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Regnault N, Lebreton E, Tang L, Fosse-Edorh S, Barry Y, Olié V, Billionnet C, Weill A, Vambergue A, Cosson E. Maternal and neonatal outcomes according to the timing of diagnosis of hyperglycaemia in pregnancy: a nationwide cross-sectional study of 695,912 deliveries in France in 2018. Diabetologia 2024; 67:516-527. [PMID: 38182910 PMCID: PMC10844424 DOI: 10.1007/s00125-023-06066-4] [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] [Received: 08/07/2023] [Accepted: 11/02/2023] [Indexed: 01/07/2024]
Abstract
AIMS/HYPOTHESIS We aimed to assess maternal-fetal outcomes according to various subtypes of hyperglycaemia in pregnancy. METHODS We used data from the French National Health Data System (Système National des Données de Santé), which links individual data from the hospital discharge database and the French National Health Insurance information system. We included all deliveries after 22 gestational weeks (GW) in women without pre-existing diabetes recorded in 2018. Women with hyperglycaemia were classified as having overt diabetes in pregnancy or gestational diabetes mellitus (GDM), then categorised into three subgroups according to their gestational age at the time of GDM diagnosis: before 22 GW (GDM<22); between 22 and 30 GW (GDM22-30); and after 30 GW (GDM>30). Adjusted prevalence ratios (95% CI) for the outcomes were estimated after adjusting for maternal age, gestational age and socioeconomic status. Due to the multiple tests, we considered an association to be statistically significant according to the Holm-Bonferroni procedure. To take into account the potential immortal time bias, we performed analyses on deliveries at ≥31 GW and deliveries at ≥37 GW. RESULTS The study population of 695,912 women who gave birth in 2018 included 84,705 women (12.2%) with hyperglycaemia in pregnancy: overt diabetes in pregnancy, 0.4%; GDM<22, 36.8%; GDM22-30, 52.4%; and GDM>30, 10.4%. The following outcomes were statistically significant after Holm-Bonferroni adjustment for deliveries at ≥31 GW using GDM22-30 as the reference. Caesarean sections (1.54 [1.39, 1.72]), large-for-gestational-age (LGA) infants (2.00 [1.72, 2.32]), Erb's palsy or clavicle fracture (6.38 [2.42, 16.8]), preterm birth (1.84 [1.41, 2.40]) and neonatal hypoglycaemia (1.98 [1.39, 2.83]) were more frequent in women with overt diabetes. Similarly, LGA infants (1.10 [1.06, 1.14]) and Erb's palsy or clavicle fracture (1.55 [1.22, 1.99]) were more frequent in GDM<22. LGA infants (1.44 [1.37, 1.52]) were more frequent in GDM>30. Finally, women without hyperglycaemia in pregnancy were less likely to have preeclampsia or eclampsia (0.74 [0.69, 0.79]), Caesarean section (0.80 [0.79, 0.82]), pregnancy and postpartum haemorrhage (0.93 [0.89, 0.96]), LGA neonate (0.67 [0.65, 0.69]), premature neonate (0.80 [0.77, 0.83]) and neonate with neonatal hypoglycaemia (0.73 [0.66, 0.82]). Overall, the results were similar for deliveries at ≥37 GW. Although the estimation of the adjusted prevalence ratio of perinatal death was five times higher (5.06 [1.87, 13.7]) for women with overt diabetes, this result was non-significant after Holm-Bonferroni adjustment. CONCLUSIONS/INTERPRETATION Compared with GDM22-30, overt diabetes, GDM<22 and, to a lesser extent, GDM>30 were associated with poorer maternal-fetal outcomes.
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Affiliation(s)
- Nolwenn Regnault
- Santé Publique France, the national public health agency, Saint-Maurice, France
| | - Elodie Lebreton
- Santé Publique France, the national public health agency, Saint-Maurice, France
| | - Luveon Tang
- Santé Publique France, the national public health agency, Saint-Maurice, France
| | | | - Yaya Barry
- Santé Publique France, the national public health agency, Saint-Maurice, France
| | - Valérie Olié
- Santé Publique France, the national public health agency, Saint-Maurice, France
| | | | - Alain Weill
- EPI-PHARE Epidemiology of Health Products, French National Agency for Medicines and Health Products Safety (ANSM) and French National Health Insurance (CNAM), Saint-Denis, France
| | - Anne Vambergue
- Endocrinology, Diabetology, Metabolism and Nutrition Department, Lille University Hospital, European Genomics Institute for Diabetes, University of Lille, Lille, France
| | - Emmanuel Cosson
- Department of Diabetology-Endocrinology-Nutrition, CRNH-IdF, CINFO, Paris 13 University, Sorbonne Paris Cité, AP-HP, Avicenne Hospital, Bobigny, France.
- Nutritional Epidemiology Research Team (EREN), Center of Research in Epidemiology and StatisticS (CRESS), Université Sorbonne Paris Nord and Université Paris CitéInserm, INRAE, CNAM, Bobigny, France.
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Tang L, Lebreton E, Vambergue A, Fosse-Edorh S, Olié V, Barry Y, Weill A, Cosson E, Regnault N. Cross-sectional study examining factors impacting on uptake of postpartum type 2 diabetes screening among women diagnosed with hyperglycaemia in pregnancy. Diabetes Res Clin Pract 2024; 208:111116. [PMID: 38266823 DOI: 10.1016/j.diabres.2024.111116] [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] [Received: 10/12/2023] [Revised: 01/16/2024] [Accepted: 01/21/2024] [Indexed: 01/26/2024]
Abstract
AIMS Early postpartum glucose screening of women with hyperglycaemia in pregnancy (HIP) can identify women who have the highest risk of developing impaired glucose tolerance and T2DM. This study examines the association between demographics, events during pregnancy, socioeconomic status and postpartum T2DM screening. METHODS Using the French National Health Data System, this cross-sectional study included all deliveries where the mother had HIP in France in 2015, (n = 76,862). The odds ratio (OR) for attending postpartum screening was calculated via multi-level logistic regression. RESULTS T2DM screening uptake at six months postpartum was 42·9% [95 % Confidence Interval: 42·6-43·3]. Several characteristics were associated with lower uptake: living in the most deprived area(OR = 0·78[0·74-0·83]); being < 25 years-old (reference age group 25-29;≤17: 0.53 [0·31-0·90];18-24: 0.73[0·69-0·78]); smoking (0·65[0·62-0·68]); obesity (0·93[0·89-0·97]); caesarean delivery (0·95[0·92-0·99]). Factors associated with higher uptake included primiparity (1·30[1·26-1·34]); having followed the French recommendations for HIP screening (1·24[1·20-1·28]); insulin prescription (1·75[1·69-1·81]) and pre-eclampsia (1·30[1·19-1·42]). p < 0.01 is justified due to sample size. CONCLUSION Improving identification of factors affecting postpartum T2DM screening uptake, such as demographics, socioeconomic context and events during pregnancy, may lead to development of target interventions to aide adherence to screening regime and thereby diagnosis of women with prediabetes or diabetes, for whom secondary and tertiary prevention is crucial.
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Affiliation(s)
- Luveon Tang
- Santé Publique France, French National Public Health Agency, S(t) Maurice, France.
