeliers, Paris 06; Institute of Cardiometabolism and Nutrition ICAN, Paris, France
| | - S Laroche
- Sorbonne University; Assistance Publique-Hôpitaux de Paris (APHP), Diabetology Department, La Pitié Salpêtrière-Charles Foix University Hospital, Paris, France
| | - A-C Jeannin
- Sorbonne University; Assistance Publique-Hôpitaux de Paris (APHP), Diabetology Department, La Pitié Salpêtrière-Charles Foix University Hospital, Paris, France
| | - A Hartemann
- Sorbonne University; Assistance Publique-Hôpitaux de Paris (APHP), Diabetology Department, La Pitié Salpêtrière-Charles Foix University Hospital, Paris, France; INSERM, UMR_S 1138, Centre de Recherche des Cordeliers, Paris 06; Institute of Cardiometabolism and Nutrition ICAN, Paris, France
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10
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Schubert L, Laroche S, Hartemann A, Bourron O, Phan F. Impaired hypoxic ventilatory drive induced by diabetic autonomic neuropathy, a cause of misdiagnosed severe cardiac events: brief report of two cases. BMC Cardiovasc Disord 2021; 21:140. [PMID: 33731006 PMCID: PMC7967959 DOI: 10.1186/s12872-021-01944-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Accepted: 03/04/2021] [Indexed: 02/08/2023] Open
Abstract
Background Sudden cardiac deaths are twice more frequent in diabetic patients with cardiac autonomic neuropathy. Sudden cardiac death etiologies remain unclear and no recommendations are made to identify factors associated with cardiorespiratory arrest in diabetic patients. We hypothesized, from two clinical cases, that impaired hypoxic ventilatory drive, induced by diabetic autonomic neuropathy, is a cause of misdiagnosed severe cardiac events. Case presentation We describe the cases of two patients with isolated low blood saturation on pulse oximeter during the systematic nurse check-up (77% and 85% respectively) contrasting with the absence of any complaint such as dyspnea, polypnea or other respiratory insufficiency signs observed during the clinical examination. Arterial blood gas measurements subsequently confirmed that blood oxygen saturation was low and both patients were indeed hypoxemic. Patient 1 suffered from vascular overload complicated by cardiac arrest caused by hypoxemia in light of the quick recovery observed after ventilation. Pulmonary edema was diagnosed in patient 2. The common denominator of these 2 cases described in this brief report is the absence of respiratory failure clinical signs contrasting with the presence of confirmed hypoxemia. Also, in both cases, such absence of precursory signs seems to be induced by an impaired ventilatory drive to hypoxemia. This appears to be related to the autonomic diabetic neuropathy encountered in those 2 patients. Conclusions Therefore, we describe, in this brief report, cardiac autonomic neuropathy as a cause of impaired hypoxic ventilatory drive involved in severe acute cardiorespiratory events in two type 1 diabetic patients. We assume that altered response to hypoxemia due to cardiac autonomic neuropathy and non-functional central neurological breathing command could play a key role in sudden deaths among diabetic patients. An important point is that hypoxemia can be easily missed since no clinical signs of respiratory failure are reported in these two clinical cases. Systematic screening of cardiac autonomic neuropathy in diabetic patients and proactive detection of impaired hypoxic ventilatory drive for early management (e.g. treatment of hypoxemia) should be systematically undertaken in diabetic patients to prevent its dramatic consequences such as cardiorespiratory arrest and death.
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Affiliation(s)
- Louis Schubert
- Diabetology Department, Pitié-Salpêtrière-Charles Foix Hospital, AP-HP, 75013, Paris, France
| | - Suzanne Laroche
- Diabetology Department, Pitié-Salpêtrière-Charles Foix Hospital, AP-HP, 75013, Paris, France
| | - Agnès Hartemann
- Diabetology Department, Pitié-Salpêtrière-Charles Foix Hospital, AP-HP, 75013, Paris, France.,Sorbonne Université, Paris, France.,INSERM, UMR_S 1138, Centre de Recherche Des Cordeliers, Paris 06, France.,Institute of Cardiometabolism and Nutrition ICAN, Paris, France
| | - Olivier Bourron
- Diabetology Department, Pitié-Salpêtrière-Charles Foix Hospital, AP-HP, 75013, Paris, France. .,Sorbonne Université, Paris, France. .,INSERM, UMR_S 1138, Centre de Recherche Des Cordeliers, Paris 06, France. .,Institute of Cardiometabolism and Nutrition ICAN, Paris, France.
| | - Franck Phan
- Diabetology Department, Pitié-Salpêtrière-Charles Foix Hospital, AP-HP, 75013, Paris, France.,Sorbonne Université, Paris, France.,INSERM, UMR_S 1138, Centre de Recherche Des Cordeliers, Paris 06, France.,Institute of Cardiometabolism and Nutrition ICAN, Paris, France
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11
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Carlier A, Phan F, Szpigel A, Hajduch E, Salem JE, Gautheron J, Le Goff W, Guérin M, Lachkar F, Ratziu V, Hartemann A, Ferré P, Foufelle F, Bourron O. Dihydroceramides in Triglyceride-Enriched VLDL Are Associated with Nonalcoholic Fatty Liver Disease Severity in Type 2 Diabetes. Cell Rep Med 2020; 1:100154. [PMID: 33377125 PMCID: PMC7762772 DOI: 10.1016/j.xcrm.2020.100154] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/06/2020] [Revised: 10/05/2020] [Accepted: 11/17/2020] [Indexed: 02/07/2023]
Abstract
Plasma dihydroceramides are predictors of type 2 diabetes and related to metabolic dysfunctions, but the underlying mechanisms are not characterized. We compare the relationships between plasma dihydroceramides and biochemical and hepatic parameters in two cohorts of diabetic patients. Hepatic steatosis, steatohepatitis, and fibrosis are assessed by their plasma biomarkers. Plasma lipoprotein sphingolipids are studied in a sub-group of diabetic patients. Liver biopsies from subjects with suspected non-alcoholic fatty liver disease are analyzed for sphingolipid synthesis enzyme expression. Dihydroceramides, contained in triglyceride-rich very-low-density lipoprotein (VLDL), are associated with steatosis and steatohepatitis. Expression of sphingolipid synthesis enzymes is correlated with histological steatosis and inflammation grades. In conclusion, association of plasma dihydroceramides with nonalcoholic fatty liver might explain their predictive character for type 2 diabetes. Our results suggest a relationship between hepatic sphingolipid metabolism and steatohepatitis and an involvement of dihydroceramides in the synthesis/secretion of triglyceride-rich VLDL, a hallmark of NAFLD and type 2 diabetes dyslipidemia. Plasma dihydroceramides are associated with NAFLD severity in type 2 diabetic patients Plasma dihydroceramides are found in triglyceride-enriched VLDL A role for dihydroceramide in triglyceride-rich VLDL synthesis/secretion is suggested Expression of enzymes of hepatic sphingolipid synthesis increases with NAFLD severity
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Affiliation(s)
- Aurélie Carlier
- Centre de Recherche des Cordeliers, INSERM, Sorbonne Université, Université de Paris, 75006 Paris, France.,Sorbonne Université, Assistance Publique-Hôpitaux de Paris, Diabetes Department, Hospital Pitié-Salpêtrière, 75013 Paris, France
| | - Franck Phan
- Centre de Recherche des Cordeliers, INSERM, Sorbonne Université, Université de Paris, 75006 Paris, France.,Sorbonne Université, Assistance Publique-Hôpitaux de Paris, Diabetes Department, Hospital Pitié-Salpêtrière, 75013 Paris, France
| | - Anaïs Szpigel
- Centre de Recherche des Cordeliers, INSERM, Sorbonne Université, Université de Paris, 75006 Paris, France
| | - Eric Hajduch
- Centre de Recherche des Cordeliers, INSERM, Sorbonne Université, Université de Paris, 75006 Paris, France.,Institute of Cardiometabolism and Nutrition, ICAN, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Joe-Elie Salem
- Institute of Cardiometabolism and Nutrition, ICAN, Assistance Publique-Hôpitaux de Paris, Paris, France.,Sorbonne Université, Assistance Publique-Hôpitaux de Paris, CIC Paris-Est, Hospital Pitié-Salpêtrière, 75013 Paris, France
| | - Jérémie Gautheron
- Institute of Cardiometabolism and Nutrition, ICAN, Assistance Publique-Hôpitaux de Paris, Paris, France.,Centre de Recherche Saint-Antoine, INSERM, Sorbonne Université, 75012 Paris, France
| | - Wilfried Le Goff
- Institute of Cardiometabolism and Nutrition, ICAN, Assistance Publique-Hôpitaux de Paris, Paris, France.,UMR ICAN, INSERM, Sorbonne Université, 75013 Paris, France
| | - Maryse Guérin
- Institute of Cardiometabolism and Nutrition, ICAN, Assistance Publique-Hôpitaux de Paris, Paris, France.,UMR ICAN, INSERM, Sorbonne Université, 75013 Paris, France
| | - Floriane Lachkar
- Centre de Recherche des Cordeliers, INSERM, Sorbonne Université, Université de Paris, 75006 Paris, France
| | - Vlad Ratziu
- Centre de Recherche des Cordeliers, INSERM, Sorbonne Université, Université de Paris, 75006 Paris, France.,Institute of Cardiometabolism and Nutrition, ICAN, Assistance Publique-Hôpitaux de Paris, Paris, France.,Sorbonne Université, Assistance Publique-Hôpitaux de Paris, Hepatology Department, Hospital Pitié-Salpêtrière, 75013 Paris, France
| | - Agnès Hartemann
- Centre de Recherche des Cordeliers, INSERM, Sorbonne Université, Université de Paris, 75006 Paris, France.,Sorbonne Université, Assistance Publique-Hôpitaux de Paris, Diabetes Department, Hospital Pitié-Salpêtrière, 75013 Paris, France.,Institute of Cardiometabolism and Nutrition, ICAN, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Pascal Ferré
- Centre de Recherche des Cordeliers, INSERM, Sorbonne Université, Université de Paris, 75006 Paris, France.,Institute of Cardiometabolism and Nutrition, ICAN, Assistance Publique-Hôpitaux de Paris, Paris, France.,Assistance Publique-Hôpitaux de Paris, Oncology and endocrine biochemistry Department, Hospital Pitié-Salpêtrière, 75013 Paris, France
| | - Fabienne Foufelle
- Centre de Recherche des Cordeliers, INSERM, Sorbonne Université, Université de Paris, 75006 Paris, France.,Institute of Cardiometabolism and Nutrition, ICAN, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Olivier Bourron
- Centre de Recherche des Cordeliers, INSERM, Sorbonne Université, Université de Paris, 75006 Paris, France.,Sorbonne Université, Assistance Publique-Hôpitaux de Paris, Diabetes Department, Hospital Pitié-Salpêtrière, 75013 Paris, France.,Institute of Cardiometabolism and Nutrition, ICAN, Assistance Publique-Hôpitaux de Paris, Paris, France
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12
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Amouyal C, Klatzmann D, Tibi E, Salem JE, Halbron M, Popelier M, Jacqueminet S, Ciangura C, Bourron O, Andreelli F, Hartemann A, Rosenzwajg M. Pregnant type 1 diabetes women with rises in C-peptide display higher levels of regulatory T cells: A pilot study. Diabetes Metab 2020; 47:101188. [PMID: 32891755 DOI: 10.1016/j.diabet.2020.04.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Revised: 04/21/2020] [Accepted: 04/22/2020] [Indexed: 10/23/2022]
Abstract
AIM During pregnancy of type 1 diabetes (T1D) women, a C peptide rise has been described, which mechanism is unclear. In T1D, a defect of regulatory T cells (Tregs) and its major controlling cytokine, interleukin-2 (IL2), is observed. METHODS Evolution of clinical, immunological (Treg (CD4+CD25hiCD127-/loFoxp3+ measured by flow cytometry and IL2 measured by luminex xMAP technology) and diabetes parameters (insulin dose per day, HbA1C, glycaemia, C peptide) was evaluated in 13 T1D women during the three trimesters of pregnancy and post-partum (PP, within 6 months) in a monocentric pilot study. Immunological parameters were compared with those of a healthy pregnant cohort (QuTe). RESULTS An improvement of beta cell function (C peptide rise and/or a decrease of insulin dose-adjusted A1c index that estimate individual exogenous insulin need) was observed in seven women (group 1) whereas the six others (group 2) did not display any positive response to pregnancy. A higher level of Tregs and IL2 was observed in group 1 compared to group 2 during pregnancy and at PP for Tregs level. However, compared to the healthy cohort, T1D women displayed a Treg deficiency CONCLUSION: This pilot study highlights that higher level of Tregs and IL2 seem to allow improvement of endogenous insulin secretion of T1D women during pregnancy.
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Affiliation(s)
- C Amouyal
- AP-HP, Pitié-Salpêtrière Hospital, Diabetology Department, F-75013 Paris, France; Sorbonne Université, Nutrition and Obesities: Systemic Approaches (NutriOmics) Research Unit, UMRS U1269, Paris, France.
| | - D Klatzmann
- AP-HP, Pitié-Salpêtrière Hospital, Biotherapy (CIC-BTi) and Inflammation-Immunopathology-Biotherapy Department (I2B), Sorbonne Université, Paris, France; Sorbonne Université, INSERM, UMR_S 959, Immunology-Immunopathology-Immunotherapy (i3), Paris, France
| | - E Tibi
- AP-HP, Pitié-Salpêtrière Hospital, Biotherapy (CIC-BTi) and Inflammation-Immunopathology-Biotherapy Department (I2B), Sorbonne Université, Paris, France
| | - J-E Salem
- Clinical Investigation Centre Paris-Est, CIC-1421, UNICO-GRECO Cardio-oncology Program, INSERM, Department of Pharmacology, Sorbonne Université, Paris, France; Department of Medicine and Pharmacology, Cardio-oncology Program, Vanderbilt University Medical Center, Nashville, TN, USA
| | - M Halbron
- AP-HP, Pitié-Salpêtrière Hospital, Diabetology Department, F-75013 Paris, France
| | - M Popelier
- AP-HP, Pitié-Salpêtrière Hospital, Diabetology Department, F-75013 Paris, France
| | - S Jacqueminet
- AP-HP, Pitié-Salpêtrière Hospital, Diabetology Department, F-75013 Paris, France
| | - C Ciangura
- AP-HP, Pitié-Salpêtrière Hospital, Diabetology Department, F-75013 Paris, France
| | - O Bourron
- AP-HP, Pitié-Salpêtrière Hospital, Diabetology Department, F-75013 Paris, France; Sorbonne Université, INSERM, UMR_S 1138, Centre de Recherche des Cordeliers, Institute of Cardiometabolism and Nutrition, Paris, France
| | - F Andreelli
- AP-HP, Pitié-Salpêtrière Hospital, Diabetology Department, F-75013 Paris, France; Sorbonne Université, Nutrition and Obesities: Systemic Approaches (NutriOmics) Research Unit, UMRS U1269, Paris, France
| | - A Hartemann
- AP-HP, Pitié-Salpêtrière Hospital, Diabetology Department, F-75013 Paris, France; Sorbonne Université, INSERM, UMR_S 1138, Centre de Recherche des Cordeliers, Institute of Cardiometabolism and Nutrition, Paris, France
| | - M Rosenzwajg
- AP-HP, Pitié-Salpêtrière Hospital, Biotherapy (CIC-BTi) and Inflammation-Immunopathology-Biotherapy Department (I2B), Sorbonne Université, Paris, France; Sorbonne Université, INSERM, UMR_S 959, Immunology-Immunopathology-Immunotherapy (i3), Paris, France
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13
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Rosenzwajg M, Salet R, Lorenzon R, Tchitchek N, Roux A, Bernard C, Carel JC, Storey C, Polak M, Beltrand J, Amouyal C, Hartemann A, Corbeau P, Vicaut E, Bibal C, Bougnères P, Tran TA, Klatzmann D. Low-dose IL-2 in children with recently diagnosed type 1 diabetes: a Phase I/II randomised, double-blind, placebo-controlled, dose-finding study. Diabetologia 2020; 63:1808-1821. [PMID: 32607749 DOI: 10.1007/s00125-020-05200-w] [Citation(s) in RCA: 45] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2019] [Accepted: 05/06/2020] [Indexed: 12/21/2022]
Abstract
AIMS/HYPOTHESIS Low-dose IL-2 (ld-IL2) selectively activates and expands regulatory T cells (Tregs) and thus has the potential to skew the regulatory/effector T (Treg/Teff) cell balance towards improved regulation. We investigated which low doses of IL-2 would more effectively and safely activate Tregs during a 1 year treatment in children with recently diagnosed type 1 diabetes. METHODS Dose Finding Study of IL-2 at Ultra-low Dose in Children With Recently Diagnosed Type 1 Diabetes (DF-IL2-Child) was a multicentre, double-blinded, placebo-controlled, dose-finding Phase I/II clinical trial conducted in four centres at university hospitals in France: 24 children (7-14 years old) with type 1 diabetes diagnosed within the previous 3 months were randomly assigned 1:1:1:1 to treatment by a centralised randomisation system, leading to a 7/5/6/6 patient distribution of placebo or IL-2 at doses of 0.125, 0.250 or 0.500 million international units (MIU)/m2, given daily for a 5 day course and then fortnightly for 1 year. A study number was attributed to patients by an investigator unaware of the randomisation list and all participants as well as investigators and staff involved in the study conduct and analyses were blinded to treatments. The primary outcome was change in Tregs, expressed as a percentage of CD4+ T cells at day 5. It pre-specified that a ≥60% increase in Tregs from baseline would identify Treg high responders. RESULTS There were no serious adverse events. Non-serious adverse events (NSAEs) were transient and mild to moderate. In treated patients vs placebo, the commonest NSAE was injection site reaction (37.9% vs 3.4%), whereas other NSAEs were at the same level (23.3% vs 19.2%). ld-IL2 induced a dose-dependent increase in the mean proportion of Tregs, from 23.9% (95% CI -11.8, 59.6) at the lowest to 77.2% (44.7, 109.8) at the highest dose, which was significantly different from placebo for all dose groups. However, the individual Treg responses to IL-2 were variable and fluctuated over time. Seven patients, all among those treated with the 0.250 and 0.500 MIU m-2 day-1 doses, were Treg high responders. At baseline, they had lower Treg proportions in CD4+ cells than Treg low responders, and serum soluble IL-2 receptor α (sIL-2RA) and vascular endothelial growth factor receptor 2 (VEGFR2) levels predicted the Treg response after the 5 day course. There was no significant change in glycaemic control in any of the dose groups compared with placebo. However, there was an improved maintenance of induced C-peptide production at 1 year in the seven Treg high responders as compared with low responders. CONCLUSIONS/INTERPRETATION The safety profile at all doses, the dose-dependent effects on Tregs and the observed variability of the Treg response to ld-IL2 in children with newly diagnosed type 1 diabetes call for use of the highest dose in future developments. The better preservation of insulin production in Treg high responders supports the potential of Tregs in regulating autoimmunity in type 1 diabetes, and warrants pursuing the investigation of ld-IL2 for its treatment and prevention. TRIAL REGISTRATION ClinicalTrials.gov NCT01862120. FUNDING Assistance Publique-Hôpitaux de Paris, Investissements d'Avenir programme (ANR-11-IDEX-0004-02, LabEx Transimmunom and ANR-16-RHUS-0001, RHU iMAP) and European Research Council Advanced Grant (FP7-IDEAS-ERC-322856, TRiPoD).