| | - Elodie Lebreton
- Santé Publique France, French National Public Health Agency, S(t) Maurice, France
| | - Anne Vambergue
- Endocrinology, Diabetology, Metabolism and Nutrition Department, Lille University Hospital, European Genomics Institute for Diabetes, University of Lille, France
| | - Sandrine Fosse-Edorh
- Santé Publique France, French National Public Health Agency, S(t) Maurice, France
| | - Valérie Olié
- Santé Publique France, French National Public Health Agency, S(t) Maurice, France
| | - Yaya Barry
- Santé Publique France, French National Public Health Agency, S(t) Maurice, France
| | - Alain Weill
- EPI-PHARE Epidemiology of Health Products, French National Agency for Medicines and Health Products Safety (ANSM) and French National Health Insurance (CNAM), Saint-Denis, France; Paris 13 University, Sorbonne Paris Cité, AP-HP, Avicenne Hospital, Department of Endocrinology, CRNH-IdF, CINFO, Bobigny, France
| | - Emmanuel Cosson
- Paris 13 University, Sorbonne Paris Cité, UMR U557 INSERM/U11125 INRA, France
| | - Nolwenn Regnault
- Santé Publique France, French National Public Health Agency, S(t) Maurice, France
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Robert L, Quindroit P, Henry H, Perez M, Rousselière C, Lemaitre M, Vambergue A, Décaudin B, Beuscart JB. Implementation of a clinical decision support system for the optimization of antidiabetic drug orders by pharmacists. Br J Clin Pharmacol 2024; 90:239-246. [PMID: 37657079 DOI: 10.1111/bcp.15898] [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] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Revised: 08/07/2023] [Accepted: 08/22/2023] [Indexed: 09/03/2023] Open
Abstract
AIMS The objective of the study was to describe the impact of a clinical decision support system (CDSS) on antidiabetic drug management by clinical pharmacists for hospitalized patients with T2DM. METHODS We performed a retrospective, single-centre study in a teaching hospital, where clinical pharmacists analysed prescriptions and issued pharmacist interventions (PIs) through a computerized physician order entry (CPOE) system. A CDSS was integrated into the pharmacists' workflow in July 2019. We analysed PIs during 2 periods of interest: one before the introduction of the CDSS (from November 2018 to April 2019, PIs issued through the CPOE alone) and one afterwards (from November 2020 to April 2021, PIs issued through the CPOE and/or the CDSS). The study covered nondiabetology wards as endocrinology, diabetes and metabolism departments were not computerized at the time of the study. RESULTS There were 203 PIs related to antidiabetic drugs in period 1 and 319 in period 2 (a 57.5% increase). Sixty-four of the 319 PIs were generated by the CDSS. Noncompliance/contraindication was the main problem identified by the CDSS (41 PIs, 68.4%), and 57.8% led to discontinuation of the drug. Most of the PIs issued through the CDSS corresponded to orders that had not been flagged up by clinical pharmacists using the CPOE. Conversely, most alerts about indications that were not being treated were detected by the clinical pharmacists using the CPOE and not by the CDSS. CONCLUSION Use of CDSS by clinical pharmacists improved antidiabetic drug management for hospitalized patients with T2DM. The CDSS might add value to diabetes care in nondiabetology wards by decreasing the frequency of potentially inappropriate prescriptions and adverse drug reactions.
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Affiliation(s)
- Laurine Robert
- Univ. Lille, CHU Lille, ULR 2694 - METRICS: Évaluation des technologies de santé et des pratiques médicales, Lille, France
| | - Paul Quindroit
- Univ. Lille, CHU Lille, ULR 2694 - METRICS: Évaluation des technologies de santé et des pratiques médicales, Lille, France
| | - Héloïse Henry
- Univ. Lille, CHU Lille, ULR 7365 - GRITA: Groupe de Recherche sur les formes Injectables et les Technologies Associées, Lille, France
| | | | | | - Madleen Lemaitre
- Department of Diabetology, Endocrinology, Metabolism and, Nutrition, Lille University Hospital, CHU Lille, Lille, France
- University of Lille, Lille, France
| | - Anne Vambergue
- Department of Diabetology, Endocrinology, Metabolism and, Nutrition, Lille University Hospital, CHU Lille, Lille, France
- University School of Medicine, European Genomic Institute for Diabetes, Lille, France
| | - Bertrand Décaudin
- Univ. Lille, CHU Lille, ULR 7365 - GRITA: Groupe de Recherche sur les formes Injectables et les Technologies Associées, Lille, France
| | - Jean-Baptiste Beuscart
- Univ. Lille, CHU Lille, ULR 2694 - METRICS: Évaluation des technologies de santé et des pratiques médicales, Lille, France
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Lemaitre M, Lionet A, Fages V, Vantyghem MC, Subtil D, Vambergue A. Case report: Non-PTH-dependent hypercalcemia in pregnancy: Consider CYP24A1 mutations. Ann Endocrinol (Paris) 2023; 84:758-760. [PMID: 37321475 DOI: 10.1016/j.ando.2023.05.009] [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: 04/07/2023] [Accepted: 05/29/2023] [Indexed: 06/17/2023]
Affiliation(s)
- Madleen Lemaitre
- Department of Diabetology, Endocrinology, Metabolism and Nutrition, Lille University Hospital, CHU of Lille, 59000 Lille, France; University of Lille, 59000 Lille, France; University of Lille, CHU of Lille, ULR 2694-METRICS: Évaluation des Technologies de Santé et des Pratiques Médicales, 59000 Lille, France.
| | - Arnaud Lionet
- Department of Nephrology, Lille University Hospital, CHU of Lille, 59000 Lille, France
| | - Victor Fages
- Department of Nephrology, Lille University Hospital, CHU of Lille, 59000 Lille, France
| | - Marie-Christine Vantyghem
- Department of Diabetology, Endocrinology, Metabolism and Nutrition, Lille University Hospital, CHU of Lille, 59000 Lille, France; University of Lille, 59000 Lille, France; European Genomic Institute for Diabetes, University School of Medicine, 59000 Lille, France
| | - Damien Subtil
- University of Lille, 59000 Lille, France; University of Lille, CHU of Lille, ULR 2694-METRICS: Évaluation des Technologies de Santé et des Pratiques Médicales, 59000 Lille, France; Department of Gynaecology and Obstetrics, Lille University Hospital, CHU of Lille, 59000 Lille, France
| | - Anne Vambergue
- Department of Diabetology, Endocrinology, Metabolism and Nutrition, Lille University Hospital, CHU of Lille, 59000 Lille, France; University of Lille, 59000 Lille, France; Department of Gynaecology and Obstetrics, Lille University Hospital, CHU of Lille, 59000 Lille, France
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Lemaitre M, Bourdon G, Bruandet A, Lenne X, Subtil D, Rakza T, Vambergue A. Pre-gestational diabetes and the risk of congenital heart defects in the offspring: A French nationwide study. Diabetes Metab 2023; 49:101446. [PMID: 37031733 DOI: 10.1016/j.diabet.2023.101446] [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] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Revised: 03/27/2023] [Accepted: 04/02/2023] [Indexed: 04/11/2023]
Abstract
AIM To compare the frequencies and types of congenital heart defects for infants of women without and with pre-gestational diabetes, type 1 and type 2 diabetes (T1DM, T2DM) and to identify risk factors. METHODS All live births between 2012 and 2020 were screened for maternal diabetes and infant congenital heart defects using the French Medical Information System Program in Medicine, Surgery and Obstetrics database (PMSI-MCO). Incidences of these defects were estimated, and a logistic model evaluated maternal and fetal prognostic risk factors. RESULTS Overall, 6,038,703 mothers did not have pre-gestational diabetes (no-diabetes), 23,147 had T1DM, and 14,401 had T2DM. The incidence of infant congenital disease was 6.2% for the no-diabetes group, 8.0%, for women with T1DM, and 8.4% for women with T2DM (P < 0.001); for congenital heart defects, incidences were respectively 0.8%, 3.0% and 2.7% (P < 0.001). In comparison with the no-diabetes group, the odds ratios (95%CI) of coronary heart defects were 2.07 (1.91;2.24) (P < 0.001) for women with T1DM and 2.20 (1.99;2.44) (P < 0.001) for women with T2DM, with no difference between T1DM and T2DM (P = 0.336). cesarian section, small and large for gestational age, and prematurity were also associated with an increased risk of congenital heart defects. CONCLUSION In this study we observed higher incidences of congenital heart defects in infants of women with pre-gestational diabetes compared to women without pre-gestational diabetes, with no difference between women with T1DM or T2DM. These data call for intensifying preconception care and justify systematic cardiac echography in selected fetuses.
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Affiliation(s)
- Madleen Lemaitre
- CHU Lille, Department of Diabetology, Endocrinology, Metabolism and Nutrition Lille University Hospital, F-59000 Lille, France; University of Lille, F-59000 France; ULR 2694-METRICS: Évaluation des Technologies de Santé et des Pratiques Médicales, F-59000 Lille, France
| | - Gurvan Bourdon
- University of Lille, F-59000 France; CHU Lille, Department of Pediatrics, Lille University Hospital, F-59000 Lille, France
| | - Amélie Bruandet
- CHU Lille, Department of Medical Information, Lille University Hospital, F-59000 Lille, France
| | - Xavier Lenne
- CHU Lille, Department of Medical Information, Lille University Hospital, F-59000 Lille, France
| | - Damien Subtil
- University of Lille, F-59000 France; ULR 2694-METRICS: Évaluation des Technologies de Santé et des Pratiques Médicales, F-59000 Lille, France; CHU Lille, Department of Gynecology and Obstetrics, Lille University Hospital, F-59000 Lille, France
| | - Thameur Rakza
- CHU Lille, Department of Pediatrics, Lille University Hospital, F-59000 Lille, France
| | - Anne Vambergue
- CHU Lille, Department of Diabetology, Endocrinology, Metabolism and Nutrition Lille University Hospital, F-59000 Lille, France; University of Lille, F-59000 France; European Genomic Institute for Diabetes, University School of Medicine, F-59000 Lille, France.