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Affiliation(s)
- Michelle Rosenzwajg
- Clinical Investigation Center for Biotherapies and Inflammation-Immunopathology-Biotherapy Department (i2B), AP-HP.Sorbonne Université, Pitié-Salpêtrière Hospital, 83 Bd de l'Hôpital, F-75013, Paris, France
- UMR_S 959, Immunology-Immunopathology-Immunotherapy (i3), Sorbonne Université and Inserm, Paris, France
| | - Randa Salet
- Department of Paediatrics, Nîmes University Hospital and Inserm U1183, Montpellier University, Montpellier, France
| | - Roberta Lorenzon
- Clinical Investigation Center for Biotherapies and Inflammation-Immunopathology-Biotherapy Department (i2B), AP-HP.Sorbonne Université, Pitié-Salpêtrière Hospital, 83 Bd de l'Hôpital, F-75013, Paris, France
- UMR_S 959, Immunology-Immunopathology-Immunotherapy (i3), Sorbonne Université and Inserm, Paris, France
| | - Nicolas Tchitchek
- Clinical Investigation Center for Biotherapies and Inflammation-Immunopathology-Biotherapy Department (i2B), AP-HP.Sorbonne Université, Pitié-Salpêtrière Hospital, 83 Bd de l'Hôpital, F-75013, Paris, France
- UMR_S 959, Immunology-Immunopathology-Immunotherapy (i3), Sorbonne Université and Inserm, Paris, France
| | - Alexandra Roux
- Clinical Investigation Center for Biotherapies and Inflammation-Immunopathology-Biotherapy Department (i2B), AP-HP.Sorbonne Université, Pitié-Salpêtrière Hospital, 83 Bd de l'Hôpital, F-75013, Paris, France
- UMR_S 959, Immunology-Immunopathology-Immunotherapy (i3), Sorbonne Université and Inserm, Paris, France
| | - Claude Bernard
- Clinical Investigation Center for Biotherapies and Inflammation-Immunopathology-Biotherapy Department (i2B), AP-HP.Sorbonne Université, Pitié-Salpêtrière Hospital, 83 Bd de l'Hôpital, F-75013, Paris, France
- UMR_S 959, Immunology-Immunopathology-Immunotherapy (i3), Sorbonne Université and Inserm, Paris, France
| | - Jean-Claude Carel
- Department of Paediatric Endocrinology and Diabetology, and Centre de Référence des Pathologies Rares de l'Insulino-Sécrétion et de l'Insulino-Sensibilité, Robert-Debré Hospital, AP-HP Nord-Université de Paris Diderot & UFR de Médecine Paris Diderot, Paris, France
| | - Caroline Storey
- Department of Paediatric Endocrinology and Diabetology, and Centre de Référence des Pathologies Rares de l'Insulino-Sécrétion et de l'Insulino-Sensibilité, Robert-Debré Hospital, AP-HP Nord-Université de Paris Diderot & UFR de Médecine Paris Diderot, Paris, France
| | - Michel Polak
- Department of Paediatric Endocrinology, Gynecology and Diabetology, and Centre de Référence des Pathologies Rares de l'Insulino-Sécrétion et de l'Insulino-Sensibilité, Necker Enfants Malades Hospital, AP-HP.Centre & Université de Paris, UFR de Médecine Paris Descartes, Paris, France
| | - Jacques Beltrand
- Department of Paediatric Endocrinology, Gynecology and Diabetology, and Centre de Référence des Pathologies Rares de l'Insulino-Sécrétion et de l'Insulino-Sensibilité, Necker Enfants Malades Hospital, AP-HP.Centre & Université de Paris, UFR de Médecine Paris Descartes, Paris, France
| | - Chloé Amouyal
- Department of Diabetology, Pitié-Salpêtrière Hospital, AP-HP. Sorbonne Université, Paris, France
| | - Agnès Hartemann
- Department of Diabetology, Pitié-Salpêtrière Hospital, AP-HP. Sorbonne Université, Paris, France
| | - Pierre Corbeau
- Immunology Department, Nîmes University Hospital, Nîmes, France
| | - Eric Vicaut
- Lariboisière Hospital, Clinical Trial Unit, AP-HP.Nord, Paris, France
| | - Cecile Bibal
- Department of Paediatric Endocrinology, Bicêtre Hospital, AP-HP.Université Paris Saclay, Le Kremlin-Bicêtre, France
| | - Pierre Bougnères
- Department of Paediatric Endocrinology, Bicêtre Hospital, AP-HP.Université Paris Saclay, Le Kremlin-Bicêtre, France
| | - Tu-Anh Tran
- Department of Paediatrics, Nîmes University Hospital and Inserm U1183, Montpellier University, Montpellier, France
| | - David Klatzmann
- Clinical Investigation Center for Biotherapies and Inflammation-Immunopathology-Biotherapy Department (i2B), AP-HP.Sorbonne Université, Pitié-Salpêtrière Hospital, 83 Bd de l'Hôpital, F-75013, Paris, France.
- UMR_S 959, Immunology-Immunopathology-Immunotherapy (i3), Sorbonne Université and Inserm, Paris, France.
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14
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Hyafil F, Chequer R, Sorbets E, Estellat C, Ducrocq G, Rouzet F, Alfaiate T, Regaieg H, Abtan J, Leygnac S, Milliner M, Imbert L, Burg S, Ben Azzouna R, Potier L, Laouénan C, Quintin C, Roussel R, Hartemann A, Montalescot G, Marie PY, Steg G, Le Guludec D. Head-to-head comparison of the diagnostic performances of Rubidium-PET and SPECT with CZT camera for the detection of myocardial ischemia in a population of women and overweight individuals. J Nucl Cardiol 2020; 27:755-768. [PMID: 30574676 DOI: 10.1007/s12350-018-01557-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2018] [Accepted: 11/11/2018] [Indexed: 12/23/2022]
Abstract
BACKGROUND The aim of this study was to compare the diagnostic performances for the detection of myocardial ischemia of 82-Rb-PET-MPS and 99m-Tc-SPECT-MPS in overweight individuals and women. METHODS AND RESULTS Men with BMI ≥ 25 and women referred for MPS were considered for inclusion. All individuals underwent 99m-Tc-SPECT-MPS with CZT cameras and 82-Rb-PET-MPS in 3D-mode. Individuals with at least one positive MPS were referred for coronary angiography (CA) with FFR measurements. A criterion for positivity was a composite endpoint including significant stenosis on CA or, in the absence of CA, the occurrence of acute coronary event during the following year. 313 patients (46% women) with mean BMI of 31.8 ± 6.5 were included. Sensitivity for the detection of myocardial ischemia was higher with 82-Rb-PET-MPS compared with 99m-Tc-SPECT-MPS (85% vs. 57%, P < .05); specificity was equally high with both imaging techniques (93% vs. 94%, P > .05). 82-Rb-PET allowed for a more accurate detection of patients with a high-risk coronary artery disease (HR-CAD) than 99m-Tc-SPECT-MPS (AUC = 0.86 vs. 0.75, respectively; P = .04). CONCLUSIONS In women and overweight individuals, 82-Rb-PET-MPS provides higher sensitivity for the detection of myocardial ischemia than 99m-Tc-SPECT-MPS thanks to a better image quality and an improved detection of HR-CAD.
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Affiliation(s)
- Fabien Hyafil
- Department of Nuclear Medicine, Bichat University Hospital, AP-HP, University Diderot, 75018, Paris, France.
- INSERM, U-1148, DHU FIRE, University Diderot, 75018, Paris, France.
| | - Renata Chequer
- Department of Nuclear Medicine, Bichat University Hospital, AP-HP, University Diderot, 75018, Paris, France
| | - Emmanuel Sorbets
- Department of Cardiology, Avicenne University Hospital, AP-HP, University Paris 13, 9300, Bobigny, France
| | - Candice Estellat
- Département de Biostatistiques, Hôpital Pitié-Salpêtrière, AP-HP, Santé Publique et Informatique Médicale, 75013, Paris, France
- INSERM, CIC-EC 1425, ECEVE UMR 1123, 75018, Paris, France
| | - Gregory Ducrocq
- INSERM, U-1148, DHU FIRE, University Diderot, 75018, Paris, France
- Department of Cardiology, Bichat University Hospital, AP-HP, 75018, Paris, France
- French Alliance for Cardiovascular Trials, and F-CRIN Network, Paris, France
| | - François Rouzet
- Department of Nuclear Medicine, Bichat University Hospital, AP-HP, University Diderot, 75018, Paris, France
- INSERM, U-1148, DHU FIRE, University Diderot, 75018, Paris, France
| | - Toni Alfaiate
- Département d'Epidémiologie, Hôpital Bichat, AP-HP, Biostatistique et Recherche Clinique, 75018, Paris, France
| | - Hamza Regaieg
- Department of Nuclear Medicine, Bichat University Hospital, AP-HP, University Diderot, 75018, Paris, France
| | - Jérémie Abtan
- Department of Cardiology, Bichat University Hospital, AP-HP, 75018, Paris, France
- French Alliance for Cardiovascular Trials, and F-CRIN Network, Paris, France
| | - Sébastien Leygnac
- Department of Nuclear Medicine, Bichat University Hospital, AP-HP, University Diderot, 75018, Paris, France
- INSERM, U-1148, DHU FIRE, University Diderot, 75018, Paris, France
| | - Milan Milliner
- Department of Nuclear Medicine, Bichat University Hospital, AP-HP, University Diderot, 75018, Paris, France
- INSERM, U-1148, DHU FIRE, University Diderot, 75018, Paris, France
| | - Laetitia Imbert
- Department of Nuclear Medicine, Brambois University Hospital, Lorraine University, 54500, Vandœuvre-Lès-Nancy, France
| | - Samuel Burg
- Department of Nuclear Medicine, Bichat University Hospital, AP-HP, University Diderot, 75018, Paris, France
- INSERM, U-1148, DHU FIRE, University Diderot, 75018, Paris, France
| | - Rana Ben Azzouna
- Department of Nuclear Medicine, Bichat University Hospital, AP-HP, University Diderot, 75018, Paris, France
- INSERM, U-1148, DHU FIRE, University Diderot, 75018, Paris, France
| | - Louis Potier
- Department of Diabetology, DHU FIRE, Bichat University Hospital, AP-HP, University Diderot, 75018, Paris, France
| | - Cédric Laouénan
- Département d'Epidémiologie, Hôpital Bichat, AP-HP, Biostatistique et Recherche Clinique, 75018, Paris, France
| | - Caroline Quintin
- Département d'Epidémiologie, Hôpital Bichat, AP-HP, Biostatistique et Recherche Clinique, 75018, Paris, France
| | - Ronan Roussel
- Department of Diabetology, DHU FIRE, Bichat University Hospital, AP-HP, University Diderot, 75018, Paris, France
| | - Agnès Hartemann
- Department of Diabetology, Pitié-Salpétriêre University Hospital, AP-HP, Sorbonne University Paris 6, 75006, Paris, France
| | - Gilles Montalescot
- ACTION Study Group, Department of Cardiology, Pitié-Salpétriêre, Sorbonne Université-Paris 6, 75006, Paris, France
| | - Pierre-Yves Marie
- Department of Nuclear Medicine, Brambois University Hospital, Lorraine University, 54500, Vandœuvre-Lès-Nancy, France
| | - Gabriel Steg
- INSERM, U-1148, DHU FIRE, University Diderot, 75018, Paris, France
- Department of Cardiology, Bichat University Hospital, AP-HP, 75018, Paris, France
- French Alliance for Cardiovascular Trials, and F-CRIN Network, Paris, France
| | - Dominique Le Guludec
- Department of Nuclear Medicine, Bichat University Hospital, AP-HP, University Diderot, 75018, Paris, France
- INSERM, U-1148, DHU FIRE, University Diderot, 75018, Paris, France
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15
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Jeannin AC, Salem JE, Massy Z, Aubert CE, Vemeer C, Amouyal C, Phan F, Halbron M, Funck-Brentano C, Hartemann A, Bourron O. Inactive matrix gla protein plasma levels are associated with peripheral neuropathy in Type 2 diabetes. PLoS One 2020; 15:e0229145. [PMID: 32092076 PMCID: PMC7039520 DOI: 10.1371/journal.pone.0229145] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2019] [Accepted: 01/30/2020] [Indexed: 02/06/2023] Open
Abstract
AIMS/HYPOTHESIS Diabetic peripheral neuropathy is a frequent and severe complication of diabetes. As Matrix-gla-protein (MGP) is expressed in several components of the nervous system and is involved in some neurological disease, MGP could play a role in peripheral nervous system homeostasis. The aim of this study was to evaluate factors associated with sensitive diabetic neuropathy in Type 2 Diabetes, and, in particular, dephospho-uncarboxylated MGP (dp-ucMGP), the inactive form of MGP. METHODS 198 patients with Type 2 Diabetes were included. Presence of sensitive diabetic neuropathy was defined by a neuropathy disability score (NDS) ≥6. Plasma levels of dp-ucMGP were measured by ELISA. RESULTS In this cohort, the mean age was 64+/-8.4 years old, and 80% of patients were men. Peripheral neuropathy was present in 15.7% of the patients and was significantly associated (r = 0.51, p<0.0001) with dp-ucMGP levels (β = -0.26, p = 0.045) after integrating effects of height (β = -0.38, p = 0.01), insulin treatment (β = 0.42, p = 0.002), retinopathy treated by laser (β = 0.26, p = 0.02), and total cholesterol levels (β = 0.3, p = 0.03) by multivariable analysis. CONCLUSIONS The association between diabetic neuropathy and the inactive form of MGP suggests the existence of new pathophysiological pathways to explore. Further studies are needed to determine if dp-ucMGP may be used as a biomarker of sensitive neuropathy. Since dp-ucMGP is a marker of poor vitamin K status, clinical studies are warranted to explore the potential protective effect of high vitamin K intake on diabetic peripheral neuropathy.
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Affiliation(s)
- Anne-Caroline Jeannin
- Sorbonne Université, Paris, France
- Assistance Publique-Hôpitaux de Paris (APHP), Diabetology Department, Pitié-Salpêtrière Hospital, Paris, France
| | - Joe-Elie Salem
- Sorbonne Université, Paris, France
- Department of Pharmacology and CIC-1421, AP-HP, Pitié-Salpêtrière Hospital, Paris, France
- INSERM, CIC-1421, Paris, France
- Institute of Cardiometabolism and Nutrition ICAN, Paris, France
| | - Ziad Massy
- Division of Nephrology, Ambroise Paré Hospital, AP-HP, Pitié-Salpêtrière Hospital, Université Paris-Saclay, Paris, France
| | - Carole Elodie Aubert
- Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland
| | - Cees Vemeer
- Cardiovascular Research Institute CARIM, Maastricht University, Maastricht, The Netherlands
| | - Chloé Amouyal
- Sorbonne Université, Paris, France
- Assistance Publique-Hôpitaux de Paris (APHP), Diabetology Department, Pitié-Salpêtrière Hospital, Paris, France
- Institute of Cardiometabolism and Nutrition ICAN, Paris, France
| | - Franck Phan
- Sorbonne Université, Paris, France
- Assistance Publique-Hôpitaux de Paris (APHP), Diabetology Department, Pitié-Salpêtrière Hospital, Paris, France
- Institute of Cardiometabolism and Nutrition ICAN, Paris, France
- INSERM, UMR_S 1138, Centre de Recherche des Cordeliers, Paris, France
| | - Marine Halbron
- Sorbonne Université, Paris, France
- Assistance Publique-Hôpitaux de Paris (APHP), Diabetology Department, Pitié-Salpêtrière Hospital, Paris, France
- Institute of Cardiometabolism and Nutrition ICAN, Paris, France
| | - Christian Funck-Brentano
- Sorbonne Université, Paris, France
- Department of Pharmacology and CIC-1421, AP-HP, Pitié-Salpêtrière Hospital, Paris, France
- INSERM, CIC-1421, Paris, France
- Institute of Cardiometabolism and Nutrition ICAN, Paris, France
| | - Agnès Hartemann
- Sorbonne Université, Paris, France
- Assistance Publique-Hôpitaux de Paris (APHP), Diabetology Department, Pitié-Salpêtrière Hospital, Paris, France
- Institute of Cardiometabolism and Nutrition ICAN, Paris, France
- INSERM, UMR_S 1138, Centre de Recherche des Cordeliers, Paris, France
| | - Olivier Bourron
- Sorbonne Université, Paris, France
- Assistance Publique-Hôpitaux de Paris (APHP), Diabetology Department, Pitié-Salpêtrière Hospital, Paris, France
- Institute of Cardiometabolism and Nutrition ICAN, Paris, France
- INSERM, UMR_S 1138, Centre de Recherche des Cordeliers, Paris, France
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16
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Amadou C, Carlier A, Amouyal C, Bourron O, Aubert C, Couture T, Fourniols E, Ha Van G, Rouanet S, Hartemann A. Five-year mortality in patients with diabetic foot ulcer during 2009-2010 was lower than expected. Diabetes Metab 2019; 46:230-235. [PMID: 31400509 DOI: 10.1016/j.diabet.2019.04.010] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/02/2019] [Revised: 04/03/2019] [Accepted: 04/07/2019] [Indexed: 11/24/2022]
Abstract
AIM Mortality rates are decreasing in patients with diabetes. However, as this observation also concerns patients with diabetic foot ulcer (DFU), additional data are needed. For this reason, our study evaluated the 5-year mortality rate in patients with DFU during 2009-2010 and identified risk factors associated with mortality. METHODS Consecutive patients who attended a clinic for new DFU during 2009-2010 were followed until healing and at 1 year. Data on mortality were collected at year 5. Multivariate Cox proportional-hazards model was used to identify mortality risk factors. RESULTS A total of 347 patients were included: mean age was 65±12 years, diabetes duration was 16 [10; 27] years; 13% were on dialysis; and 7% had an organ transplant. At 5 years, 49 patients (14%) were considered lost to follow-up. Total mortality rate at 5 years was 35%, and 16% in patients with neuropathy. On multivariate analyses, mortality was positively associated with: age [hazard ratio (HR): 1.05 (1.03-1.07), P<0.0001]; duration of diabetes [HR: 1.02 (1.001-1.03], P=0.03]; PEDIS perfusion grade 2 vs. 1 [HR: 2.35 (1.28-4.29), P=0.006)]; PEDIS perfusion grade 3 vs. 1 [HR: 3.14 (1.58-6.24), P=0.001); and ulcer duration at year 1 [HR 2.09 (1.35-3.22), P=0.0009]. CONCLUSION Mortality rates were not as high as expected despite the large number of comorbidities, suggesting that progress has been made in the health management of these patients. In particular, patients with neuropathic foot ulcer had a survival rate of 84% at 5 years.
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Affiliation(s)
- C Amadou
- Diabetology department, Pitié-Salpêtrière Hospital, AP-HP, 83, boulevard de l'Hôpital, 75013 Paris, France
| | - A Carlier
- Diabetology department, Pitié-Salpêtrière Hospital, AP-HP, 83, boulevard de l'Hôpital, 75013 Paris, France; Inserm, CIC-1421, Department of Pharmacology, Pitié-Salpêtrière Hospital, AP-HP, 83, boulevard de l'Hôpital, 75013 Paris, France; Sorbonne Université, 91, boulevard de l'Hôpital, 75013 Paris, France
| | - C Amouyal
- Inserm, Sorbonne-Université, Research Unit on Cardiovascular, Metabolic and Nutrition Diseases (UMRS-1166), Institute of Cardiometabolism and Nutrition, 91, boulevard de l'Hôpital, 75013 Paris, France
| | - O Bourron
- Diabetology department, Pitié-Salpêtrière Hospital, AP-HP, 83, boulevard de l'Hôpital, 75013 Paris, France; Inserm, CIC-1421, Department of Pharmacology, Pitié-Salpêtrière Hospital, AP-HP, 83, boulevard de l'Hôpital, 75013 Paris, France; Sorbonne Université, 91, boulevard de l'Hôpital, 75013 Paris, France
| | - C Aubert
- Department of Internal Medicine, Fribourg Hospital, Fribourg, Switzerland
| | - T Couture
- Sorbonne Université, 91, boulevard de l'Hôpital, 75013 Paris, France; Department of Vascular Surgery, Pitié-Salpêtrière Hospital, AP-HP, 83, boulevard de l'Hôpital, 75013 Paris, France
| | - E Fourniols
- Department of Orthopedic Surgery, Pitié-Salpêtrière Hospital, AP-HP, 83, boulevard de l'Hôpital, 75013 Paris, France
| | - G Ha Van
- Diabetology department, Pitié-Salpêtrière Hospital, AP-HP, 83, boulevard de l'Hôpital, 75013 Paris, France
| | - S Rouanet
- StatEthic SASU, 73, rue Paul-Vaillant-Couturier, 92300 Levallois-Perret, France
| | - A Hartemann
- Diabetology department, Pitié-Salpêtrière Hospital, AP-HP, 83, boulevard de l'Hôpital, 75013 Paris, France; Inserm, CIC-1421, Department of Pharmacology, Pitié-Salpêtrière Hospital, AP-HP, 83, boulevard de l'Hôpital, 75013 Paris, France; Sorbonne Université, 91, boulevard de l'Hôpital, 75013 Paris, France.
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17
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Lázaro-Martínez JL, Edmonds M, Rayman G, Apelqvist J, Van Acker K, Hartemann A, Martini J, Lobmann R, Bohbot S, Kerihuel JC, Piaggesi A. Optimal wound closure of diabetic foot ulcers with early initiation of TLC-NOSF treatment: post-hoc analysis of Explorer. J Wound Care 2019; 28:358-367. [DOI: 10.12968/jowc.2019.28.6.358] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Objective: In March 2018, the Explorer study, an international, double-blind, randomised controlled trial (RCT), established that adding a TLC-NOSF (UrgoStart Contact, Laboratoires Urgo, France) dressing to good local standard of care (SoC) significantly and substantially increases wound closure and reduces the healing time of neuroischaemic diabetic foot ulcers (DFU). Besides the TLC-NOSF treatment, the wound duration was the only other covariate that had an influence on the wound closure rate in the regression model used in the original study. The purpose of this work was to further document the impact of wound duration on the healing outcomes of the DFUs included in the Explorer study and to discuss complementary pragmatic observations on the TLC-NOSF effect. Method: In this post-hoc analysis of the Explorer data, the wound closure rates by week 20 are reported for the global cohort (n=240, Intention-to-treat population) and for the treated (n=126) and control groups (n=114) according to DFU duration and location. Results: For the combined group, wound closure rates decreased with the increase of wound duration at baseline (from 57% in wounds ≤2 months to 19% in wounds >11 months). Whatever the wound duration subgroups analysed, higher closure rates were reported in the TLC-NOSF group than in the control group. However, the maximal difference between the two treatments was reported in wounds with a duration of ≤2 months (71% versus 41%, 30 percentage points difference, Relative Risk 1.7, 95% Confidence Interval 1.1 to 2.8). Regarding wound location subgroup analyses, the outcomes were always in favour of the TLC-NOSF treatment, with closure rates ranging between 43% and 61% within the TLC-NOSF group, and between 25% and 40% within the control group. Conclusion: This clinical evidence supports that treating DFUs with TLC-NOSF dressing and good SoC results in higher wound closure rates than with a neutral dressing and the same good standard of care, whatever the duration and the location of the treated wounds. However, the earlier the TLC-NOSF dressing is initiated in DFU treatment, the greater the benefits.
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Affiliation(s)
| | | | - Gerry Rayman
- The Ipswich Diabetic Foot Unit, Diabetes Centre, The Ipswich Hospital NHS Trust, Ipswich, Suffolk, UK
| | - Jan Apelqvist
- Department of Endocrinology, University Hospital of Malmö, Malmö, Sweden
| | | | - Agnès Hartemann
- Department of Diabetology, Pitié-Salpêtrière University Hospital, Paris, France
| | - Jacques Martini
- Department of Endocrinology, Rangueil University Hospital, Toulouse, France
| | - Ralf Lobmann
- Department of Endocrinology, Diabetology and Geriatrics, Klinikum Stuttgart, Germany
| | - Serge Bohbot
- Medical Affairs Department, Laboratoires URGO, Paris, France
| | | | - Alberto Piaggesi
- Department of Endocrinology and Metabolism, University of Pisa, Pisa, Italy
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Hartemann A. [What management for a diabetic foot ulcer in a GP office]. Rev Prat 2019; 69:626-627. [PMID: 31626418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Affiliation(s)
- Agnès Hartemann
- Service de diabétologie, groupe hôpital de La Pitié-Salpêtrière, AP-HP, Sorbonne Université médecine, Paris, France
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Hartemann A. [Diabetic foot: 10 messages]. Rev Prat 2019; 69:633. [PMID: 31626420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Affiliation(s)
- Agnès Hartemann
- Service de diabétologie, groupe hôpital de La Pitié-Salpêtrière, AP-HP, Sorbonne Université médecine, Paris, France
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Popelier M, Ciangura C, Flahault C, Louot C, Vanier A, Sachon C, Grimaldi A, Malavia M, Hartemann A. Évaluation de deux approches de médecine narrative, le théâtre du vécu et un atelier d’écriture, dans une prise en charge éducative intégrée de patients diabétiques de type 1. ACTA ACUST UNITED AC 2019. [DOI: 10.1051/tpe/2019003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
La détresse émotionnelle liée au diabète impacte la qualité de vie et l’équilibre métabolique ce qui rend indispensable l’exploration du vécu de la maladie. Nous avons comparé 2 approches de médecine narrative, un atelier d’écriture où le patient écrit « une lettre à son diabète » (LAMD) et le « théâtre du vécu » (TDV) où un récit est transformé en une saynète qui est interprétée par des comédiens professionnels, mise en scène par le patient à l’aide du directeur d’acteurs. Deux groupes de patients diabétiques de type 1 hospitalisés dans le cadre d’un séjour d’éducation thérapeutique ont été randomisés dans une session soit avec LAMD (n = 27) soit avec TDV (n = 28). Deux questionnaires portant sur la détresse émotionnelle liée au diabète (PAID) et sur ses représentations du diabète (IPQR) ont été réalisés en début de programme et 3 mois plus tard et les résultats comparés par un test de Wilcoxon apparié. Une analyse qualitative menée par une psychologue a été effectuée chez 11 patients 3 mois après l’intervention. Nous n’avons pas observé de différence significative sur l’évolution du score des questionnaires entre les 2 approches mais l’analyse qualitative suggère un effet positif des 2 processus narratifs, plus marqué pour le TDV.
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Aubert CE, Liabeuf S, Amouyal C, Kemel S, Lajat-Kiss F, Lacorte JM, Halbron M, Carlier A, Salem JE, Funck-Brentano C, Perisic Matic L, Witasp A, Stenvinkel P, Phan F, Massy ZA, Hartemann A, Bourron O. Serum concentration and vascular expression of adiponectin are differentially associated with the diabetic calcifying peripheral arteriopathy. Diabetol Metab Syndr 2019; 11:32. [PMID: 31168327 PMCID: PMC6489190 DOI: 10.1186/s13098-019-0429-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2019] [Accepted: 04/17/2019] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Medial calcification in diabetes contributes to the arterial occlusive process occurring below the knee level. Adiponectin is an adipokine with atheroprotective properties and possible protective role against arterial calcification. The aim of the study was to investigate, in type 2 diabetes, the link between vascular expression and serum concentration of adiponectin and (1) peripheral arterial calcification and (2) lower limb occlusive arterial disease. METHODS Scoring of peripheral vascular calcification and peripheral arterial occlusive disease, using CT-scan and color-duplex ultrasonography respectively, were conducted and explored in relation to serum adiponectin level in a cross sectional study of 197 patients with type 2 diabetes. Vascular adiponectin expression in the arterial wall of diabetic patients with and without medial calcification was evaluated by immunohistochemistry. RESULTS Peripheral arterial calcification score was higher in patients with the highest adiponectin concentration. In a multivariate logistic regression analysis, an increase of 1 µg/mL of adiponectin was associated with a 22% increase of arterial calcification (adjusted OR = 1.22; 95% CI 1.03-1.44; p = 0.02). Arterial occlusive score was also higher in patients with adiponectin concentration > median (2.8 ± 4.8 vs 4.2 ± 5.7, p = 0.034). Immunohistochemical analyses showed a strong and specific staining of adiponectin in smooth muscle cells in calcified arteries, with a more pronounced expression of adiponectin in early stages of medial calcification. CONCLUSIONS Peripheral arterial calcification is positively associated with circulating adiponectin levels in patients with type 2 diabetes, but vascular adiponectin expression is already observed at early stages of calcification. Adiponectin secretion could be a compensatory mechanism against the calcification process.Trial registration DIACART NCT number: NCT02431234. Registered 30 April 2015.