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Mailliez A, Ternynck C, Duhamel A, Mailliez A, Ploquin A, Desauw C, Lemaitre M, Bertrand N, Vambergue A, Turpin A. Diabetes is associated with high risk of severe adverse events during chemotherapy for cancer patients: A single-center study. Int J Cancer 2023; 152:408-416. [PMID: 36054752 PMCID: PMC10087807 DOI: 10.1002/ijc.34268] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2021] [Revised: 05/31/2022] [Accepted: 06/02/2022] [Indexed: 02/01/2023]
Abstract
Diabetes mellitus (DM) is a common comorbidity among cancer patients, but its impact on chemotherapy tolerance has not been widely studied. We aimed to compare the occurrence of severe grade 3/4 adverse events (G3/4 AEs) within 90 days of starting chemotherapy between patients with and without diabetes. We conducted a retrospective single-center study in Lille University Hospital Oncology Department, France. Patients who received the first cycle of chemotherapy for gastrointestinal, gynecological or cancer of unknown primary source between 1 May 2013 and 1 May 2016, were included. Overall, 609 patients were enrolled: 490 patients without diabetes (80.5%) and 119 patients with diabetes (19.5%). Within 90 days of starting chemotherapy, patients with diabetes had a significantly higher occurrence of AEs G3/4 compared to those with no diabetes (multivariate odds ratio [OR]: 1.57 [1.02-2.42], P = .04). More frequent G3/4 AEs in patients with diabetes were infection (26%), hematological disorders (13%), endocrine disorders (13%) and deterioration of the general condition (13%). In the year following the beginning of chemotherapy, patients with diabetes were twice as likely to be hospitalized as those without diabetes (univariate OR: 2.1 [1.40-3.15], P = .0003). After multivariate adjustment, diabetes was no longer significantly associated with the risk of hospitalization (P = .051). There were no differences between patients with and without diabetes regarding dose reduction and chemotherapy treatment delays (P = .61 and P = .30, respectively). Our study suggests the need for better consideration of DM in the personalized care plan to improve chemotherapy tolerance and quality of life of patients with DM.
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Affiliation(s)
- Aurélie Mailliez
- Department of Geriatrics, CHU Lille, Lille, France.,U1167-RID-AGE-Facteurs de Risque et Déterminants Moléculaires des Maladies Liées au Vieillissement, Université de Lille, Inserm, CHU Lille, Institut Pasteur de Lille, Lille, France
| | - Camille Ternynck
- ULR 2694-METRICS: Évaluation Des Technologies De Santé Et Des Pratiques Médicales, Université de Lille, CHU Lille, Lille, France
| | - Alain Duhamel
- ULR 2694-METRICS: Évaluation Des Technologies De Santé Et Des Pratiques Médicales, Université de Lille, CHU Lille, Lille, France
| | - Audrey Mailliez
- Medical Oncology Department, Breast Cancer Unit, Oscar Lambret Center, Lille, France
| | - Anne Ploquin
- Medical Oncology Department, CHU Lille, ULR 2694 METRICS, University of Lille, Lille, France
| | - Christophe Desauw
- Medical Oncology Department, CHU Lille, ULR 2694 METRICS, University of Lille, Lille, France
| | - Madleen Lemaitre
- CHU Lille, Department of Diabetology, Endocrinology, Metabolism and Nutrition, Lille University Hospital, Lille, France.,European Genomic Institute for Diabetes, Lille University School of Medicine, Lille, France
| | - Nicolas Bertrand
- Medical Oncology Department, CHU Lille, ULR 2694 METRICS, University of Lille, Lille, France
| | - Anne Vambergue
- CHU Lille, Department of Diabetology, Endocrinology, Metabolism and Nutrition, Lille University Hospital, Lille, France.,European Genomic Institute for Diabetes, Lille University School of Medicine, Lille, France
| | - Anthony Turpin
- CHU Lille, Institut Pasteur de Lille, UMR9020-UMR-S 1277-Canther-Cancer Heterogeneity, Plasticity and Resistance to Therapies, University of Lille, CNRS, Inserm, Lille, France.,Medical Oncology Department, CHU Lille, University of Lille, Lille, France
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Tollini V, Lemaître M, Garabedian C, Martin C, Bengler C, Vambergue A, Ghesquière L. The impact of lockdown on maternal and neonatal morbidity in gestational diabetes mellitus. Am J Obstet Gynecol 2022; 227:775-777. [PMID: 35764141 PMCID: PMC9617643 DOI: 10.1016/j.ajog.2022.06.033] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Revised: 06/15/2022] [Accepted: 06/21/2022] [Indexed: 11/01/2022]
Affiliation(s)
- Valentine Tollini
- CHU Lille, Department of Gynecology and Obstetrics, Lille University Hospital, Lille, France
| | - Madleen Lemaître
- CHU Lille, Department of Diabetology, Endocrinology, Metabolism and Nutrition, Lille University Hospital, Lille, France
| | - Charles Garabedian
- CHU Lille, Department of Gynecology and Obstetrics, Lille University Hospital, Lille, France; Univ. Lille, CHU Lille, ULR 2694 - METRICS : évaluation des technologies de santé et des pratiques médicales, Lille, France
| | - Claire Martin
- CHU Lille, Department of Biostatistics, Lille University Hospital, Lille, France; Univ. Lille, CHU Lille, ULR 2694 - METRICS : évaluation des technologies de santé et des pratiques médicales, Lille, France
| | - Cyril Bengler
- CHU Lille, Department of Gynecology and Obstetrics, Lille University Hospital, Lille, France
| | - Anne Vambergue
- CHU Lille, Department of Diabetology, Endocrinology, Metabolism and Nutrition, Lille University Hospital, Lille, France; European Genomic Institute for Diabetes, University School of Medicine, Lille, France
| | - Louise Ghesquière
- CHU Lille, Department of Gynecology and Obstetrics, Lille University Hospital, Lille, France; Univ. Lille, CHU Lille, ULR 2694 - METRICS : évaluation des technologies de santé et des pratiques médicales, F-59000 Lille, France.
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8
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Lemaitre M, Faiz K, Baudoux F, Subtil D, Vambergue A. Intermittently scanned continuous glucose monitoring is associated with lower spontaneous abortion rate compared with conventional blood glucose monitoring in pregnant women with type 1 diabetes: An observational study. Diab Vasc Dis Res 2022; 19:14791641221136837. [PMID: 36515497 PMCID: PMC9756364 DOI: 10.1177/14791641221136837] [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: 12/15/2022] Open
Abstract
AIM The objective of the present real-life study in France was to assess and compare characteristics and outcomes in a cohort of pregnant women with type 1 diabetes (T1D) using intermittently scanned continuous glucose monitoring (isCGM) or conventional blood glucose monitoring (BGM). MATERIAL AND METHODS We performed an observational study of a cohort of 153 women with T1D: 77 women were using isCGM, and 76 were using BGM. We compared the groups' maternal characteristics and maternal-fetal complications. The level of HbA1c was measured before pregnancy and then four times (after 8-12, 24-28, 30-33, and 35-37 weeks of gestation). RESULTS The two groups were similar in terms of age, prepregnancy BMI, diabetes duration, and diabetic vascular complications. There were no significant intergroup differences in the obstetric history. The spontaneous abortion rate was lower in the isCGM group than in the blood glucose monitoring group (5.3% vs. 20%, respectively; p = .0129), while the prepregnancy and first-trimester HbA1c levels were similar. There were no significant intergroup differences in the incidence of other maternal-fetal complications. CONCLUSIONS This observational study demonstrates that isCGM use is associated with lower spontaneous abortion compared with conventional BGM. Large prospective studies are needed to corroborate our findings and fully understand the relationship between glucose data at the time of conception/early pregnancy and foetal outcome.