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Affiliation(s)
- Carole E. Aubert
- Assistance Publique-Hôpitaux de Paris (APHP), Diabetology Department, Pitié Salpêtrière Hospital, 47-83 Boulevard de l’Hôpital, Paris, France
| | - Sophie Liabeuf
- INSERM U1088, UFR de Médecine et Pharmacie, Jules Verne University of Picardy, Amiens, France
- Clinical Research Centre, Division of Clinical Pharmacology, Amiens University Hospital and the Jules Verne University of Picardy, Amiens, France
| | - Chloé Amouyal
- Sorbonne Université, UPMC Univ, Paris 06, France
- Assistance Publique-Hôpitaux de Paris (APHP), Diabetology Department, Pitié Salpêtrière Hospital, 47-83 Boulevard de l’Hôpital, Paris, France
- Institute of Cardiometabolism and Nutrition ICAN, Paris, France
| | - Salim Kemel
- Cardiovascular and Interventional Radiology Department, AP-HP, Pitié-Salpêtrière Hospital, Paris, France
| | | | - Jean-Marc Lacorte
- Sorbonne Université, UPMC Univ, Paris 06, France
- Department of Endocrine and Oncologic Biochemistry, AP-HP, Pitié-Salpêtrière Hospital, Paris, France
- Institute of Cardiometabolism and Nutrition ICAN, Paris, France
- INSERM U1166, Paris, France
| | - Marine Halbron
- Assistance Publique-Hôpitaux de Paris (APHP), Diabetology Department, Pitié Salpêtrière Hospital, 47-83 Boulevard de l’Hôpital, Paris, France
- Institute of Cardiometabolism and Nutrition ICAN, Paris, France
| | - Aurélie Carlier
- Sorbonne Université, UPMC Univ, Paris 06, France
- Assistance Publique-Hôpitaux de Paris (APHP), Diabetology Department, Pitié Salpêtrière Hospital, 47-83 Boulevard de l’Hôpital, Paris, France
- Institute of Cardiometabolism and Nutrition ICAN, Paris, France
| | - Joe-Elie Salem
- Sorbonne Université, UPMC Univ, Paris 06, France
- Institute of Cardiometabolism and Nutrition ICAN, Paris, France
- Department of Pharmacology and CIC-1421, AP-HP, AP-HP, Pitié-Salpêtrière Hospital, Paris, France
- INSERM, CIC-1421, Paris, France
| | - Christian Funck-Brentano
- Sorbonne Université, UPMC Univ, Paris 06, France
- Institute of Cardiometabolism and Nutrition ICAN, Paris, France
- Department of Pharmacology and CIC-1421, AP-HP, AP-HP, Pitié-Salpêtrière Hospital, Paris, France
- INSERM, CIC-1421, Paris, France
| | - Ljubica Perisic Matic
- Division of Vascular Surgery, Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
- Center for Molecular Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Anna Witasp
- Center for Molecular Medicine, Karolinska Institutet, Stockholm, Sweden
- Division of Renal Medicine, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
| | - Peter Stenvinkel
- Division of Renal Medicine, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
| | - Franck Phan
- Sorbonne Université, UPMC Univ, Paris 06, France
- Assistance Publique-Hôpitaux de Paris (APHP), Diabetology Department, Pitié Salpêtrière Hospital, 47-83 Boulevard de l’Hôpital, Paris, France
- Institute of Cardiometabolism and Nutrition ICAN, Paris, France
| | - Ziad A. Massy
- Division of Nephrology, Ambroise Paré Hospital, AP-HP, Boulogne-Billancourt, France
- INSERM U1018, Research Centre in Epidemiology and Population Health (CESP) Team 5, University of Paris Saclay-Versailles-St-Quentin-en-Yvelines (UVSQ), Villejuif, France
| | - Agnès Hartemann
- Sorbonne Université, UPMC Univ, Paris 06, France
- Assistance Publique-Hôpitaux de Paris (APHP), Diabetology Department, Pitié Salpêtrière Hospital, 47-83 Boulevard de l’Hôpital, Paris, France
- INSERM, UMR_S 1138, Centre de Recherche des Cordeliers, Paris 06, France
- Institute of Cardiometabolism and Nutrition ICAN, Paris, France
| | - Olivier Bourron
- Sorbonne Université, UPMC Univ, Paris 06, France
- Assistance Publique-Hôpitaux de Paris (APHP), Diabetology Department, Pitié Salpêtrière Hospital, 47-83 Boulevard de l’Hôpital, Paris, France
- INSERM, UMR_S 1138, Centre de Recherche des Cordeliers, Paris 06, France
- Institute of Cardiometabolism and Nutrition ICAN, Paris, France
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Amouyal C, Levy P, Andreelli F, Hartemann A. Acute pancreatitis with dipeptidyl peptidase-4 (DPP4) inhibitor or fulminant type 1 diabetes? Diabetes Metab 2018; 44:95-96. [PMID: 28483292 DOI: 10.1016/j.diabet.2017.03.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/27/2017] [Accepted: 03/28/2017] [Indexed: 06/07/2023]
Affiliation(s)
- C Amouyal
- Department of Diabetology, Assistance publique-Hôpitaux de Paris (AP-HP), Pitié-Salpêtrière Hospital, 75013 Paris, France; Institute of Cardiometabolism and Nutrition, 75013 Paris, France; UMR S1166, Pierre-and-Marie-Curie University-Paris VI, 75013 Paris, France.
| | - P Levy
- Department of Gastroenterology/Pancreatology, Assistance publique-Hôpitaux de Paris (AP-HP), Beaujon Hospital, 92110 Clichy, France; DHU UNITY, Denis Diderot University-Paris VII, 92110 Paris, France
| | - F Andreelli
- Department of Diabetology, Assistance publique-Hôpitaux de Paris (AP-HP), Pitié-Salpêtrière Hospital, 75013 Paris, France; Institute of Cardiometabolism and Nutrition, 75013 Paris, France; UMR S1166, Pierre-and-Marie-Curie University-Paris VI, 75013 Paris, France
| | - A Hartemann
- Department of Diabetology, Assistance publique-Hôpitaux de Paris (AP-HP), Pitié-Salpêtrière Hospital, 75013 Paris, France; Institute of Cardiometabolism and Nutrition, 75013 Paris, France; UMR S938, Pierre-and-Marie-Curie University-Paris VI, 75006 Paris, France
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Azogui-Lévy S, Dray-Spira R, Attal S, Hartemann A, Anagnostou F, Azerad J. Factors associated with oral health-related quality of life in patients with diabetes. Aust Dent J 2018; 63:163-169. [DOI: 10.1111/adj.12577] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/04/2017] [Indexed: 01/01/2023]
Affiliation(s)
- S Azogui-Lévy
- Department of Oral Public Health; Denis-Diderot University - Paris 07; Paris France
- Department of Odontology; Assistance Publique-Hôpitaux de Paris (AP-HP); Pitié-Salpêtrière Hospital; Paris France
| | - R Dray-Spira
- Pierre Louis Institut - Epidemiology and Public Health (IPLESP); Inserm-Pierre et Marie Curie University - Paris 06; Paris France
| | - S Attal
- Department of Oral Public Health; Denis-Diderot University - Paris 07; Paris France
- Department of Odontology; Assistance Publique-Hôpitaux de Paris (AP-HP); Pitié-Salpêtrière Hospital; Paris France
| | - A Hartemann
- Endocrinology, Nutrition and Diabetes Department; Assistance Publique-Hôpitaux de Paris (AP-HP); Pitié-Salpêtrière Hospital; Paris France
- Pierre et Marie Curie University - Paris 06; Paris France
- Institute of Cardiometabolism and Nutrition; Paris France
| | - F Anagnostou
- Department of Odontology; Assistance Publique-Hôpitaux de Paris (AP-HP); Pitié-Salpêtrière Hospital; Paris France
- Department of Periodontology; Denis-Diderot University - Paris 07; Paris France
| | - J Azerad
- Department of Odontology; Assistance Publique-Hôpitaux de Paris (AP-HP); Pitié-Salpêtrière Hospital; Paris France
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Potier L, Chequer R, Roussel R, Mohammedi K, Sismail S, Hartemann A, Amouyal C, Marre M, Le Guludec D, Hyafil F. Relationship between cardiac microvascular dysfunction measured with 82Rubidium-PET and albuminuria in patients with diabetes mellitus. Cardiovasc Diabetol 2018; 17:11. [PMID: 29325551 PMCID: PMC5763541 DOI: 10.1186/s12933-017-0652-1] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2017] [Accepted: 12/23/2017] [Indexed: 12/14/2022] Open
Abstract
Background Albuminuria is of one the strongest predictors of cardiovascular disease (CVD) in diabetes. Diabetes is associated with cardiac microvascular dysfunction (CMD), a powerful, independent prognostic factor for cardiac mortality. The aim of this study was to evaluate the relationship between CMD and microvascular complications in patients without known CVD. Methods In this monocentric study, myocardial flow reserve (MFR) was measured with cardiac 82Rubidium positron emission tomography (Rb-PET) in 311 patients referred to nuclear medicine department of Bichat University Hospital for screening of coronary artery disease from 2012 to 2014. Patients with hemodynamically relevant stenosis on coronary angiography or myocardial ischemia on Rb-PET were excluded. Among patients with diabetes, MFR values were compared according to the presence of retinopathy and albuminuria. Results Overall, 175 patients (118 with type 2 diabetes) were included. MFR was significantly lower in patients with diabetes compared with those without diabetes (2.6 ± 1.1 vs. 3.3 ± 1.7; p < 0.005). In patients with diabetes, MFR decreased progressively in relation to albumin urinary excretion (normoalbuminuria: 2.9 ± 1.1, microalbuminuria: 2.3 ± 1.0, macroalbuminuria: 1.8 ± 0.7; p < 0.0001). MFR was not significantly different in patients with vs. without retinopathy (2.4 ± 1.0 vs. 2.7 ± 1.1, p = 0.07). Microalbuminuria and macroalbuminuria remained strongly associated with impaired MFR after multiple adjustments [odds ratio 2.6 (95% CI 1.1–8.4) and 5.3 (95% CI 1.2–44.7), respectively]. This association was confirmed when analyses were restricted to patients with low levels of coronary calcifications on computed tomography. Conclusions Impaired MFR was more frequent in patients with diabetes and was strongly associated with the degree of albuminuria suggesting that CMD and albuminuria might share common mechanisms. Electronic supplementary material The online version of this article (10.1186/s12933-017-0652-1) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Louis Potier
- Department of Diabetology, Endocrinology and Nutrition, DHU-FIRE, HUPNVS, AP-HP, Paris, France. .,Paris Diderot-Sorbonne Paris Cité University, Paris, France. .,Centre de Recherche des Cordeliers, INSERM, U-1138, Paris, France.
| | - Renata Chequer
- Department of Nuclear Medicine, DHU-FIRE, HUPNVS, AP-HP, Paris, France
| | - Ronan Roussel
- Department of Diabetology, Endocrinology and Nutrition, DHU-FIRE, HUPNVS, AP-HP, Paris, France.,Paris Diderot-Sorbonne Paris Cité University, Paris, France.,Centre de Recherche des Cordeliers, INSERM, U-1138, Paris, France
| | - Kamel Mohammedi
- Department of Diabetology, Endocrinology and Nutrition, DHU-FIRE, HUPNVS, AP-HP, Paris, France.,Paris Diderot-Sorbonne Paris Cité University, Paris, France.,Centre de Recherche des Cordeliers, INSERM, U-1138, Paris, France
| | - Souad Sismail
- Department of Diabetology, Endocrinology and Nutrition, DHU-FIRE, HUPNVS, AP-HP, Paris, France
| | - Agnès Hartemann
- Department of Diabetology-Metabolism, Pitié-Salpêtrière-Charles Foix Hospital, AP-HP, Paris, France.,Pierre and Marie Curie University (UPMC), Sorbonne University, Paris, France.,INSERM U-1166, Institute of Cardiometabolism and Nutrition (ICAN), Paris, France
| | - Chloé Amouyal
- Department of Diabetology-Metabolism, Pitié-Salpêtrière-Charles Foix Hospital, AP-HP, Paris, France.,Pierre and Marie Curie University (UPMC), Sorbonne University, Paris, France.,INSERM U-1166, Institute of Cardiometabolism and Nutrition (ICAN), Paris, France
| | - Michel Marre
- Department of Diabetology, Endocrinology and Nutrition, DHU-FIRE, HUPNVS, AP-HP, Paris, France.,Paris Diderot-Sorbonne Paris Cité University, Paris, France.,Centre de Recherche des Cordeliers, INSERM, U-1138, Paris, France
| | - Dominique Le Guludec
- Paris Diderot-Sorbonne Paris Cité University, Paris, France.,Department of Nuclear Medicine, DHU-FIRE, HUPNVS, AP-HP, Paris, France.,INSERM, U-1148, Paris, France
| | - Fabien Hyafil
- Paris Diderot-Sorbonne Paris Cité University, Paris, France.,Department of Nuclear Medicine, DHU-FIRE, HUPNVS, AP-HP, Paris, France.,INSERM, U-1148, Paris, France
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Hoden L, Dureau P, Funck-Brentano C, Badilini F, Vaglio M, Hartemann A, Bourron O, Salem J. Complex influence of endocrine and neuro-vegetative disorders on ventricular repolarization in diabetic patients. Archives of Cardiovascular Diseases Supplements 2018. [DOI: 10.1016/j.acvdsp.2017.11.259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Dubourdieu V, Mosbah H, Amouyal C, Hartemann A, Andreelli F. Importance of alternative-site blood glucose testing in the diagnosis of artifactual hypoglycaemia in systemic scleroderma. Diabetes Metab 2017; 43:490-491. [PMID: 28389064 DOI: 10.1016/j.diabet.2017.03.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/08/2017] [Accepted: 03/15/2017] [Indexed: 06/07/2023]
Affiliation(s)
- V Dubourdieu
- Inserm UMRS 1166, diabetology-metabolism department, Sorbonne université, Pierre-et-Marie-Curie university (UPMC), Paris 6, institute of cardiometabolism and nutrition (ICAN), Pitié-Salpêtrière-Charles-Foix hospital, AP-HP, Paris, France
| | - H Mosbah
- Inserm UMRS 1166, diabetology-metabolism department, Sorbonne université, Pierre-et-Marie-Curie university (UPMC), Paris 6, institute of cardiometabolism and nutrition (ICAN), Pitié-Salpêtrière-Charles-Foix hospital, AP-HP, Paris, France
| | - C Amouyal
- Inserm UMRS 1166, diabetology-metabolism department, Sorbonne université, Pierre-et-Marie-Curie university (UPMC), Paris 6, institute of cardiometabolism and nutrition (ICAN), Pitié-Salpêtrière-Charles-Foix hospital, AP-HP, Paris, France
| | - A Hartemann
- Inserm UMRS 1166, diabetology-metabolism department, Sorbonne université, Pierre-et-Marie-Curie university (UPMC), Paris 6, institute of cardiometabolism and nutrition (ICAN), Pitié-Salpêtrière-Charles-Foix hospital, AP-HP, Paris, France
| | - F Andreelli
- Inserm UMRS 1166, diabetology-metabolism department, Sorbonne université, Pierre-et-Marie-Curie university (UPMC), Paris 6, institute of cardiometabolism and nutrition (ICAN), Pitié-Salpêtrière-Charles-Foix hospital, AP-HP, Paris, France.
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27
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Mary A, Hartemann A, Brazier M, Aubert CE, Kemel S, Salem JE, Cluzel P, Liabeuf S, Massy Z, Mentaverri R, Bourron O, Kamel S. Higher parathyroid hormone levels are associated with increased below-the-knee arterial calcification in type 2 diabetes. Diabetes Metab 2017; 44:305-308. [PMID: 28602488 DOI: 10.1016/j.diabet.2017.04.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/10/2017] [Revised: 04/07/2017] [Accepted: 04/18/2017] [Indexed: 01/13/2023]
Affiliation(s)
- A Mary
- Inserm U-1088, 80025 Amiens, France; Amiens university hospital, 80054 Amiens, France; Picardie Jules Verne university, 80054 Amiens, France.
| | - A Hartemann
- Pitié Salpêtrière hospital, 75005 Paris, France; UMPC, university Paris-Sorbonne, 75005 Paris, France; Inserm UMR S1138, centre de recherche des Cordeliers, 75006 Paris, France; Institute of cardiometabolism and nutrition, 75013 Paris, France
| | - M Brazier
- Inserm U-1088, 80025 Amiens, France; Amiens university hospital, 80054 Amiens, France; Picardie Jules Verne university, 80054 Amiens, France
| | - C E Aubert
- Inserm UMR S1138, centre de recherche des Cordeliers, 75006 Paris, France; Department of general internal medicine, university hospital, university of Bern, 3010 Bern, Switzerland
| | - S Kemel
- Pitié Salpêtrière hospital, 75005 Paris, France; UMPC, university Paris-Sorbonne, 75005 Paris, France; France2Biomedical Imaging Lab, 92100 Boulogne-Billancourt, France
| | - J E Salem
- Pitié Salpêtrière hospital, 75005 Paris, France; UMPC, university Paris-Sorbonne, 75005 Paris, France; Institute of cardiometabolism and nutrition, 75013 Paris, France
| | - P Cluzel
- Pitié Salpêtrière hospital, 75005 Paris, France; UMPC, university Paris-Sorbonne, 75005 Paris, France; France2Biomedical Imaging Lab, 92100 Boulogne-Billancourt, France
| | - S Liabeuf
- Inserm U-1088, 80025 Amiens, France; Amiens university hospital, 80054 Amiens, France; Picardie Jules Verne university, 80054 Amiens, France
| | - Z Massy
- Ambroise Paré hospital, 92104 Boulogne-Billancourt, France; University Versailles Saint-Quentin-en-Yvelines, Paris-Île-de-France-Ouest, 78000 Versailles, France; Inserm U-1018, 94807 Villejuif, France
| | - R Mentaverri
- Inserm U-1088, 80025 Amiens, France; Amiens university hospital, 80054 Amiens, France; Picardie Jules Verne university, 80054 Amiens, France
| | - O Bourron
- Pitié Salpêtrière hospital, 75005 Paris, France; UMPC, university Paris-Sorbonne, 75005 Paris, France; Inserm UMR S1138, centre de recherche des Cordeliers, 75006 Paris, France; Institute of cardiometabolism and nutrition, 75013 Paris, France
| | - S Kamel
- Inserm U-1088, 80025 Amiens, France; Amiens university hospital, 80054 Amiens, France; Picardie Jules Verne university, 80054 Amiens, France.