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Affiliation(s)
- Madleen Lemaitre
- CHU Lille, Department of Diabetology, Endocrinology, Metabolism and Nutrition, Lille University Hospital, France
- University of Lille, France
- CHU Lille, ULR 2694-METRICS, évaluation des Technologies de Santé et des Pratiques Médicales, University of Lille, France
| | - Kenza Faiz
- CHU Lille, Department of Diabetology, Endocrinology, Metabolism and Nutrition, Lille University Hospital, France
| | - Florence Baudoux
- CHU Lille, Department of Diabetology, Endocrinology, Metabolism and Nutrition, Lille University Hospital, France
| | - Damien Subtil
- University of Lille, France
- CHU Lille, ULR 2694-METRICS, évaluation des Technologies de Santé et des Pratiques Médicales, University of Lille, France
- Department of Gynecology and Obstetrics, CHU Lille, France
| | - Anne Vambergue
- CHU Lille, Department of Diabetology, Endocrinology, Metabolism and Nutrition, Lille University Hospital, France
- University of Lille, France
- European Genomic Institute for Diabetes, France
- Anne Vambergue, Department of Diabetology, Endocrinology, Metabolism and Nutrition, Claude Huriez Hospital, rue Michel Polonovski, F-59037 Lille cedex, France.
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Sarvepalli SM, Bailey BA, D'Alessio D, Lemaitre M, Vambergue A, Rathinavelu J, Hadziahmetovic M. Risk factors for the development or progression of diabetic retinopathy in pregnancy: Meta‐analysis and systematic review. Clin Exp Ophthalmol 2022; 51:195-204. [PMID: 36098625 DOI: 10.1111/ceo.14168] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2022] [Revised: 09/04/2022] [Accepted: 09/06/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND Diabetic retinopathy (DR) is the leading cause of blindness in the working-age population, and it increases in severity during pregnancy. METHODS Systematic review of literature from PubMed, Cochrane Library and Web of Science using keywords 'diabetic retinopathy' and 'pregnancy' and 'progression' from inception to 2021 was completed. Included studies were (1) peer-reviewed observational studies addressing progression/development of DR in pregnancy, (2) provided the number of diabetic patients that developed/progressed in DR during pregnancy, and (3) included differential data on variables between progression and non-progression groups. This was applied by two independent researchers and referred to a third researcher as necessary. Twenty-seven of the original 138 studies met this criterion. Data were pooled and analysed using fixed-effects in meta-analysis. RESULTS From 27 studies, 2537 patients were included. Pre-eclampsia [Risk Ratio (RR) 2.62 (95% CI = 1.72, 4.00)] and hypertension treatment during pregnancy [RR 2.74 (95% CI = 1.72, 4.00)] were significantly associated with the development/progression of DR. HbA1c at baseline [MD 0.82 (95% CI = 0.59, 1.06)], duration of diabetes [mean difference (MD) 5.97 (95% CI = 5.38, 6.57)], and diastolic blood pressure at baseline [MD 3.29 (95% CI = 0.46, 6.12)] were all significantly higher in the progression group while only mean birth weight [MD -0.17 (95% CI = -0.31, -0.03)] was significantly higher in the non-progression group. CONCLUSIONS This study fills a gap in the literature and provide physicians with more information on the risk factors associated with the progression of DR in pregnancy and how to counsel this vulnerable patient population appropriately.
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Affiliation(s)
| | - Beth A. Bailey
- Central Michigan University College of Medicine Mt. Pleasant Michigan USA
| | - David D'Alessio
- Department of Endocrinology Duke University Durham North Carolina USA
| | - Madleen Lemaitre
- Department of Endocrinology, Diabetology and Metabolism Lille University Hospital Lille France
- Center Regional Hospital University of Lille Lille France
| | - Anne Vambergue
- Department of Endocrinology, Diabetology and Metabolism Lille University Hospital Lille France
- Center Regional Hospital University of Lille Lille France
- European Genomic Institute for Diabetes University School of Medicine Lille France
- Duke University School of Medicine Durham North Carolina USA
| | - Jay Rathinavelu
- Duke University School of Medicine Durham North Carolina USA
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10
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Gerard E, Quindroit P, Lemaitre M, Robert L, Gautier S, Decaudin B, Vambergue A, Beuscart JB. Defining explicit definitions of potentially inappropriate prescriptions for antidiabetic drugs in patients with type 2 diabetes: A systematic review. PLoS One 2022; 17:e0274256. [PMID: 36094919 PMCID: PMC9467327 DOI: 10.1371/journal.pone.0274256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 04/05/2022] [Accepted: 08/25/2022] [Indexed: 11/18/2022] Open
Abstract
Introduction Potentially inappropriate prescriptions (PIPs) of antidiabetic drugs (ADs) (PIPADs) to patients with type 2 diabetes mellitus (T2DM) have been reported in some studies. The detection of PIPs in electronic databases requires the development of explicit definitions. This approach is widely used in geriatrics but has not been extended to PIPADs in diabetes mellitus. The objective of the present literature review was to identify all explicit definitions of PIPADs in patients with T2DM. Materials and methods We performed a systematic review of the literature listed on Medline (via PubMed), Scopus, Web of Science, and, Embase between 2010 and 2021. The query included a combination of three concepts ("T2DM" AND "PIPs" AND "ADs") and featured a total of 86 keywords. Two independent reviewers selected publications, extracted explicit definitions of PIPADs, and then classified the definitions by therapeutic class and organ class. Results Of the 4,093 screened publications, 39 were included. In all, 171 mentions of PIPADs (corresponding to 56 unique explicit definitions) were identified. More than 50% of the definitions were related to either metformin (34%) or sulfonylureas (29%). More than 75% of the definitions were related to either abnormal renal function (56%) or age (22%). In addition, 20% (n = 35) mentions stated that biguanides were inappropriate in patients with renal dysfunction and 17.5% (n = 30) stated that sulfonylureas were inappropriate above a certain age. The definitions of PIPADs were heterogeneous and had various degrees of precision. Conclusion Our results showed that researchers focused primarily on the at-risk situations related to biguanide prescriptions in patients with renal dysfunction and the prescription of sulfonylureas to older people. Our systematic review of the literature revealed a lack of consensus on explicit definitions of PIPADs, which were heterogeneous and limited (in most cases) to a small number of drugs and clinical situations.