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Billionnet C, Mitanchez D, Weill A, Nizard J, Alla F, Hartemann A, Jacqueminet S. Gestational diabetes and adverse perinatal outcomes from 716,152 births in France in 2012. Diabetologia 2017; 60:636-644. [PMID: 28197657 PMCID: PMC6518373 DOI: 10.1007/s00125-017-4206-6] [Citation(s) in RCA: 300] [Impact Index Per Article: 42.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2016] [Accepted: 12/20/2016] [Indexed: 11/05/2022]
Abstract
AIMS/HYPOTHESIS The aim of this study was to assess the risk of adverse perinatal outcomes in gestational diabetes mellitus (GDM) in a large national cohort. METHODS All deliveries taking place after 22 weeks in France in 2012 were included by extracting data from the hospital discharge database and the national health insurance system. The diabetic status of mothers was determined by the use of glucose-lowering agents and by hospital diagnosis. Outcomes were analysed according to the type of diabetes and, in the GDM group, whether or not diabetes was insulin-treated. RESULTS The cohort of 796,346 deliveries involved 57,629 (7.24%) mothers with GDM. Mother-infant linkage was obtained for 705,198 deliveries. The risks of adverse outcomes were much lower with GDM than with pregestational diabetes. After limiting the analysis to deliveries after 28 weeks to reduce immortal time bias, the risks of preterm birth (OR 1.3 [95% CI 1.3, 1.4]), Caesarean section (OR 1.4 [95% CI 1.4, 1.4]), pre-eclampsia/eclampsia (OR 1.7 [95% CI 1.6, 1.7]), macrosomia (OR 1.8 [95% CI 1.7, 1.8]), respiratory distress (OR 1.1 [95% CI 1.0, 1.3]), birth trauma (OR 1.3 [95% CI 1.1, 1.5]) and cardiac malformations (OR 1.3 [95% CI 1.1, 1.4]) were increased in women with GDM compared with the non-diabetic population. Higher risks were observed in women with insulin-treated GDM than those with diet-treated GDM. After limiting the analysis to term deliveries, an increased risk of perinatal mortality was observed. After excluding women suspected to have undiagnosed pregestational diabetes, the risk remained moderately increased only for those with diet-treated GDM (OR 1.3 [95% CI 1.0, 1.6]). CONCLUSIONS/INTERPRETATION GDM is associated with a moderately increased risk of adverse perinatal outcomes, which is higher in insulin-treated GDM than in non-insulin-treated GDM for most outcomes.
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Affiliation(s)
- Cécile Billionnet
- Department of Public Health Studies, Division of Statistics, Strategic Research and Development, National Health Insurance, Paris, France
| | - Delphine Mitanchez
- Division of Neonatology, Department of Perinatology, Armand Trousseau Hospital, APHP, Paris, France
- Sorbonne University, UPMC Univ Paris 06, Paris, France
| | - Alain Weill
- Department of Public Health Studies, Division of Statistics, Strategic Research and Development, National Health Insurance, Paris, France
| | - Jacky Nizard
- Sorbonne University, UPMC Univ Paris 06, Paris, France
- Department of Obstetrics and Gynaecology, Groupe Hospitalier Pitié-Salpêtrière, APHP CNRS UMR 7222, Inserm U1150, Paris, France
| | - François Alla
- Department of Public Health Studies, Division of Statistics, Strategic Research and Development, National Health Insurance, Paris, France
| | - Agnès Hartemann
- Sorbonne University, UPMC Univ Paris 06, Paris, France
- Institute of Cardiometabolism and Nutrition, Assistance Publique-Hôpitaux de Paris, Pitié-Salpêtrière Hospital, Paris, France
- Diabetes and Metabolic Diseases Department, Pitié-Salpêtrière Hospital, 83 boulevard de l'Hôpital, 75013, Paris, France
| | - Sophie Jacqueminet
- Institute of Cardiometabolism and Nutrition, Assistance Publique-Hôpitaux de Paris, Pitié-Salpêtrière Hospital, Paris, France.
- Diabetes and Metabolic Diseases Department, Pitié-Salpêtrière Hospital, 83 boulevard de l'Hôpital, 75013, Paris, France.
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29
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Hyafil F, Chequer R, Sorbets E, Estellat C, Rouzet F, Ducrocq G, Abtan J, Touati A, Alfaiate T, Leygnac S, Milliner M, Ben Azzouna R, Hartemann A, Roussel R, Montalescot G, Marie P, Le Guludec D. High diagnostic performances of 82 Rubidium-PET for the detection of coronary artery disease as compared to 99 Tc-MIBI with CZT gamma cameras in a population of overweighed patients and women. Archives of Cardiovascular Diseases Supplements 2017. [DOI: 10.1016/s1878-6480(17)30163-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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30
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Pérol L, Lindner JM, Caudana P, Nunez NG, Baeyens A, Valle A, Sedlik C, Loirat D, Boyer O, Créange A, Cohen JL, Rogner UC, Yamanouchi J, Marchant M, Leber XC, Scharenberg M, Gagnerault MC, Mallone R, Battaglia M, Santamaria P, Hartemann A, Traggiai E, Piaggio E. Loss of immune tolerance to IL-2 in type 1 diabetes. Nat Commun 2016; 7:13027. [PMID: 27708334 PMCID: PMC5059699 DOI: 10.1038/ncomms13027] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2016] [Accepted: 08/25/2016] [Indexed: 12/28/2022] Open
Abstract
Type 1 diabetes (T1D) is characterized by a chronic, progressive autoimmune attack against pancreas-specific antigens, effecting the destruction of insulin-producing β-cells. Here we show interleukin-2 (IL-2) is a non-pancreatic autoimmune target in T1D. Anti-IL-2 autoantibodies, as well as T cells specific for a single orthologous epitope of IL-2, are present in the peripheral blood of non-obese diabetic (NOD) mice and patients with T1D. In NOD mice, the generation of anti-IL-2 autoantibodies is genetically determined and their titre increases with age and disease onset. In T1D patients, circulating IgG memory B cells specific for IL-2 or insulin are present at similar frequencies. Anti-IL-2 autoantibodies cloned from T1D patients demonstrate clonality, a high degree of somatic hypermutation and nanomolar affinities, indicating a germinal centre origin and underscoring the synergy between cognate autoreactive T and B cells leading to defective immune tolerance. Type 1 diabetes is driven by T-cell autoimmunity to pancreatic islet cells. Here the authors show that autoreactive anti-IL-2 T and B cells are present in type 1 diabetes patients, and that anti-IL-2 antibodies precede diabetes onset in mice, suggesting their potential as a diagnostic marker.
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Affiliation(s)
- Louis Pérol
- Sorbonne Universités, Pierre and Marie Curie University Paris 06, Paris 75005, France.,Centre National de la Recherche Scientifique, UMR 7211, Paris 75013, France.,Institut National de la Santé et de la Recherche Médicale (INSERM), U 959, Immunology- Immunopathology-Immunotherapy (I3), Paris 75013, France.,Institut Curie, PSL Research University, INSERM U932, F-75005 Paris, France.,SiRIC TransImm Translational Immunotherapy Team, Translational Research Department, Research Center, PSL Research University, Institut Curie, Paris F-75005, France.,Centre d'Investigation Clinique Biothérapie CICBT 1428, Institut Curie, Paris F-75005, France
| | - John M Lindner
- Novartis Institutes for Biomedical Research, Basel 4056, Switzerland
| | - Pamela Caudana
- Institut Curie, PSL Research University, INSERM U932, F-75005 Paris, France.,SiRIC TransImm Translational Immunotherapy Team, Translational Research Department, Research Center, PSL Research University, Institut Curie, Paris F-75005, France.,Centre d'Investigation Clinique Biothérapie CICBT 1428, Institut Curie, Paris F-75005, France
| | - Nicolas Gonzalo Nunez
- Institut Curie, PSL Research University, INSERM U932, F-75005 Paris, France.,SiRIC TransImm Translational Immunotherapy Team, Translational Research Department, Research Center, PSL Research University, Institut Curie, Paris F-75005, France.,Centre d'Investigation Clinique Biothérapie CICBT 1428, Institut Curie, Paris F-75005, France
| | - Audrey Baeyens
- Sorbonne Universités, Pierre and Marie Curie University Paris 06, Paris 75005, France.,Centre National de la Recherche Scientifique, UMR 7211, Paris 75013, France.,Institut National de la Santé et de la Recherche Médicale (INSERM), U 959, Immunology- Immunopathology-Immunotherapy (I3), Paris 75013, France
| | - Andrea Valle
- Diabetes Research Institute (DRI), IRCCS San Raffaele Scientific Institute, Milan 20132, Italy
| | - Christine Sedlik
- Institut Curie, PSL Research University, INSERM U932, F-75005 Paris, France.,SiRIC TransImm Translational Immunotherapy Team, Translational Research Department, Research Center, PSL Research University, Institut Curie, Paris F-75005, France.,Centre d'Investigation Clinique Biothérapie CICBT 1428, Institut Curie, Paris F-75005, France
| | - Delphine Loirat
- SiRIC TransImm Translational Immunotherapy Team, Translational Research Department, Research Center, PSL Research University, Institut Curie, Paris F-75005, France.,Centre d'Investigation Clinique Biothérapie CICBT 1428, Institut Curie, Paris F-75005, France
| | - Olivier Boyer
- INSERM, U905, Rouen 76183, France.,Normandie Univ. IRIB, Rouen 76183, France.,Rouen University Hospital, Laboratory of Immunology, Rouen 76183, France
| | - Alain Créange
- Service de Neurologie, Groupe Hospitalier Henri Mondor, AP-HP, Créteil F-94010, France.,EA 4391, Université Paris Est, Créteil F-94010, France
| | - José Laurent Cohen
- Université Paris-Est Créteil, Créteil F-94010, France.,INSERM U 955, Institut Mondor de Recherche Biomédicale (IMRB), Créteil F-94010, France.,AP-HP, Groupe Hospitalier Henri-Mondor Albert-Chenevier, CIC-BT-504, Créteil F-94010, France
| | - Ute Christine Rogner
- Institut Pasteur, CNRS URA 2578, Département Biologie du développement et cellules souches, Paris 75015, France
| | - Jun Yamanouchi
- Julia McFarlane Diabetes Research Centre and Department of Microbiology, Immunology and Infectious Diseases, Snyder Institute for Chronic Diseases, Cumming School of Medicine. University of Calgary, Calgary, Alberta, Canada T2N 4N1
| | - Martine Marchant
- Novartis Institutes for Biomedical Research, Basel 4056, Switzerland
| | | | - Meike Scharenberg
- Novartis Institutes for Biomedical Research, Basel 4056, Switzerland
| | - Marie-Claude Gagnerault
- INSERM, U1016, Cochin Institute, DeAR Lab, Paris 75014, France.,Assistance Publique-Hôpitaux de Paris, Hôpital Cochin, Service de Diabétologie, Paris 75014, France.,Paris Descartes University, Sorbonne Paris Cité, Faculté de Médecine, Paris 75270, France
| | - Roberto Mallone
- INSERM, U1016, Cochin Institute, DeAR Lab, Paris 75014, France.,Assistance Publique-Hôpitaux de Paris, Hôpital Cochin, Service de Diabétologie, Paris 75014, France.,Paris Descartes University, Sorbonne Paris Cité, Faculté de Médecine, Paris 75270, France
| | - Manuela Battaglia
- Diabetes Research Institute (DRI), IRCCS San Raffaele Scientific Institute, Milan 20132, Italy
| | - Pere Santamaria
- Julia McFarlane Diabetes Research Centre and Department of Microbiology, Immunology and Infectious Diseases, Snyder Institute for Chronic Diseases, Cumming School of Medicine. University of Calgary, Calgary, Alberta, Canada T2N 4N1.,Institut D'Investigacions Biomediques August Pi i Sunyer, Barcelona 08036, Spain
| | - Agnès Hartemann
- Department of Medicine Faculty, Université Pierre et Marie Curie-Paris 6, Paris 75005, France.,Department of Endocrinology, Nutrition and Diabetes, Assistance Publique-Hôpitaux de Paris (AP-HP), Pitié-Salpêtrière-Charles Foix Hospital, Paris 75013, France
| | | | - Eliane Piaggio
- Sorbonne Universités, Pierre and Marie Curie University Paris 06, Paris 75005, France.,Centre National de la Recherche Scientifique, UMR 7211, Paris 75013, France.,Institut National de la Santé et de la Recherche Médicale (INSERM), U 959, Immunology- Immunopathology-Immunotherapy (I3), Paris 75013, France.,Institut Curie, PSL Research University, INSERM U932, F-75005 Paris, France.,SiRIC TransImm Translational Immunotherapy Team, Translational Research Department, Research Center, PSL Research University, Institut Curie, Paris F-75005, France.,Centre d'Investigation Clinique Biothérapie CICBT 1428, Institut Curie, Paris F-75005, France
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31
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Lebeau G, Consoli SM, Le Bouc R, Sola-Gazagnes A, Hartemann A, Simon D, Reach G, Altman JJ, Pessiglione M, Limosin F, Lemogne C. Delay discounting of gains and losses, glycemic control and therapeutic adherence in type 2 diabetes. Behav Processes 2016; 132:42-48. [PMID: 27663668 DOI: 10.1016/j.beproc.2016.09.006] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2016] [Revised: 09/18/2016] [Accepted: 09/19/2016] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Delay discounting is the tendency to prefer smaller, sooner rewards to larger, later ones. Poor adherence in type 2 diabetes could be partially explained by a discounted value of health, as a function of delay. Delay discounting can be described with a hyperbolic model characterized by a coefficient, k. The higher k, the less future consequences are taken into account when making decisions. This study aimed to determine whether k would be correlated with glycated hemoglobin and adherence in type 2 diabetes. METHODS Ninety-three patients were recruited in two diabetology departments. Delay discounting coefficients were measured with a computerized task. HbA1c was recorded and adherence was assessed by questionnaires. Potential socio-demographic and clinical confounding factors were collected. RESULTS There was a positive correlation between delay discounting of gains and HbA1c (r=0.242, P=0.023). This association remained significant after adjusting for potential confounding factors (F=4.807, P=0.031, η2=0.058). This association was partially mediated by adherence to medication (β=0.048, 95% CI [0.004-0.131]). CONCLUSIONS Glycemic control is associated with delay discounting in patients suffering from type 2 diabetes. Should these findings be replicated with a prospective design, they could lead to new strategies to improve glycemic control among these patients.
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Affiliation(s)
- Gaële Lebeau
- Paris Descartes University, Sorbonne Paris Cité, Faculty of Medicine, Paris, France; Inserm U894, Center for Psychiatry and Neuroscience, Paris, France; AP-HP, West Paris University Hospitals, Department of Psychiatry, Paris, France.
| | - Silla M Consoli
- Paris Descartes University, Sorbonne Paris Cité, Faculty of Medicine, Paris, France; AP-HP, West Paris University Hospitals, Department of Psychiatry, Paris, France
| | - Raphael Le Bouc
- Inserm U1127, CNRS U7225, Brain and Spine Institute, "Motivation, Brain and Behavior" Team, Pitié-Salpêtrière Hospital, Paris, France; Pierre and Marie Curie University, Paris, France; AP-HP, Neurology Department, Pitié-Salpêtrière Hospital, Paris, France
| | | | - Agnès Hartemann
- Pierre and Marie Curie University, Paris, France; AP-HP, Diabetology Department, Pitié-Salpêtrière Hospital, Paris, France
| | - Dominique Simon
- Pierre and Marie Curie University, Paris, France; AP-HP, Diabetology Department, Pitié-Salpêtrière Hospital, Paris, France; Institute of Cardiometabolism and Nutrition (ICAN), Pitié Salpêtrière Hospital, Paris, France
| | - Gerard Reach
- AP-HP, Endocrinology, Diabetology and Metabolic Diseases Department, Avicenne Hospital, Bobigny, France; Paris 13 University, Sorbonne Paris Cité, Bobigny, France
| | - Jean-Jacques Altman
- Paris Descartes University, Sorbonne Paris Cité, Faculty of Medicine, Paris, France; AP-HP, West Paris University Hospitals, Diabetology Department, Paris, France
| | - Mathias Pessiglione
- Inserm U1127, CNRS U7225, Brain and Spine Institute, "Motivation, Brain and Behavior" Team, Pitié-Salpêtrière Hospital, Paris, France; Pierre and Marie Curie University, Paris, France
| | - Frédéric Limosin
- Paris Descartes University, Sorbonne Paris Cité, Faculty of Medicine, Paris, France; Inserm U894, Center for Psychiatry and Neuroscience, Paris, France; AP-HP, West Paris University Hospitals, Department of Psychiatry, Paris, France
| | - Cédric Lemogne
- Paris Descartes University, Sorbonne Paris Cité, Faculty of Medicine, Paris, France; Inserm U894, Center for Psychiatry and Neuroscience, Paris, France; AP-HP, West Paris University Hospitals, Department of Psychiatry, Paris, France
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32
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Hamel Y, Mauvais FX, Pham HP, Kratzer R, Marchi C, Barilleau É, Waeckel-Enée E, Arnoux JB, Hartemann A, Cordier C, Mégret J, Rocha B, de Lonlay P, Beltrand J, Six A, Robert JJ, van Endert P. A unique CD8(+) T lymphocyte signature in pediatric type 1 diabetes. J Autoimmun 2016; 73:54-63. [PMID: 27318739 DOI: 10.1016/j.jaut.2016.06.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2015] [Revised: 06/01/2016] [Accepted: 06/08/2016] [Indexed: 12/16/2022]
Abstract
Human type 1 diabetes results from a destructive auto-reactive immune response in which CD8(+) T lymphocytes play a critical role. Given the intense ongoing efforts to develop immune intervention to prevent and/or cure the disease, biomarkers suitable for prediction of disease risk and progress, as well as for monitoring of immunotherapy are required. We undertook separate multi-parameter analyses of single naïve and activated/memory CD8(+) T lymphocytes from pediatric and adult patients, with the objective of identifying cellular profiles associated with onset of type 1 diabetes. We observe global perturbations in gene and protein expression and in the abundance of T cell populations characterizing pediatric but not adult patients, relative to age-matched healthy individuals. Pediatric diabetes is associated with a unique population of CD8(+) T lymphocytes co-expressing effector (perforin, granzyme B) and regulatory (transforming growth factor β, interleukin-10 receptor) molecules. This population persists after metabolic normalization and is especially abundant in children with high titers of auto-antibodies to glutamic acid decarboxylase and with elevated HbA1c values. These findings highlight striking differences between pediatric and adult type 1 diabetes, indicate prolonged large-scale perturbations in the CD8(+) T cell compartment in the former, and suggest that CD8(+)CD45RA(-) T cells co-expressing effector and regulatory factors are of interest as biomarkers in pediatric type 1 diabetes.