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Affiliation(s)
- Erwin Gerard
- Univ. Lille, CHU Lille, ULR 2694 - METRICS: Évaluation des Technologies de Santé et des Pratiques Médicales, Lille, France
- CHU Lille, Institut de Pharmacie, Lille, France
- * E-mail:
| | - Paul Quindroit
- Univ. Lille, CHU Lille, ULR 2694 - METRICS: Évaluation des Technologies de Santé et des Pratiques Médicales, Lille, France
| | - Madleen Lemaitre
- CHU Lille, Department of Diabetology, Endocrinology, Metabolism and Nutrition, Lille University Hospital, Lille, France
- University of Lille, Lille, France
| | - Laurine Robert
- Univ. Lille, CHU Lille, ULR 2694 - METRICS: Évaluation des Technologies de Santé et des Pratiques Médicales, Lille, France
- CHU Lille, Institut de Pharmacie, Lille, France
| | - Sophie Gautier
- CHU de Lille, Centre Régional de Pharmacovigilance, Lille, France
| | - Bertrand Decaudin
- CHU Lille, Institut de Pharmacie, Lille, France
- Univ. Lille, CHU Lille, ULR 7365 - GRITA: Groupe de Recherche sur les Formes Injectables et les Technologies Associées, Lille, France
| | - Anne Vambergue
- CHU Lille, Department of Diabetology, Endocrinology, Metabolism and Nutrition, Lille University Hospital, Lille, France
- European Genomic Institute for Diabetes, University School of Medicine, Lille, France
| | - Jean-Baptiste Beuscart
- Univ. Lille, CHU Lille, ULR 2694 - METRICS: Évaluation des Technologies de Santé et des Pratiques Médicales, Lille, France
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11
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Vambergue A, Lemaitre M, Desir C, Le Roux Mallouf T, Tourki Y, Franc S, Lablanche S, Subtil D, Charpentier G, Benhamou PY. Management of Pregnancy in a Patient with Type 1 Diabetes and Hypoglycemia Unawareness by DBL-hu Closed-Loop Insulin Delivery System. Diabetes Technol Ther 2022; 24:672-674. [PMID: 35604800 DOI: 10.1089/dia.2022.0043] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [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: 11/12/2022]
Affiliation(s)
- Anne Vambergue
- Department of Endocrinology, Lille University Hospital, Lille, France
| | - Madleen Lemaitre
- Department of Endocrinology, Lille University Hospital, Lille, France
| | | | | | | | - Sylvia Franc
- CERITD (Center for Study and Research for Improvement of the Treatment of Diabetes), Bioparc-Genopole Evry-Corbeil, Evry, France
- Department of Diabetes Sud Francilien Hospital, Corbeil-Essonnes, France
| | - Sandrine Lablanche
- Department of Endocrinology, Grenoble Alpes University, Grenoble University Hospital, INSERM U1055, LBFA, Grenoble, France
| | - Damien Subtil
- Department of Obstetrics, Lille University Hospital, Lille, France
| | - Guillaume Charpentier
- CERITD (Center for Study and Research for Improvement of the Treatment of Diabetes), Bioparc-Genopole Evry-Corbeil, Evry, France
- Department of Diabetes Sud Francilien Hospital, Corbeil-Essonnes, France
| | - Pierre Yves Benhamou
- Department of Endocrinology, Grenoble Alpes University, Grenoble University Hospital, INSERM U1055, LBFA, Grenoble, France
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12
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Cariou B, Wargny M, Boureau AS, Smati S, Tramunt B, Desailloud R, Lebeault M, Amadou C, Ancelle D, Balkau B, Bordier L, Borot S, Bourgeon M, Bourron O, Cosson E, Eisinger M, Gonfroy-Leymarie C, Julla JB, Marchand L, Meyer L, Seret-Bégué D, Simon D, Sultan A, Thivolet C, Vambergue A, Vatier C, Winiszewski P, Saulnier PJ, Bauduceau B, Gourdy P, Hadjadj S. Impact of diabetes on COVID-19 prognosis beyond comorbidity burden: the CORONADO initiative. Diabetologia 2022; 65:1436-1449. [PMID: 35701673 PMCID: PMC9197674 DOI: 10.1007/s00125-022-05734-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Accepted: 04/06/2022] [Indexed: 12/11/2022]
Abstract
AIMS/HYPOTHESIS Diabetes has been recognised as a pejorative prognostic factor in coronavirus disease 2019 (COVID-19). Since diabetes is typically a disease of advanced age, it remains unclear whether diabetes remains a COVID-19 risk factor beyond advanced age and associated comorbidities. We designed a cohort study that considered age and comorbidities to address this question. METHODS The Coronavirus SARS-CoV-2 and Diabetes Outcomes (CORONADO) initiative is a French, multicentric, cohort study of individuals with (exposed) and without diabetes (non-exposed) admitted to hospital with COVID-19, with a 1:1 matching on sex, age (±5 years), centre and admission date (10 March 2020 to 10 April 2020). Comorbidity burden was assessed by calculating the updated Charlson comorbidity index (uCCi). A predefined composite primary endpoint combining death and/or invasive mechanical ventilation (IMV), as well as these two components separately, was assessed within 7 and 28 days following hospital admission. We performed multivariable analyses to compare clinical outcomes between patients with and without diabetes. RESULTS A total of 2210 pairs of participants (diabetes/no-diabetes) were matched on age (mean±SD 69.4±13.2/69.5±13.2 years) and sex (36.3% women). The uCCi was higher in individuals with diabetes. In unadjusted analysis, the primary composite endpoint occurred more frequently in the diabetes group by day 7 (29.0% vs 21.6% in the no-diabetes group; HR 1.43 [95% CI 1.19, 1.72], p<0.001). After multiple adjustments for age, BMI, uCCi, clinical (time between onset of COVID-19 symptoms and dyspnoea) and biological variables (eGFR, aspartate aminotransferase, white cell count, platelet count, C-reactive protein) on admission to hospital, diabetes remained associated with a higher risk of primary composite endpoint within 7 days (adjusted HR 1.42 [95% CI 1.17, 1.72], p<0.001) and 28 days (adjusted HR 1.30 [95% CI 1.09, 1.55], p=0.003), compared with individuals without diabetes. Using the same adjustment model, diabetes was associated with the risk of IMV, but not with risk of death, within 28 days of admission to hospital. CONCLUSIONS/INTERPRETATION Our results demonstrate that diabetes status was associated with a deleterious COVID-19 prognosis irrespective of age and comorbidity status. TRIAL REGISTRATION ClinicalTrials.gov NCT04324736.
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Grants
- the Fondation Francophone de Recherche sur le Diabète (FFRD), supported by Novo Nordisk, Merck Sharpe Dome (MSD), Abbott, AstraZeneca, Lilly and FFD (Fédération Française des Diabétiques) – CORONADO initiative emergency grant
- The CORONADO control leg of the study was supported by a grant from the French Ministry of Health
- Société Francophone du Diabète (SFD) – CORONADO initiative emergency grant
- Fonds de dotation du CHU de Nantes (CORONADO project: Sanofi, Air Liquid Healthcare, Novo Nordisk, NHC, Allergan, Lifescan)
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Affiliation(s)
- Bertrand Cariou
- CHU Nantes, CNRS, Inserm, l'institut du thorax, Nantes Université, Nantes, France.
| | - Matthieu Wargny
- CHU Nantes, CNRS, Inserm, l'institut du thorax, Nantes Université, Nantes, France
- CHU Nantes, Inserm CIC 1413, Pôle Hospitalo-Universitaire 11 : Santé Publique, Clinique des données, Nantes, France
| | - Anne-Sophie Boureau
- CHU Nantes, CNRS, Inserm, l'institut du thorax, Nantes Université, Nantes, France
- CHU Nantes, Pôle de Gérontologie Clinique, Nantes, France
| | - Sarra Smati
- CHU Nantes, CNRS, Inserm, l'institut du thorax, Nantes Université, Nantes, France
| | - Blandine Tramunt
- Service de Diabétologie, Maladies Métaboliques & Nutrition, CHU Toulouse, Institut des Maladies Métaboliques & Cardiovasculaires, UMR1297 Inserm/UT3, Université de Toulouse, Toulouse, France
| | - Rachel Desailloud
- Department of Endocrinology, Diabetes Mellitus and Nutrition, Amiens University Hospital, Amiens, France; PériTox UMR_I 01, University of Picardie Jules Verne, Amiens, France
| | - Maylis Lebeault
- Département de Diabétologie, Centre Hospitalier Universitaire, Angers, France
| | - Coralie Amadou
- Département de Diabétologie, Centre Hospitalier Sud Francilien, Corbeil Essonne, France
- Université Paris-Saclay, Le Kremlin-Bicêtre, Paris, France
| | - Deborah Ancelle
- Service endocrinologie-diabétologie-nutrition, CH Le Havre, Montivilliers, France
| | - Beverley Balkau
- Épidémiologie Clinique, Centre de Recherche en Épidémiologie et Santé des Populations, Inserm U1018, Université Paris-Saclay, USVQ, Université Paris-Sud, Villejuif, France
| | - Lyse Bordier
- Service d'endocrinologie et maladies métaboliques, H.I.A Bégin, Saint-Mandé, France
| | - Sophie Borot
- Department of Endocrinology, Diabetology and Nutrition, Besançon University Hospital, Besançon, France
| | - Muriel Bourgeon
- Department of Endocrinology, Diabetology and Nutrition, Assistance Publique Hôpitaux de Paris, Paris-Saclay University, Antoine Béclère Hospital, Clamart, Bicêtre Hospital, Le Kremlin-Bicêtre, France
| | - Olivier Bourron
- Assistance Publique Hôpitaux de Paris, Département de Diabétologie, CHU La Pitié-Salpêtrière - Charles-Foix; Inserm, UMR_S 1138, Centre de Recherche des Cordeliers, Paris 06; Institute of Cardiometabolism and Nutrition ICAN, Sorbonne Université, Paris, France
| | - Emmanuel Cosson
- Assistance Publique Hôpitaux de Paris, Avicenne Hospital, Paris 13 University, Sorbonne Paris Cité, Department of Endocrinology, Diabetology and Nutrition, CRNH-IdF, CINFO, Bobigny, France
- Paris 13 University, Sorbonne Paris Cité, UMR U557 Inserm / U11125 INRAE / CNAM / Paris13 University, Nutritional Epidemiological Research Unit, Bobigny, France
| | - Martin Eisinger
- Hôpital de la Conception, Service d'Endocrinologie, Maladies Métaboliques et Nutrition, Marseille, France
- Inserm, INRAE, C2VN, Aix Marseille Univ, Marseille, France
| | | | - Jean-Baptiste Julla
- Département Diabète et Endocrinologie, Hôpital Lariboisière, Assistance Publique Hôpitaux de Paris, Paris, France
- Inserm UMRS 1138, Université Paris Diderot-Paris VII, Sorbonne Paris Cité, Paris, France
| | | | - Laurent Meyer
- Département d'Endocrinologie, Diabétologie et Nutrition, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - Dominique Seret-Bégué
- Unité de Diabétologie, Endocrinologie et Nutrition, Centre Hospitalier de Gonesse, Gonesse, France
| | | | - Ariane Sultan
- Department of Endocrinology-Diabetology-Nutrition, CHU Montpellier, University of Montpellier, Montpellier, France
- PhyMedExp, CHU Montpellier, Inserm, CNRS, University of Montpellier, Montpellier, France
| | - Charles Thivolet
- Centre du Diabète DIAB-eCARE, Hospices Civils de Lyon et Laboratoire CarMeN, Inserm, INRA, INSA, Université Claude Bernard Lyon 1, Lyon, France
- Société Francophone du Diabète (SFD), Paris, France
| | - Anne Vambergue
- Department of Diabetology, Endocrinology, Metabolism and Nutrition Lille University Hospital, Lille, France
- European Genomic Institute of Diabetes, University School of Medicine, Lille, France
| | - Camille Vatier
- Assistance Publique Hôpitaux de Paris, Saint-Antoine Hospital, Reference Center of Rare Diseases of Insulin Secretion and Insulin Sensitivity (PRISIS), Department of Endocrinology, Paris, France
- Inserm UMRS 938, Saint-Antoine Research Center, Sorbonne University, Paris, France
| | - Patrice Winiszewski
- Service d'Endocrinologie, Diabétologie et Nutrition, Hôpital Nord Franche-Comté, Trévenans, France
| | - Pierre-Jean Saulnier
- Clinical Investigation Centre CIC1402, University of Poitiers, Inserm, CHU Poitiers, Poitiers, France
| | - Bernard Bauduceau
- Service d'endocrinologie et maladies métaboliques, H.I.A Bégin, Saint-Mandé, France
- Fondation Francophone pour la Recherche sur le Diabète (FFRD), Paris, France
| | - Pierre Gourdy
- Service de Diabétologie, Maladies Métaboliques & Nutrition, CHU Toulouse, Institut des Maladies Métaboliques & Cardiovasculaires, UMR1297 Inserm/UT3, Université de Toulouse, Toulouse, France
| | - Samy Hadjadj
- CHU Nantes, CNRS, Inserm, l'institut du thorax, Nantes Université, Nantes, France
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13
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Lemaitre M, Douillard C, Froguel P, Bonnefond A, Vambergue A. Management of pregnancy in a patient with congenital hyperinsulinism treated with association of diazoxide/calcium channel blocker. Acta Diabetol 2022; 59:1117-1120. [PMID: 35624321 DOI: 10.1007/s00592-022-01898-9] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2022] [Accepted: 04/22/2022] [Indexed: 11/01/2022]
Affiliation(s)
- Madleen Lemaitre
- University of Lille, 59000, Lille, France
- CHU Lille, Department of Diabetology, Endocrinology, Metabolism and Nutrition, Lille University Hospital, Polonovski Street, 59000, Lille, France
| | - Claire Douillard
- CHU Lille, Department of Diabetology, Endocrinology, Metabolism and Nutrition, Lille University Hospital, Polonovski Street, 59000, Lille, France
| | - Philippe Froguel
- University of Lille, 59000, Lille, France
- CHU Lille, Department of Diabetology, Endocrinology, Metabolism and Nutrition, Lille University Hospital, Polonovski Street, 59000, Lille, France
- Inserm UMR1283, CNRS UMR8199, European Genomic Institute for Diabetes (EGID), Institut Pasteur de Lille, 59000, Lille, France
- Department of Metabolism, Imperial College London, London, W12 0NN, UK
| | - Amélie Bonnefond
- University of Lille, 59000, Lille, France
- Inserm UMR1283, CNRS UMR8199, European Genomic Institute for Diabetes (EGID), Institut Pasteur de Lille, 59000, Lille, France
- Department of Metabolism, Imperial College London, London, W12 0NN, UK
| | - Anne Vambergue
- University of Lille, 59000, Lille, France.
- CHU Lille, Department of Diabetology, Endocrinology, Metabolism and Nutrition, Lille University Hospital, Polonovski Street, 59000, Lille, France.
- Inserm UMR1283, CNRS UMR8199, European Genomic Institute for Diabetes (EGID), Institut Pasteur de Lille, 59000, Lille, France.
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14
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Delsart P, Lemaitre M, Vambergue A, Ninni S, Bauters C, Ledieu G, Eymard DF, Baudoux F, Le Chevalier De Preville A, Sobocinski J, Montaigne D, Mounier-Vehier C. Prognostic significance of reverse dipping status on lower limb event in type 2 diabetic patients without peripheral arterial disease. Acta Diabetol 2022; 59:843-850. [PMID: 35333978 DOI: 10.1007/s00592-022-01879-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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: 12/20/2021] [Accepted: 03/08/2022] [Indexed: 11/01/2022]
Abstract
AIMS We assessed reverse dipping influence on the risk of lower limb events in type 2 diabetic patients without peripheral arterial disease. METHODS Patients with type 2 diabetes addressed for cardiovascular risk stratification in our university hospital from 2008 to 2012 underwent 24 h blood pressure monitoring. Patients with a prior history of limb revascularization or with a stenosis > 50% of the legs were excluded. Reverse dipping was defined as a greater night-versus day-time systolic blood pressure. The endpoint was the first occurrence of lower limb revascularization or limb amputation. Hazard ratios (HRs) and 95% confidence intervals were calculated using the Cox model. RESULTS Two hundred and eighty-one patients were included. During a median follow-up of 9.4 [7.7-10.6] years, 20 lower limb events and 45 all-cause deaths were observed. Thirty-five patients were reverse dippers. The reverse dipping status was associated with lower limb events when considering all-cause death as a competitive risk, (HR 3.61 [1.16-11.2], P = 0.026). Reverse dipping, HbA1C and proteinuria were independently associated with lower limb outcome in a multivariable analysis (respectively HR 4.09 [1.29-12.9], P = 0.017, HR 1.30 [1.04-1.63], P = 0.022 and HR 1.06 [1.02-1.11], P = 0.001). CONCLUSIONS Reverse dipping status is independently associated with worse limb outcome in type 2 diabetic patients.
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Affiliation(s)
- Pascal Delsart
- CHU Lille, Vascular Medicine and Hypertension Department, Institut Cœur Poumon, Boulevard Pr Leclercq, 59000, Lille, France.