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Affiliation(s)
- Yamina Hamel
- Institut National de la Sante et de la Recherche Médicale, Unité 1151, 75015 Paris, France; Université Paris Descartes, Sorbonne Paris Cité, Faculté de médecine, 75015 Paris, France; Centre National de la Recherche Scientifique, UMR8253, 75015 Paris, France
| | - François-Xavier Mauvais
- Institut National de la Sante et de la Recherche Médicale, Unité 1151, 75015 Paris, France; Université Paris Descartes, Sorbonne Paris Cité, Faculté de médecine, 75015 Paris, France; Centre National de la Recherche Scientifique, UMR8253, 75015 Paris, France
| | - Hang-Phuong Pham
- Sorbonne Universités, UPMC Université Paris 6, 75015 Paris, France; Institut National de la Sante et de la Recherche Médicale, UMRS 959, Immunology-Immunopathology-Immunotherapy (i3), 75013 Paris, France
| | - Roland Kratzer
- Institut National de la Sante et de la Recherche Médicale, Unité 1151, 75015 Paris, France; Université Paris Descartes, Sorbonne Paris Cité, Faculté de médecine, 75015 Paris, France; Centre National de la Recherche Scientifique, UMR8253, 75015 Paris, France
| | - Christophe Marchi
- Institut National de la Sante et de la Recherche Médicale, Unité 1151, 75015 Paris, France; Université Paris Descartes, Sorbonne Paris Cité, Faculté de médecine, 75015 Paris, France; Centre National de la Recherche Scientifique, UMR8253, 75015 Paris, France
| | - Émilie Barilleau
- Institut National de la Sante et de la Recherche Médicale, Unité 1151, 75015 Paris, France; Université Paris Descartes, Sorbonne Paris Cité, Faculté de médecine, 75015 Paris, France; Centre National de la Recherche Scientifique, UMR8253, 75015 Paris, France
| | - Emmanuelle Waeckel-Enée
- Institut National de la Sante et de la Recherche Médicale, Unité 1151, 75015 Paris, France; Université Paris Descartes, Sorbonne Paris Cité, Faculté de médecine, 75015 Paris, France; Centre National de la Recherche Scientifique, UMR8253, 75015 Paris, France
| | - Jean-Baptiste Arnoux
- Université Paris Descartes, Sorbonne Paris Cité, Faculté de médecine, 75015 Paris, France; Centre de référence des Maladies Héréditaires du Métabolisme, Hôpital Necker, Assistance Publique-Hôpitaux de Paris, 75015 Paris, France
| | - Agnès Hartemann
- Université Pierre & Marie Curie, IHU ICAN, 75013 Paris, France; Service de Diabétologie, Hôpital de la Pitié-Salpétrière, Assistance Publique-Hôpitaux de Paris, 75013 Paris, France
| | - Corinne Cordier
- Institut National de la Sante et de la Recherche Médicale, US24, 75015 Paris, France; Centre National de la Recherche Scientifique, UMS3633, 75015 Paris, France
| | - Jerome Mégret
- Institut National de la Sante et de la Recherche Médicale, US24, 75015 Paris, France; Centre National de la Recherche Scientifique, UMS3633, 75015 Paris, France
| | - Benedita Rocha
- Institut National de la Sante et de la Recherche Médicale, Unité 1151, 75015 Paris, France; Université Paris Descartes, Sorbonne Paris Cité, Faculté de médecine, 75015 Paris, France; Centre National de la Recherche Scientifique, UMR8253, 75015 Paris, France
| | - Pascale de Lonlay
- Université Paris Descartes, Sorbonne Paris Cité, Faculté de médecine, 75015 Paris, France; Centre de référence des Maladies Héréditaires du Métabolisme, Hôpital Necker, Assistance Publique-Hôpitaux de Paris, 75015 Paris, France; Institut Imagine, Institut National de la Sante et de la Recherche Médicale, Unité 1163, 75015 Paris, France
| | - Jacques Beltrand
- Université Paris Descartes, Sorbonne Paris Cité, Faculté de médecine, 75015 Paris, France; Endocrinologie, Gynécologie et Diabétologie Pédiatrique, Hôpital Necker, Assistance Publique-Hôpitaux de Paris, 75015 Paris, France
| | - Adrien Six
- Sorbonne Universités, UPMC Université Paris 6, 75015 Paris, France; Institut National de la Sante et de la Recherche Médicale, UMRS 959, Immunology-Immunopathology-Immunotherapy (i3), 75013 Paris, France
| | - Jean-Jacques Robert
- Université Paris Descartes, Sorbonne Paris Cité, Faculté de médecine, 75015 Paris, France; Endocrinologie, Gynécologie et Diabétologie Pédiatrique, Hôpital Necker, Assistance Publique-Hôpitaux de Paris, 75015 Paris, France
| | - Peter van Endert
- Institut National de la Sante et de la Recherche Médicale, Unité 1151, 75015 Paris, France; Université Paris Descartes, Sorbonne Paris Cité, Faculté de médecine, 75015 Paris, France; Centre National de la Recherche Scientifique, UMR8253, 75015 Paris, France.
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Game FL, Attinger C, Hartemann A, Hinchliffe RJ, Löndahl M, Price PE, Jeffcoate WJ. IWGDF guidance on use of interventions to enhance the healing of chronic ulcers of the foot in diabetes. Diabetes Metab Res Rev 2016; 32 Suppl 1:75-83. [PMID: 26340818 DOI: 10.1002/dmrr.2700] [Citation(s) in RCA: 72] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Affiliation(s)
- F L Game
- Department of Diabetes and Endocrinology, Derby Teaching Hospitals NHS FT, Derby, UK
| | - C Attinger
- Department of Plastic Surgery, Medstar Georgetown University. Hospital, Washington DC, USA
| | - A Hartemann
- Pitié-Salpêtrière Hospital, APHP, Paris 6 University, ICAN, Paris, France
| | - R J Hinchliffe
- St George's Vascular Institute, St George's Healthcare NHS Trust, London, UK
| | - M Löndahl
- Department of Endocrinology, Skåne University Hospital, Malmö, Sweden
| | - P E Price
- Vice-Chancellors' Office, Cardiff University, Cardiff, UK
| | - W J Jeffcoate
- Department of Diabetes and Endocrinology, Nottingham University Hospitals NHS Trust, Nottingham, UK
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34
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Game FL, Apelqvist J, Attinger C, Hartemann A, Hinchliffe RJ, Löndahl M, Price PE, Jeffcoate WJ. Effectiveness of interventions to enhance healing of chronic ulcers of the foot in diabetes: a systematic review. Diabetes Metab Res Rev 2016; 32 Suppl 1:154-68. [PMID: 26344936 DOI: 10.1002/dmrr.2707] [Citation(s) in RCA: 117] [Impact Index Per Article: 14.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
The outcome of management of diabetic foot ulcers remains a challenge, and there remains continuing uncertainty concerning optimal approaches to management. It is for these reasons that in 2008 and 2012, the International Working Group of the Diabetic Foot (IWGDF) working group on wound healing published systematic reviews of the evidence to inform protocols for routine care and to highlight areas, which should be considered for further study. The same working group has now updated this review by considering papers on the interventions to improve the healing of chronic ulcers published between June 2010 and June 2014. Methodological quality of selected studies was independently assessed by two reviewers using Scottish Intercollegiate Guidelines Network criteria. Selected studies fell into the following ten categories: sharp debridement and wound bed preparation with larvae or hydrotherapy; wound bed preparation using antiseptics, applications and dressing products; resection of the chronic wound; oxygen and other gases, compression or negative pressure therapy; products designed to correct aspects of wound biochemistry and cell biology associated with impaired wound healing; application of cells, including platelets and stem cells; bioengineered skin and skin grafts; electrical, electromagnetic, lasers, shockwaves and ultrasound and other systemic therapies, which did not fit in the aforementioned categories. Heterogeneity of studies prevented pooled analysis of results. Of the 2161 papers identified, 30 were selected for grading following full text review. The present report is an update of the earlier IWGDF systematic reviews, and the conclusion is similar: that with the possible exception of negative pressure wound therapy in post-operative wounds, there is little published evidence to justify the use of newer therapies. Analysis of the evidence continues to present difficulties in this field as controlled studies remain few and the majority continue to be of poor methodological quality.
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Affiliation(s)
- F L Game
- Department of Diabetes and Endocrinology, Derby Teaching Hospitals NHS FT, Derby, UK
| | - J Apelqvist
- Department of Endocrinology, University Hospital of Malmö, Sweden
| | - C Attinger
- Department of Plastic Surgery, Medstar Georgetown University, Hospital, Washington D.C., USA
| | - A Hartemann
- Pitié-Salpêtrière Hospital, APHP, Paris 6 University, ICAN, France
| | - R J Hinchliffe
- St George's Vascular Institute, St George's Healthcare NHS Trust, London, UK
| | - M Löndahl
- Department of Endocrinology, University Hospital of Malmö, Sweden
| | - P E Price
- Vice-Chancellors' Office, Cardiff University, Cardiff, Wales, UK
| | - W J Jeffcoate
- Department of Diabetes and Endocrinology, Nottingham University Hospitals NHS Trust, Nottingham, UK
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Hartemann A. [COMMENTS ON FRENCH RECOMMENDATIONS ON GLYCEMIC CONTROL IN TYPE 2 DIABETES]. Rev Prat 2015; 65:1033-1037. [PMID: 26749699] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
The French guidelines recently changed after that several studies highlighted that normoglycemia was not an acceptable target for everyone. Normoglycemia can be only recommended at the beginning of diabetes, using metformin as treatment. But later, targeting an HbA1c < 7% is a good objective, except in patients with a severe cardiovascular disease: in that case, an HbAlc <8% without hypoglycemia is reasonable. In old patients with severe comorbidities, a comfortable objective is an HbA1c <9%. After melformine use, sulfoaylurea may he used as the second line treatment DPP-4 inhibitors are the third line treatment GLP-1 analogs have to be kept for patients with complicated overweight and an HbA1c above 1% over target
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Hartemann A. [Treatment of type 2 diabetes]. Rev Prat 2015; 65:1031-1032. [PMID: 26749698] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
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Rosenzwajg M, Churlaud G, Mallone R, Six A, Dérian N, Chaara W, Lorenzon R, Long SA, Buckner JH, Afonso G, Pham HP, Hartemann A, Yu A, Pugliese A, Malek TR, Klatzmann D. Low-dose interleukin-2 fosters a dose-dependent regulatory T cell tuned milieu in T1D patients. J Autoimmun 2015; 58:48-58. [PMID: 25634360 DOI: 10.1016/j.jaut.2015.01.001] [Citation(s) in RCA: 180] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2014] [Revised: 12/26/2014] [Accepted: 01/05/2015] [Indexed: 12/13/2022]
Abstract
Most autoimmune diseases (AID) are linked to an imbalance between autoreactive effector T cells (Teffs) and regulatory T cells (Tregs). While blocking Teffs with immunosuppression has long been the only therapeutic option, activating/expanding Tregs may achieve the same objective without the toxicity of immunosuppression. We showed that low-dose interleukin-2 (ld-IL-2) safely expands/activates Tregs in patients with AID, such HCV-induced vasculitis and Type 1 Diabetes (T1D). Here we analyzed the kinetics and dose-relationship of IL-2 effects on immune responses in T1D patients. Ld-IL-2 therapy induced a dose-dependent increase in CD4(+)Foxp3(+) and CD8(+)Foxp3(+) Treg numbers and proportions, the duration of which was markedly dose-dependent. Tregs expressed enhanced levels of activation markers, including CD25, GITR, CTLA-4 and basal pSTAT5, and retained a 20-fold higher sensitivity to IL-2 than Teff and NK cells. Plasma levels of regulatory cytokines were increased in a dose-dependent manner, while cytokines linked to Teff and Th17 inflammatory cells were mostly unchanged. Global transcriptome analyses showed a dose-dependent decrease in immune response signatures. At the highest dose, Teff responses against beta-cell antigens were suppressed in all 4 patients tested. These results inform of broader changes induced by ld-IL-2 beyond direct effects on Tregs, and relevant for further development of ld-IL-2 for therapy and prevention of T1D, and other autoimmune and inflammatory diseases.
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Affiliation(s)
- Michelle Rosenzwajg
- AP-HP, Hôpital Pitié-Salpêtrière, Biotherapy (CIC-BTi) and Inflammation-Immunopathology-Biotherapy Department (I2B), F-75651, Paris, France; Sorbonne Université, UPMC Univ Paris 06, UMRS 959, Immunology-Immunopathology-Immunotherapy (I3), F-75005, Paris, France; Inserm, UMRS 959, Immunology-Immunopathology-Immunotherapy (I3), F-75005, Paris, France
| | - Guillaume Churlaud
- AP-HP, Hôpital Pitié-Salpêtrière, Biotherapy (CIC-BTi) and Inflammation-Immunopathology-Biotherapy Department (I2B), F-75651, Paris, France; Sorbonne Université, UPMC Univ Paris 06, UMRS 959, Immunology-Immunopathology-Immunotherapy (I3), F-75005, Paris, France; Inserm, UMRS 959, Immunology-Immunopathology-Immunotherapy (I3), F-75005, Paris, France
| | - Roberto Mallone
- Inserm, U1016, Institut Cochin, Immunology of Diabetes Team, DeAR Lab, F-75014, Paris, France; CNRS, UMR8104, F-75014, Paris, France; Université Paris Descartes, Sorbonne Paris Cité, F-75014, Paris, France; AP-HP, Hôpital Cochin-Port Royal, Diabetology Department, F-75014, Paris, France
| | - Adrien Six
- AP-HP, Hôpital Pitié-Salpêtrière, Biotherapy (CIC-BTi) and Inflammation-Immunopathology-Biotherapy Department (I2B), F-75651, Paris, France; Sorbonne Université, UPMC Univ Paris 06, UMRS 959, Immunology-Immunopathology-Immunotherapy (I3), F-75005, Paris, France; Inserm, UMRS 959, Immunology-Immunopathology-Immunotherapy (I3), F-75005, Paris, France
| | - Nicolas Dérian
- AP-HP, Hôpital Pitié-Salpêtrière, Biotherapy (CIC-BTi) and Inflammation-Immunopathology-Biotherapy Department (I2B), F-75651, Paris, France; Sorbonne Université, UPMC Univ Paris 06, UMRS 959, Immunology-Immunopathology-Immunotherapy (I3), F-75005, Paris, France; Inserm, UMRS 959, Immunology-Immunopathology-Immunotherapy (I3), F-75005, Paris, France
| | - Wahiba Chaara
- AP-HP, Hôpital Pitié-Salpêtrière, Biotherapy (CIC-BTi) and Inflammation-Immunopathology-Biotherapy Department (I2B), F-75651, Paris, France; Sorbonne Université, UPMC Univ Paris 06, UMRS 959, Immunology-Immunopathology-Immunotherapy (I3), F-75005, Paris, France; Inserm, UMRS 959, Immunology-Immunopathology-Immunotherapy (I3), F-75005, Paris, France
| | - Roberta Lorenzon
- AP-HP, Hôpital Pitié-Salpêtrière, Biotherapy (CIC-BTi) and Inflammation-Immunopathology-Biotherapy Department (I2B), F-75651, Paris, France; Sorbonne Université, UPMC Univ Paris 06, UMRS 959, Immunology-Immunopathology-Immunotherapy (I3), F-75005, Paris, France; Inserm, UMRS 959, Immunology-Immunopathology-Immunotherapy (I3), F-75005, Paris, France
| | - S Alice Long
- Translational Research Program, Benaroya Research Institute at Virginia Mason, Seattle, WA, USA
| | - Jane H Buckner
- Translational Research Program, Benaroya Research Institute at Virginia Mason, Seattle, WA, USA
| | - Georgia Afonso
- Inserm, U1016, Institut Cochin, Immunology of Diabetes Team, DeAR Lab, F-75014, Paris, France; CNRS, UMR8104, F-75014, Paris, France; Université Paris Descartes, Sorbonne Paris Cité, F-75014, Paris, France; AP-HP, Hôpital Cochin-Port Royal, Diabetology Department, F-75014, Paris, France
| | - Hang-Phuong Pham
- ILTOO Pharma, iPEPS ICM, Hôpital Pitié Salpêtrière, 75013, Paris, France
| | - Agnès Hartemann
- AP-HP, Hôpital Pitié-Salpêtrière, Diabetology, F-75651, Paris, France
| | - Aixin Yu
- The Diabetes Research Institute, University of Miami, Miami, FL, USA; Department of Microbiology and Immunology, University of Miami, Miami, FL, USA
| | - Alberto Pugliese
- The Diabetes Research Institute, University of Miami, Miami, FL, USA; Department of Medicine, Miller School of Medicine, University of Miami, Miami, FL, USA; Department of Microbiology and Immunology, University of Miami, Miami, FL, USA
| | - Thomas R Malek
- The Diabetes Research Institute, University of Miami, Miami, FL, USA; Department of Microbiology and Immunology, University of Miami, Miami, FL, USA
| | - David Klatzmann
- AP-HP, Hôpital Pitié-Salpêtrière, Biotherapy (CIC-BTi) and Inflammation-Immunopathology-Biotherapy Department (I2B), F-75651, Paris, France; Sorbonne Université, UPMC Univ Paris 06, UMRS 959, Immunology-Immunopathology-Immunotherapy (I3), F-75005, Paris, France; Inserm, UMRS 959, Immunology-Immunopathology-Immunotherapy (I3), F-75005, Paris, France.