| | - Madleen Lemaitre
- Endocrinology, Diabetology and Metabolism, CHU Lille, 59000, Lille, France
| | - Anne Vambergue
- Endocrinology, Diabetology and Metabolism, CHU Lille, 59000, Lille, France
| | - Sandro Ninni
- Inserm U1011, CHU Lille, Institut Pasteur de Lille, EGID, Univ. Lille, 59000, Lille, France
| | - Christophe Bauters
- Inserm U1167, CHU Lille, Institut Pasteur, Univ. Lille, 59000, Lille, France
| | - Guillaume Ledieu
- CHU Lille, Vascular Medicine and Hypertension Department, Institut Cœur Poumon, Boulevard Pr Leclercq, 59000, Lille, France
| | - Diane-Flore Eymard
- CHU Lille, Vascular Medicine and Hypertension Department, Institut Cœur Poumon, Boulevard Pr Leclercq, 59000, Lille, France
| | - Florence Baudoux
- Endocrinology, Diabetology and Metabolism, CHU Lille, 59000, Lille, France
| | | | | | - David Montaigne
- Inserm U1011, CHU Lille, Institut Pasteur de Lille, EGID, Univ. Lille, 59000, Lille, France
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15
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Benhamou PY, Lablanche S, Vambergue A, Pou S, Madrolle S, Romero-Ugalde H, Franc S, Charpentier G. The beneficial effects of closed-loop insulin delivery in patients with highly unstable type 1 diabetes eligible for islet transplantation are maintained over 6 months: An extension study of the DBLHU-WP10 trial. Diabetes Obes Metab 2022; 24:956-961. [PMID: 35099098 DOI: 10.1111/dom.14654] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Revised: 01/10/2022] [Accepted: 01/24/2022] [Indexed: 01/12/2023]
Affiliation(s)
- Pierre-Yves Benhamou
- Department of Endocrinology, Grenoble University Hospital, Grenoble Alpes University, Grenoble, France
| | - Sandrine Lablanche
- Department of Endocrinology, Grenoble University Hospital, Grenoble Alpes University, Grenoble, France
| | - Anne Vambergue
- Department of Endocrinology, Lille University Hospital, Lille, France
| | | | | | | | - Sylvia Franc
- CERITD (Center for Study and Research for Improvement of the Treatment of Diabetes), Bioparc-Genopole Evry-Corbeil, Evry, France
- Department of Diabetes and Endocrinology, Sud-Francilien Hospital, Corbeil, France
| | - Guillaume Charpentier
- CERITD (Center for Study and Research for Improvement of the Treatment of Diabetes), Bioparc-Genopole Evry-Corbeil, Evry, France
- Department of Diabetes and Endocrinology, Sud-Francilien Hospital, Corbeil, France
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16
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Lemaitre M, Ternynck C, Bourry J, Baudoux F, Subtil D, Vambergue A. Association Between HbA1c Levels on Adverse Pregnancy Outcomes During Pregnancy in Patients With Type 1 Diabetes. J Clin Endocrinol Metab 2022; 107:e1117-e1125. [PMID: 34694409 PMCID: PMC8852207 DOI: 10.1210/clinem/dgab769] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Indexed: 11/19/2022]
Abstract
CONTEXT Despite optimization of metabolic balance during pregnancy in type 1 diabetes (T1D), maternal-fetal complications remain higher than in the background population. OBJECTIVE We examined whether there is an association between glycated hemoglobin (HbA1c) levels and these complications. METHODS Retrospective study of pregnancies in 678 T1D subjects at Lille Hospital (1997-2019). The association between variations in HbA1c levels and complications was examined. The composite criterion (CC) was defined as having at least 1 of the following complications: prematurity, pre-eclampsia, large for gestational age (LGA), small for gestational age (SGA), or cesarean section. RESULTS Among the 678 births, median preconception HbA1c was 7.2% (55 mmol/mol), 361 were LGA (56%), 29 were SGA (4.5%), and 504 were births without preterm delivery (76.1%). The CC occurred in 81.8%. Higher HbA1c during the first trimester was associated with the CC (OR 1.04; 95% CI 1.02-1.06 per 0.1% increase; P < .001). Higher HbA1c during the third trimester was associated with the CC (OR 1.07; 95% CI 1.03-1.10 per 0.1% increase; P < .001). The group defined by a first trimester Hba1c >6.5% (48 mmol/mol) and a third trimester HbA1c <6% was associated with an increased rate of the CC (OR 2.81; 95% CI 1.01-7.86) and an increased rate of LGA (OR 2.20; 95% CI 1.01- 4.78). CONCLUSION Elevated HbA1c is associated with maternal-fetal complications. Despite optimization of metabolic balance during the third trimester, for patients with early glycemic imbalance the risk of LGA persists.
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Affiliation(s)
- Madleen Lemaitre
- Department of Diabetology, Endocrinology, Metabolism, and Nutrition, CHU Lille, Lille University Hospital, Lille, France
- Department of Medicine, University of Lille, France
| | - Camille Ternynck
- , ULR 2694-METRICS: évaluation des technologies de santé et des pratiques médicales, University of Lille, CHU Lille, Lille, France
- Department of Biostatistics, CHU Lille, Lille, France
| | - Julien Bourry
- Department of Diabetology, Endocrinology, Metabolism, and Nutrition, CHU Lille, Lille University Hospital, Lille, France
- Department of Medicine, University of Lille, France
| | - Florence Baudoux
- Department of Diabetology, Endocrinology, Metabolism, and Nutrition, CHU Lille, Lille University Hospital, Lille, France
| | - Damien Subtil
- Department of Medicine, University of Lille, France
- Department of Gynecology and Obstetrics, CHU Lille, Lille University Hospital, Lille, France
| | - Anne Vambergue
- Department of Diabetology, Endocrinology, Metabolism, and Nutrition, CHU Lille, Lille University Hospital, Lille, France
- Department of Medicine, University of Lille, France
- European Genomic Institute for Diabetes, University School of Medicine, Lille, France
- Correspondence: Anne Vambergue, Department of Diabetology, Endocrinology, Metabolism, and Nutrition Claude Huriez Hospital, Polonovski Street, 59037 Lille, cedex, France.
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Lemaitre M, Passet M, Ghesquière L, Martin C, Drumez E, Subtil D, Vambergue A. Is the Development of Gestational Diabetes Associated With the ABO Blood Group/Rhesus Phenotype? Front Endocrinol (Lausanne) 2022; 13:916903. [PMID: 35813660 PMCID: PMC9256971 DOI: 10.3389/fendo.2022.916903] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2022] [Accepted: 05/19/2022] [Indexed: 12/02/2022] Open
Abstract
AIMS There are few published data on the putative association between the ABO blood group/rhesus (Rh) factor and the risk of developing gestational diabetes mellitus (GDM). Our aim was to explore the link between each one factor and GDM development. METHODS All women having given birth at Lille University Medical Center (Lille, France) between August 1st, 2017, and February 28th, 2018, were tested for GDM, using the method recommended in the French national guidelines. The risk of GDM was assessed for each ABO blood group, each Rh phenotype and combinations thereof, using logistic regression models. RESULTS 1194 women had at least one GDM risk factor. The percentage of GDM varied with the ABO group (p=0.013). Relative to group O women, group AB women were more likely to develop GDM (OR = 2.50, 95% CI [1.43 to 4.36], p=0.001). Compared with the Rh-positive O group, only the Rh-positive AB group had an elevated risk of developing GDM (OR = 3.02, 95% CI [1.69 to 5.39], p < 0.001). CONCLUSIONS Our results showed that Rh-positive group AB women have a greater risk of GDM. With a view to preventing GDM, at-risk individuals could be identified by considering the ABO blood group phenotype either as a single risk factor or in combination with other risk factors.
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Affiliation(s)
- M. Lemaitre
- University of Medicine, Lille, France
- CHU Lille, Department of Diabetology, Endocrinology, Metabolism and Nutrition, Lille University Hospital, Lille, France
- Univ. Lille, CHU Lille, ULR 2694 - METRICS: évaluation des technologies de santé et des pratiques médicales, Lille, France
| | - M. Passet
- CHU Lille, Department of Gynecology and Obstetrics, Lille University Hospital, Lille, France
| | - L. Ghesquière
- University of Medicine, Lille, France
- Univ. Lille, CHU Lille, ULR 2694 - METRICS: évaluation des technologies de santé et des pratiques médicales, Lille, France
- CHU Lille, Department of Gynecology and Obstetrics, Lille University Hospital, Lille, France
| | - C. Martin
- Univ. Lille, CHU Lille, ULR 2694 - METRICS: évaluation des technologies de santé et des pratiques médicales, Lille, France
- CHU Lille, Department of Biostatistics, Lille University Hospital, Lille, France
| | - E. Drumez
- Univ. Lille, CHU Lille, ULR 2694 - METRICS: évaluation des technologies de santé et des pratiques médicales, Lille, France
- CHU Lille, Department of Biostatistics, Lille University Hospital, Lille, France
| | - D. Subtil
- University of Medicine, Lille, France
- Univ. Lille, CHU Lille, ULR 2694 - METRICS: évaluation des technologies de santé et des pratiques médicales, Lille, France
- CHU Lille, Department of Gynecology and Obstetrics, Lille University Hospital, Lille, France
| | - A. Vambergue
- University of Medicine, Lille, France
- CHU Lille, Department of Diabetology, Endocrinology, Metabolism and Nutrition, Lille University Hospital, Lille, France
- European Genomic Institute for Diabetes, University School of Medicine, Lille, France
- *Correspondence: A. Vambergue, ; orcid.org/0000-0003-4307-8695
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18
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Reach G, Benarbia L, Benhamou PY, Delemer B, Dubois S, Gouet D, Guerci B, Jeandidier N, Lachgar K, Le Pape G, Leroy R, Masgnaux JH, Raclet P, Reznik Y, Riveline JP, Schaepelynck P, Vambergue A, Vergès B. An Unsafe/Safe Typology in People with Type 2 Diabetes: Bridging Patients' Expectations, Personality Traits, Medication Adherence, and Clinical Outcomes. Patient Prefer Adherence 2022; 16:1333-1350. [PMID: 35642243 PMCID: PMC9148599 DOI: 10.2147/ppa.s365398] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Accepted: 05/05/2022] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Support programs are provided to people with diabetes to help them manage their disease. However, adherence to and persistence in support programs are often low, making it difficult to demonstrate their effectiveness. AIM To identify the determinants of patients' perceived interest in diabetes support programs because it may be a powerful determinant of effective participation in such programs. PATIENTS AND METHODS An online study conducted in April 2021 in metropolitan France on 600 people with diabetes recruited from a consumer panel. A 64-item psychosocial questionnaire including a question asking to evaluate the helpfulness of a support program was used. Univariate, multivariate, and multiple correspondence analyses were performed. RESULTS The existence of a typology, known as Unsafe/Safe, was discovered, in which patients with type 2 diabetes respond in two distinct ways. Type U (unsafe) patients, who believe that a support program would be helpful, are more likely to be nonadherent to their treatment, have high hemoglobin A1c levels, have at least one diabetic complication, lack information regarding their disease and treatment, rate the burden of their disease and impairment of their quality of life as high, worry about their future, and are pessimistic. Type S (safe) patients have the opposite characteristics. Type U patients can be dichotomized into two broad classes: one in which they lack information regarding disease and treatment and the other in which alterations in the quality of life and burden of the disease predominate. Insulin-treated patients give more importance to the lack of information, whereas noninsulin-treated patients complain primarily about the burden of the disease and impairment of quality of life. CONCLUSION This study describes this new U/S typology, proposes a simple method based on a nine-item questionnaire to identify type U patients by calculating a Program Helpfulness Score described herein, and clarifies the nature of the intervention to be provided to them. This novel approach could be applied to other chronic diseases.