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Abstract
Regulatory T cells (Tregs) play a major role in controlling effector T cells (Teffs) responding to self-antigens, which cause autoimmune diseases. An improper Treg/Teff balance contributes to most autoimmune diseases, including type 1 diabetes (T1D). To restore a proper balance, blocking Teffs with immunosuppressants has been the only option, which was partly effective and too toxic. It now appears that expanding/activating Tregs with low-dose interleukin-2 (IL-2) could provide immunoregulation without immunosuppression. This is particularly interesting in T1D as Tregs from T1D patients are reported as dysfunctional and a relative deficiency in IL-2 production and/or IL-2-mediated signaling could contribute to this phenotype. A clinical study of low-dose IL-2 showed a very good safety profile and good Treg expansion/activation in T1D patients. This opens the way for efficacy trials to test low-dose IL-2 in prevention and treatment of T1D and to establish in which condition restoration of a proper Treg/Teff balance would be beneficial in the field of autoimmune and inflammatory diseases.
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Affiliation(s)
- Michelle Rosenzwajg
- Biotherapy (CIC-BTi) and Inflammation-Immunopathology-Biotherapy Department (i2B), AP-HP, Hôpital Pitié-Salpêtrière, 83 Boulevard de l'Hôpital, 75651, Paris, France,
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Aubert CE, Michel PL, Gillery P, Jaisson S, Fonfrede M, Morel F, Hartemann A, Bourron O. Association of peripheral neuropathy with circulating advanced glycation end products, soluble receptor for advanced glycation end products and other risk factors in patients with type 2 diabetes. Diabetes Metab Res Rev 2014; 30:679-85. [PMID: 24449227 DOI: 10.1002/dmrr.2529] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2013] [Revised: 11/17/2013] [Accepted: 12/24/2013] [Indexed: 01/11/2023]
Abstract
BACKGROUND The pathogenesis of diabetic peripheral neuropathy remains uncertain and nonenzymatic glycoxidation is one of the contributing mechanisms. The aim of this study was to assess the respective relationship of diabetic peripheral neuropathy with glycoxidation, compared with other identified risk factors, in patients with type 2 diabetes. METHODS We included 198 patients with type 2 diabetes and high risk for vascular complications. Circulating concentrations of three advanced glycation end products (carboxymethyllysine, methyl-glyoxal-hydroimidazolone-1, pentosidine) and of their soluble receptor (sRAGE) were measured. Peripheral neuropathy was assessed by the neuropathy disability score and by the monofilament test and defined as either an abnormal monofilament test and/or a neuropathy disability score ≥6. Multivariate regression analyses were performed adjusting for potential confounding factors for neuropathy: age, gender, diabetes duration, current smoking, systolic blood pressure, waist circumference, height, peripheral arterial occlusive disease, glycated haemoglobin, estimated glomerular filtration rate and lipid profile. RESULTS Prevalence of peripheral neuropathy was 20.7%. sRAGE and carboxymethyllysine were independently and positively associated with the presence of peripheral neuropathy. No significant association was found between peripheral neuropathy and methyl-glyoxal-hydroimidazolone-1 or pentosidine. Waist circumference, height and peripheral arterial occlusive disease were independently associated with peripheral neuropathy. CONCLUSIONS Carboxymethyllysine and sRAGE were independently associated with peripheral neuropathy in patients with type 2 diabetes. Although the conclusions are limited by the absence of a healthy control population, this study confirms the relationship between advanced glycoxidation and diabetic peripheral neuropathy, independently of other risk factors.
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Affiliation(s)
- C E Aubert
- Diabetes and Metabolic Diseases Department, AP-HP, Pitié-Salpêtrière Hospital, Paris, France; Internal Medicine Department, Fribourg Cantonal Hospital, Fribourg, Switzerland
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Bourron O, Aubert CE, Liabeuf S, Cluzel P, Lajat-Kiss F, Dadon M, Komajda M, Mentaverri R, Brazier M, Pierucci A, Morel F, Jacqueminet S, Massy ZA, Hartemann A. Below-knee arterial calcification in type 2 diabetes: association with receptor activator of nuclear factor κB ligand, osteoprotegerin, and neuropathy. J Clin Endocrinol Metab 2014; 99:4250-8. [PMID: 25013993 DOI: 10.1210/jc.2014-1047] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
CONTEXT Calcification of the arterial wall in diabetes contributes to the arterial occlusive process occurring below the knee. The osteoprotegerin (OPG)/receptor activator of nuclear factor κB ligand (RANKL) system is suspected to be involved in the calcification process. OBJECTIVE The aim of the study was to investigate whether there is a link between arterial calcification in type 2 diabetes and 1) conventional cardiovascular risk factors, 2) serum RANKL and OPG levels, and 3) neuropathy. PATIENTS AND METHODS We objectively scored, in a cross-sectional study, infrapopliteal vascular calcification using computed tomography scanning in 198 patients with type 2 diabetes, a high cardiovascular risk, and a glomerular filtration rate >30 mL/min. Color duplex ultrasonography was performed to assess peripheral arterial occlusive disease, and mediacalcosis. Peripheral neuropathy was defined by a neuropathy disability score >6. RANKL and OPG were measured in the serum by routine chemistry. RESULTS Below-knee arterial calcification was associated with arterial occlusive disease. In multivariate logistic regression analysis, the variables significantly and independently associated with the calcification score were age (odds ratio [OR] = 1.08; 95% confidence interval [CI] = 1.04-1.13; P < .0001), male gender (OR = 3.53; 95% CI = 1.54-8.08; P = .003), previous cardiovascular disease (OR = 2.78; 95% CI = 1.39-5.59; P = .005), and neuropathy disability score (per 1 point, OR = 1.21; 95% CI = 1.05-1.38; P = .006). The association with ln OPG, significantly associated with calcification score in univariate analysis (OR = 3.14; 95% CI = 1.05-9.40; P = .045), was no longer significant in multivariate analysis. RANKL and OPG/RANKL were not significantly associated with the calcification score. CONCLUSIONS Below-knee arterial calcification severity is clearly correlated with peripheral neuropathy severity and with several usual cardiovascular risk factors, but not with serum RANKL level.
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Affiliation(s)
- Olivier Bourron
- Diabetes and Metabolic Diseases (O.B., C.E.A., S.J., A.H.), Radiology (P.C.), Vascular Surgery (F.L.-K., M.D.), Biostatistics and Clinical Research (A.P.), and Cardiology (M.K.) Departments and Laboratory of Biochemistry (F.M.), Assistance Publique-Hôpitaux de Paris, Pitié-Salpêtrière Hospital, 75013 Paris, France; Sorbonne Universités (O.B., P.C., M.K., A.H.), Université Pierre et Marie Curie University Paris 06, Paris, France; Inserm U1088 (S.L., R.M., M.B., Z.A.M.), Unité de formation et de recherche de Médecine et Pharmacie, Jules Verne Université of Picardy, Amiens, France; Clinical Research Centre Division of Clinical Pharmacology (S.L.), Amiens University Hospital and the Jules Verne University of Picardy, 80000 Amiens, France; Division of Nephrology (Z.A.M.), Ambroise Paré Hospital, 92100 Boulogne-Billancourt, France; Institute of Cardiometabolism and Nutrition (O.B., P.C., M.K., A.H.), 75013 Paris, France; and INSERM UMR_S 1138, Centre de recherche des Cordeliers (O.B., A.H.), 75006 Paris, France
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Bourron O, Caron-Debarle M, Hie M, Amoura Z, Andreelli F, Halbron M, Fonfrede M, Leroux G, Vigouroux C, Hartemann A. Type B Insulin-resistance syndrome: a cause of reversible autoimmune hypoglycaemia. Lancet 2014; 384:1548. [PMID: 25390580 DOI: 10.1016/s0140-6736(14)61833-x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Olivier Bourron
- Assistance Publique-Hôpitaux de Paris, Department of Endocrinology, Nutrition, and Diabetes, Paris, France; Sorbonne Universités, Paris, France; INSERM UMR_S 1138 Centre de recherche des Cordeliers, Paris, France; Institute of Cardiometabolism and Nutrition, Paris, France.
| | - Martine Caron-Debarle
- Sorbonne Universités, Paris, France; INSERM UMR_S 938 Saint-Antoine Research Centre, Paris, France; Institute of Cardiometabolism and Nutrition, Paris, France
| | - Miguel Hie
- Department of Internal Medicine, Pitié-Salpêtrière Hospital, Paris, France; Sorbonne Universités, Paris, France
| | - Zahir Amoura
- Department of Internal Medicine, Pitié-Salpêtrière Hospital, Paris, France; Sorbonne Universités, Paris, France
| | - Fabrizio Andreelli
- Assistance Publique-Hôpitaux de Paris, Department of Endocrinology, Nutrition, and Diabetes, Paris, France; Sorbonne Universités, Paris, France; Institute of Cardiometabolism and Nutrition, Paris, France
| | - Marine Halbron
- Assistance Publique-Hôpitaux de Paris, Department of Endocrinology, Nutrition, and Diabetes, Paris, France; Institute of Cardiometabolism and Nutrition, Paris, France
| | - Michelle Fonfrede
- Department of Biochemistry, Pitié-Salpêtrière Hospital, Paris, France
| | - Gaëlle Leroux
- Department of Internal Medicine, Pitié-Salpêtrière Hospital, Paris, France
| | - Corinne Vigouroux
- Department of Molecular Biology, Saint-Antoine Hospital, Paris, France; Sorbonne Universités, Paris, France; INSERM UMR_S 938 Saint-Antoine Research Centre, Paris, France; Institute of Cardiometabolism and Nutrition, Paris, France
| | - Agnès Hartemann
- Assistance Publique-Hôpitaux de Paris, Department of Endocrinology, Nutrition, and Diabetes, Paris, France; Sorbonne Universités, Paris, France; INSERM UMR_S 1138 Centre de recherche des Cordeliers, Paris, France; Institute of Cardiometabolism and Nutrition, Paris, France
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Halbron M, Sachon C, Simon D, Obadia T, Grimaldi A, Hartemann A. Evaluation of a 5-day education programme in type 1 diabetes: achieving individual targets with a patient-centred approach. Diabet Med 2014; 31:500-3. [PMID: 24299225 DOI: 10.1111/dme.12372] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2013] [Revised: 10/28/2013] [Accepted: 11/17/2013] [Indexed: 11/28/2022]
Abstract
AIMS To evaluate if a single inpatient education training programme can achieve individualized therapeutic targets. METHODS Patients with Type 1 diabetes participating in a flexible intensive therapy programme were consecutively included in a prospective monocentric study. They all participated in the same education programme which had a patient-centred approach. Before the intervention, patients were divided into three groups according to their main therapeutic target: Group 1, to decrease HbA1c concentration in patients with baseline HbA1c ≥ 58 mmol/mol (7.5%); Group 2, to improve quality of life and satisfaction with treatment in patients with baseline HbA1c < 58 mmol/mol (7.5%); and Group 3, to decrease the frequency of hypoglycaemic episodes in patients with severe or frequent hypoglycaemic episodes. Therapeutic targets were evaluated at 12 months. Quality of life and treatment satisfaction were evaluated with validated questionnaires completed at baseline and 6 months. RESULTS In Group 1 (n = 74), the mean ± sd HbA1c concentration decreased from 75 ± 15 mmol/mol (9.0 ±1.4%) to 68 ±15 mmol/mol (8.4 ± 1.4%; P < 0.001), with 53% of patients experiencing a decrease in HbA1c concentration of at least 6 mmol/mol (0.5%), without weight gain or more frequent hypoglycaemia. In Group 2 (n = 12), patient satisfaction with treatment improved significantly (P < 0.0001). In Group 3 (n = 35), minor hypoglycaemia significantly decreased from a mean ± sd of 6.6 ± 4.7 to 3.2 ± 3.0 hypoglycaemic episodes/week (P < 0.001) and the incidence of severe hypoglycaemia dropped significantly from a mean ± sd of 2.31 ± 3.07 to 0.86 ± 2.46 episodes/patient/year (P < 0.001). CONCLUSIONS Many patients with different needs, who attended the same flexible intensive therapy education programme, which had a patient-centred approach, were able to achieve their individual therapeutic targets.
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Affiliation(s)
- M Halbron
- Diabetology Department, AP-HP, Hopital Pitie-Salpetriere, Paris, France
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Aubert CE, Cluzel P, Kemel S, Michel PL, Lajat-Kiss F, Dadon M, Hartemann A, Bourron O. Influence of peripheral vascular calcification on efficiency of screening tests for peripheral arterial occlusive disease in diabetes--a cross-sectional study. Diabet Med 2014; 31:192-9. [PMID: 23952656 DOI: 10.1111/dme.12309] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2013] [Revised: 07/10/2013] [Accepted: 08/12/2013] [Indexed: 01/09/2023]
Abstract
AIMS Pulse palpation and ankle brachial index are recommended to screen for peripheral arterial occlusive disease in people with diabetes. However, vascular calcification can be associated with false negative tests (arteriopathy present despite normal screening tests). We therefore studied the impact of peripheral vascular calcification on the performance of these tests. METHODS This cross-sectional study included 200 people with diabetes at high risk of cardiovascular disease. The main exclusion factor was an estimated glomerular filtration rate < 30 ml/min. Peripheral arterial occlusive disease was diagnosed by colour duplex ultrasonography and peripheral vascular calcification scored by computed tomography scan. We measured sensitivity, specificity, predictive values, accuracy and likelihood ratios of pulse palpation and ankle brachial index, and looked for the impact of calcification on false negative tests (arteriopathy present despite normal screening tests). RESULTS Ankle brachial index alone had poor sensitivity and negative predictive value and high negative likelihood ratio. Pulse palpation had higher sensitivity and negative predictive value. An abnormal pulse palpation, defined by weak or missing pulses, combined with an abnormal ankle brachial index, had the highest sensitivity and negative predictive value (92.3 and 89.8%, respectively). Vascular calcification score was higher in patients with false negative tests, for both pulse palpation and ankle brachial index (P < 0.0001 for all). Ankle systolic blood pressure was higher in patients with false negative tests for pulse palpation (P = 0.004). CONCLUSIONS Below-knee vascular calcification gave a high rate of false negative results for ankle brachial index. Refined pulse palpation combined with ankle brachial index remained the best strategy to screen for peripheral arteriopathy.
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Affiliation(s)
- C E Aubert
- Diabetes and Metabolic Diseases Department, AP-HP, Pitié-Salpêtrière Hospital, Paris, France; Internal Medicine Department, Fribourg Cantonal Hospital, Fribourg, Switzerland
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Hartemann A, Bensimon G, Payan CA, Jacqueminet S, Bourron O, Nicolas N, Fonfrede M, Rosenzwajg M, Bernard C, Klatzmann D. Low-dose interleukin 2 in patients with type 1 diabetes: a phase 1/2 randomised, double-blind, placebo-controlled trial. Lancet Diabetes Endocrinol 2013; 1:295-305. [PMID: 24622415 DOI: 10.1016/s2213-8587(13)70113-x] [Citation(s) in RCA: 308] [Impact Index Per Article: 28.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND An improper balance of regulatory/effector T (Treg/Teff) cells is central to the development of autoimmune diseases, including type 1 diabetes. We previously showed that low-dose interleukin 2 (IL2) induced Treg cell expansion and activation and clinical improvement in patients with hepatitis-C-virus-induced vasculitis. We aimed to establish which low doses of IL2 would be safe and induce Treg cells in patients with type 1 diabetes, considering that: (1) type 1 diabetes might be linked to alteration of the IL2/IL2R activation pathway; (2) activation of pathogenic Teff cells by IL2 could exacerbate disease; and (3) the safety of low-dose IL2 is not known in type 1 diabetes. METHODS This was a single-centre phase 1/2 study. 24 adult patients (18-55 years) with established insulin-dependent type 1 diabetes and at least one diabetes-related autoantibody were enrolled and randomly assigned (in a 1:1:1:1 ratio, by computer-generated randomisation list, with block size four) to placebo or IL2 at 0.33 MIU/day, 1 MIU/day, or 3 MIU/day for a 5-day course and were followed up for 60 days. All investigators and participants were masked to assignment. The primary outcome was change in Treg cells, measured by flow cytometry, and expressed as a percentage of CD4+ T cells, from day 1 to day 60. This trial is registered with ClinicalTrials.gov, number NCT01353833. FINDINGS Six patients were assigned to each group between June 1, 2011, and Feb 3, 2012. IL2 was well tolerated at all doses, with no serious adverse events. However, there was a dose-response association for non-serious adverse events during the treatment phase (days 1-6); one patient in the placebo group, three patients in the 0.33 MIU group, five patients in the 1 MIU group, and six patients in the 3 MIU group had non-serious adverse events. The most common adverse events in the treatment phase were injection-site reaction (no patients with placebo vs three patients with 0.33 MIU and 1 MIU vs two patients with 3 MIU) and influenza-like syndrome (no patients with placebo vs one patient with 0.33 MIU and 1 MIU vs four patients with 3 MIU). After the treatment phase, adverse events did not differ between groups. IL2 did not induce deleterious changes in glucose-metabolism variables. IL2 induced a dose-dependent increase in the proportion of Treg cells, significant at all doses compared with placebo (placebo mean increase 0.5% [SD 0.4]; 0.33 MIU 2.8% [1.2], p=0.0039; 1 MIU 3.9% [1.8], p=0.0039; 3 MIU 4.8% [1.9] p=0.0039). INTERPRETATION We have defined a well-tolerated and immunologically effective dose range of IL2 for application to type 1 diabetes therapy and prevention, which could be relevant to other disorders in which a Treg cell increase would be desirable.
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Affiliation(s)
- Agnès Hartemann
- Department of Diabetology, Hôpital Pitié-Salpêtrière, Paris, France
| | - Gilbert Bensimon
- Department of Clinical Pharmacology, Hôpital Pitié-Salpêtrière, Paris, France; Pharmacologie, Paris, France
| | - Christine A Payan
- Department of Clinical Pharmacology, Hôpital Pitié-Salpêtrière, Paris, France
| | | | - Olivier Bourron
- Department of Diabetology, Hôpital Pitié-Salpêtrière, Paris, France
| | - Nathalie Nicolas
- Clinical Investigation Center Paris-Est-CIC-9304, Hôpital Pitié-Salpêtrière, Paris, France
| | - Michèle Fonfrede
- Department of Biochemistry, Hôpital Pitié-Salpêtrière, Paris, France
| | - Michelle Rosenzwajg
- Clinical Investigation Center for Biotherapies and Inflammation-Immunopathology-Biotherapy Department AP-HP, Hôpital Pitié-Salpêtrière, Paris, France; Immunology-Immunopathology-Immunotherapy UPMC Univ Paris 06, Paris, France; INSERM, UMR_S 959, Immunology-Immunopathology-Immunotherapy, Paris, France; CNRS, UMR 7211, Immunology-Immunopathology-Immunotherapy, Paris, France
| | - Claude Bernard
- Clinical Investigation Center for Biotherapies and Inflammation-Immunopathology-Biotherapy Department AP-HP, Hôpital Pitié-Salpêtrière, Paris, France; Immunology-Immunopathology-Immunotherapy UPMC Univ Paris 06, Paris, France; INSERM, UMR_S 959, Immunology-Immunopathology-Immunotherapy, Paris, France; CNRS, UMR 7211, Immunology-Immunopathology-Immunotherapy, Paris, France
| | - David Klatzmann
- Clinical Investigation Center for Biotherapies and Inflammation-Immunopathology-Biotherapy Department AP-HP, Hôpital Pitié-Salpêtrière, Paris, France; Immunology-Immunopathology-Immunotherapy UPMC Univ Paris 06, Paris, France; INSERM, UMR_S 959, Immunology-Immunopathology-Immunotherapy, Paris, France; CNRS, UMR 7211, Immunology-Immunopathology-Immunotherapy, Paris, France.
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Bouhassira D, Letanoux M, Hartemann A. Chronic pain with neuropathic characteristics in diabetic patients: a French cross-sectional study. PLoS One 2013; 8:e74195. [PMID: 24058527 PMCID: PMC3772849 DOI: 10.1371/journal.pone.0074195] [Citation(s) in RCA: 107] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2013] [Accepted: 07/29/2013] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE Our aim was to estimate the prevalence of distal chronic pain with neuropathic characteristics in patients with type 1 and type 2 diabetes mellitus and its impact on quality of life, mood, anxiety, sleep and healthcare utilization. METHODS In total, 885 patients were screened and 766 diabetic patients (38.7% with type 1 diabetes mellitus, 44.8% women, mean age: 57.2 ± 14.9 years) were enrolled consecutively over a three-month period in this observational study by 85 diabetes specialists working in a hospital department or in private practice. All the patients completed a series of questionnaires for the detection of chronic pain (i.e. daily pain for more than three months) in the lower limbs and assessment of health-related quality of life (Medical Outcomes Short Form 12 scale), sleep disturbances (MOS sleep scale), depression and anxiety (Hospital Anxiety and Depression scale). Patients with chronic pain were also assessed with the 7-item DN4-interview questionnaire, the monofilament test and the Michigan Neuropathy Screening Instrument (MNSI). RESULTS The overall prevalence of chronic pain with neuropathic characteristics was 20.3% [95% CI 17.4-23.1]. The MNSI examination score suggested that pain was related to polyneuropathy, in 80.1% of these patients (89.5% of those with bilateral pain). Patients with chronic pain had a poorer quality of life and more sleep disturbances, anxiety and depression than patients without pain and the presence of neuropathic characteristics was predictive of such impairments. Only 38.6% of the patients had received appropriate treatment for neuropathic pain. CONCLUSIONS Chronic pain with neuropathic characteristics concerns one in five diabetic patients, has a significant impact on quality of life and is not adequately managed. The close correlation between the DN4 questionnaire and MNSI results suggests that screening tools for neuropathic pain could be used in daily practice for the identification of painful diabetic polyneuropathy.
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Affiliation(s)
- Didier Bouhassira
- INSERM U-987, Centre d’Evaluation et Traitement de la Douleur, CHU Ambroise Paré, APHP, Boulogne-Billancourt, France
- Université Versailles-Saint-Quentin, Versailles, France
- * E-mail:
| | | | - Agnès Hartemann
- Service de Diabétologie, CHU Pitié-Salpétrière, Paris, France
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Abstract
Administration of low-dose interleukin-2 (IL-2) alone or combined with rapamycin (RAPA) prevents hyperglycemia in NOD mice. Also, low-dose IL-2 cures recent-onset type 1 diabetes (T1D) in NOD mice, partially by boosting pancreatic regulatory T cells (Treg cells). These approaches are currently being evaluated in humans. Our objective was to study the effect of higher IL-2 doses (250,000-500,000 IU daily) as well as low-dose IL-2 (25,000 IU daily) and RAPA (1 mg/kg daily) (RAPA/IL-2) combination. We show that, despite further boosting of Treg cells, high doses of IL-2 rapidly precipitated T1D in prediabetic female and male mice and increased myeloid cells in the pancreas. Also, we observed that RAPA counteracted IL-2 effects on Treg cells, failed to control IL-2-boosted NK cells, and broke IL-2-induced tolerance in a reversible way. Notably, the RAPA/IL-2 combination failure to cure T1D was associated with an unexpected deleterious effect on glucose homeostasis at multiple levels, including β-cell division, glucose tolerance, and liver glucose metabolism. Our data help to understand the therapeutic limitations of IL-2 alone or RAPA/IL-2 combination and could lead to the design of improved therapies for T1D.
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Affiliation(s)
- Audrey Baeyens
- Université Pierre et Marie Curie, Paris, France
- Centre National de la Recherche Scientifique, UMR 7211, Paris, France
- Department of Immunology-Immunopathology-Immunotherapy, INSERM U959, Paris, France
| | - Louis Pérol
- Université Pierre et Marie Curie, Paris, France
- Centre National de la Recherche Scientifique, UMR 7211, Paris, France
- Department of Immunology-Immunopathology-Immunotherapy, INSERM U959, Paris, France
| | - Gwladys Fourcade
- Université Pierre et Marie Curie, Paris, France
- Centre National de la Recherche Scientifique, UMR 7211, Paris, France
- Department of Immunology-Immunopathology-Immunotherapy, INSERM U959, Paris, France
| | - Nicolas Cagnard
- INSERM U580, Paris, France
- Bioinformatics Platform, Faculty of Medicine Paris Descartes, Hôpital Necker-Enfants Malades, Paris, France
| | - Wassila Carpentier
- Université Pierre et Marie Curie, Paris, France
- Plateforme Post-Génomique P3S, Université Pierre et Marie Curie, Faculty of Medicine, Paris, France
| | - Janine Woytschak
- Laboratory of Applied Immunobiology, University of Zurich, Zurich, Switzerland
| | - Onur Boyman
- Laboratory of Applied Immunobiology, University of Zurich, Zurich, Switzerland
- Allergy Unit, Department of Dermatology, University Hospital Zurich, Zurich, Switzerland
| | - Agnès Hartemann
- Department of Endocrinology, Nutrition and Diabetes, Assistance Publique-Hôpitaux de Paris, Pitié-Salpêtrière-Charles Foix Hospital, Paris, France
- Department of Medicine Faculty, Université Pierre et Marie Curie, Paris, France
| | - Eliane Piaggio
- Université Pierre et Marie Curie, Paris, France
- Centre National de la Recherche Scientifique, UMR 7211, Paris, France
- Department of Immunology-Immunopathology-Immunotherapy, INSERM U959, Paris, France
- Corresponding author: Eliane Piaggio,
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Aubert CE, Le Doeuff J, Lajou J, Barthelemy O, Hartemann A, Bourron O. Influence of peripheral arterial occlusive disease on the Neuropad(®) test performance in patients with diabetes. Diabet Med 2013; 30:e178-84. [PMID: 23398465 DOI: 10.1111/dme.12150] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2012] [Revised: 12/13/2012] [Accepted: 02/05/2013] [Indexed: 02/06/2023]
Abstract
AIMS The specificity of the Neuropad(®) test to screen for peripheral neuropathy is moderate, but this test has several advantages, such as self-use, educative value and good sensitivity. Use of the Neuropad is usually contra-indicated in the presence of peripheral arterial occlusive disease, a condition associated with skin dryness. The aim of this study was to assess the influence of peripheral arterial occlusive disease on the performance of the Neuropad for screening peripheral neuropathy, and to compare it with the monofilament test. METHODS We included 200 patients with diabetes. Peripheral neuropathy was defined by a neuropathy disability score ≥ 6. The Neuropad was determined as normal or abnormal at 10 and 20 min, respectively, and its performance was compared in patients with and without peripheral arterial occlusive disease diagnosed by colour duplex ultrasonography. The performances of the Neuropad and of the monofilament test were compared. RESULTS Prevalences of peripheral neuropathy and of peripheral arterial occlusive disease were 15.8 and 44%, respectively. At 10 min, sensitivity and negative predictive value were high (93.8 and 95.1%), while specificity and positive predictive value were poor (23.2 and 18.9%). The Neuropad performance was not significantly different between patients with and without arteriopathy. Between 10 and 20 min, there was significant loss of sensitivity and gain in specificity. The Neuropad at 10 min was more sensitive but less specific than the monofilament test. CONCLUSIONS The reliability of the Neuropad is not significantly different in the presence or absence of peripheral arterial occlusive disease.
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Affiliation(s)
- C E Aubert
- Diabetes and Metabolic Diseases Department, AP-HP, Pitié-Salpêtrière Hospital, Paris, France.
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Billionnet C, Weill A, Neumann A, Ricordeau P, Hartemann A, Alla F, Allemand H. Intérêt du chaînage des informations mère-enfant dans le PMSI et le Sniiram : à propos de l’exemple du diabète et de la grossesse. Rev Epidemiol Sante Publique 2013. [DOI: 10.1016/j.respe.2013.01.052] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Bourron O, Chebbi F, Halbron M, Saint-Martin C, Bellanné-Chantelot C, Abed A, Charbit B, Magnan C, Lacorte J, Hartemann A. Incretin effect of glucagon-like peptide 1 receptor agonist is preserved in presence of ABCC8/SUR1 mutation in β-cell. Diabetes Care 2012; 35:e76. [PMID: 23093687 PMCID: PMC3476900 DOI: 10.2337/dc12-0535] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Affiliation(s)
- Olivier Bourron
- From the Department of Endocrinology, Nutrition and Diabetes, Assistance Publique-Hôpitaux de Paris (AP-HP), Pitié-Salpêtrière-Charles Foix Hospital, Paris, France; the
- Medicine Faculty, Université Pierre et Marie Curie - Paris 6, Paris, France; the
| | - Fatma Chebbi
- Department of Endocrine and Oncological Biochemistry, Assistance Publique-Hôpitaux de Paris, Pitié-Salpêtrière-Charles Foix Hospital, Paris, France; the
| | - Marine Halbron
- From the Department of Endocrinology, Nutrition and Diabetes, Assistance Publique-Hôpitaux de Paris (AP-HP), Pitié-Salpêtrière-Charles Foix Hospital, Paris, France; the
| | - Cécile Saint-Martin
- Department of Genetics, Assistance Publique-Hôpitaux de Paris (AP-HP), Pitié-Salpêtrière-Charles Foix Hospital Hospital, Paris, France
| | - Christine Bellanné-Chantelot
- Medicine Faculty, Université Pierre et Marie Curie - Paris 6, Paris, France; the
- Department of Genetics, Assistance Publique-Hôpitaux de Paris (AP-HP), Pitié-Salpêtrière-Charles Foix Hospital Hospital, Paris, France
| | - Ahmed Abed
- Department of Endocrine and Oncological Biochemistry, Assistance Publique-Hôpitaux de Paris, Pitié-Salpêtrière-Charles Foix Hospital, Paris, France; the
- Université Pierre et Marie Curie - Paris 6, UMR S 872, Les Cordeliers, Paris, France
- INSERM, U872, Paris, France
| | - Beny Charbit
- INSERM, Clinical Investigation Center Paris-EST (CIC 9304), Paris, France; and
| | - Christophe Magnan
- Biologie Fonctionnelle et Adaptative, Centre National de la Recherche Scientifique, Université Paris Diderot - Paris 5, Paris, France
| | - J.M. Lacorte
- Department of Endocrine and Oncological Biochemistry, Assistance Publique-Hôpitaux de Paris, Pitié-Salpêtrière-Charles Foix Hospital, Paris, France; the
- Université Pierre et Marie Curie - Paris 6, UMR S 872, Les Cordeliers, Paris, France
- INSERM, U872, Paris, France
| | - Agnès Hartemann
- From the Department of Endocrinology, Nutrition and Diabetes, Assistance Publique-Hôpitaux de Paris (AP-HP), Pitié-Salpêtrière-Charles Foix Hospital, Paris, France; the
- Medicine Faculty, Université Pierre et Marie Curie - Paris 6, Paris, France; the
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Bergmann JF, Thervet E, Timsit J, Blacher J, Varet B, Hartemann A, Chosidow O, Mariette X, Gervais A, Amoura Z, Bruckert E, Pariente A, Vernant JP, Penformis F, Dautzenberg B, Sobel A, Guillevin L, Valla D, Leblond V, Gaudric A, Chast F, Bourdillon F, Fredenrich A, Bourgeois P, Grimaldi A. [How to differentiate between useful and useless drugs?]. Rev Prat 2012; 62:1192-1195. [PMID: 23272464] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
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