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Affiliation(s)
- Gérard Reach
- Health Education and Promotion Laboratory (LEPS EA 3412), Sorbonne Paris Nord University, Bobigny, France
- Correspondence: Gérard Reach, Health Education and Promotion Laboratory (LEPS EA 3412), Sorbonne Paris Nord University, 74 Rue Marcel Cachin, Bobigny Cedex, 93017, France, Tel + 33 (0)6 60 84 53 25, Email
| | | | - Pierre-Yves Benhamou
- Department of Endocrinology, Grenoble University Hospital; Grenoble Alpes University, INSERM U1055, LBFA, Grenoble, France
| | - Brigitte Delemer
- Service d’Endocrinologie – Diabète – Nutrition, CHU de Reims - Hôpital Robert Debré, and Université de Reims Champagne Ardenne, UFR Sciences Exactes Et Naturelles, Reims, France
| | - Séverine Dubois
- Department of Diabetology and Endocrinology, CHU Angers, Angers, France
| | - Didier Gouet
- Department of Diabetology and Endocrinology, Saint Louis Hospital, La Rochelle, France
| | - Bruno Guerci
- Department of Endocrinology, Diabetology and Nutrition, CHRU of Nancy, Brabois Hospital, and ILCV Lorraine University, Vandoeuvre-les-Nancy, France
| | - Nathalie Jeandidier
- Department of Endocrinology, Diabetes and Nutrition, Hôpitaux Universitaires de Strasbourg, and Université de Strasbourg, Strasbourg, France
| | - Karim Lachgar
- Department of Diabetology and Endocrinology, Centre Hospitalier Simone Veil, Eaubonne, France
| | | | - Rémy Leroy
- Private Medical Practice, Endocrinology and Diabetology, Lille, France
| | | | - Philippe Raclet
- Association Française des Diabétiques de Bourgogne Franche-Comté, Dijon, France
| | - Yves Reznik
- Department oEndocrinology and Diabetology, CHU Côte de Nacre, Caen, and University of Caen Basse-Normandie, Medical School, Caen, France
| | - Jean-Pierre Riveline
- Department of Diabetology and Endocrinology, Lariboisière Hospital, Assistance Publique - Hôpitaux de Paris, Paris, France
- Unité INSERM U1138 Immunity and Metabolism in Diabetes, ImMeDiab Team, Centre de Recherches des Cordeliers, and Université de Paris, Paris, France
| | - Pauline Schaepelynck
- Department of Nutrition-Endocrinology-Metabolic Diseases, Pôle ENDO, APHM-Hôpital la Conception, Marseille, France
| | - Anne Vambergue
- Department of Diabetology, Endocrinology, Metabolism and Nutrition, CHU Lille, and University Hospital European Genomic Institute for Diabetes, Lille, France
| | - Bruno Vergès
- Department of Endocrinology-Diabetology,CHU Dijon, and University of Burgundy, INSERM LNC UMR1231, Dijon, France
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Delagenière J, Schwartz C, Doron M, Huneker E, Franc S, Charpentier G, Vambergue A, Benhamou PY, Lablanche S. Prospective analysis of satisfaction and usability of closed-loop Diabeloop DBLHU treatment in patients with highly unstable type 1 diabetes. Acta Diabetol 2021; 58:1709-1711. [PMID: 34272606 DOI: 10.1007/s00592-021-01769-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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] [Received: 04/12/2021] [Accepted: 06/23/2021] [Indexed: 11/24/2022]
Affiliation(s)
- Johanna Delagenière
- Univ. Grenoble Alpes, CHU Grenoble Alpes, Department of Endocrinology, INSERM U1055, LBFA, CS10217, 38043, Grenoble, France.
| | - Christel Schwartz
- CIC-IT-Pavillon Taillefer-Grenoble Alpes University Hospital, Grenoble Alpes University, Grenoble, France
| | - Maeva Doron
- Univ. Grenoble Alpes, CEA, LETI, DTBS, LS2P, 38000, Grenoble, France
| | - Erik Huneker
- DIABELOOP SA, HQ 155-157 cours Berriat, 38028, Grenoble, France
| | - Sylvia Franc
- CERITD (Center for Study and Research for Improvement of the Treatment of Diabetes), Bioparc-Genopole Evry-Corbeil, Evry, France
| | - Guillaume Charpentier
- CERITD (Center for Study and Research for Improvement of the Treatment of Diabetes), Bioparc-Genopole Evry-Corbeil, Evry, France
| | - Anne Vambergue
- Department of Endocrinology, Lille University Hospital, Lille, France
| | - Pierre-Yves Benhamou
- Univ. Grenoble Alpes, CHU Grenoble Alpes, Department of Endocrinology, INSERM U1055, LBFA, CS10217, 38043, Grenoble, France
| | - Sandrine Lablanche
- Univ. Grenoble Alpes, CHU Grenoble Alpes, Department of Endocrinology, INSERM U1055, LBFA, CS10217, 38043, Grenoble, France
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20
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Benhamou PY, Lablanche S, Vambergue A, Doron M, Franc S, Charpentier G. Patients with highly unstable type 1 diabetes eligible for islet transplantation can be managed with a closed-loop insulin delivery system: A series of N-of-1 randomized controlled trials. Diabetes Obes Metab 2021; 23:186-194. [PMID: 33001536 DOI: 10.1111/dom.14214] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [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] [Received: 07/16/2020] [Revised: 09/24/2020] [Accepted: 09/26/2020] [Indexed: 12/11/2022]
Abstract
AIM To compare the efficacy of the closed-loop Diabeloop for highly unstable diabetes (DBLHU) system with the open-loop predictive low glucose suspend (PLGS) system in patients with highly unstable type 1 diabetes (T1D) who experience acute metabolic events. METHODS DBLHU-WP10 was an interventional, controlled, randomized, open-label study that comprised two cycles of N-of-1 trials (2-of-1 trials). Each trial consisted of two crossover 4-week periods of treatment with either DBLHU or PLGS in randomized order. The primary outcome was the percentage of time spent in the 70-180 mg/dL glucose range (time in range [TIR]). RESULTS Five out of seven randomized patients completed the aggregated 2-of-1 trials. TIR was significantly higher with DBLHU (73.3% ± 1.7%) compared with PLGS (43.5% ± 1.7%; P < .0001). The percentage of time below 70 mg/dL was significantly lower with DBLHU (0.9% ± 0.4%) versus PLGS (3.7% ± 0.4%; P < .0001). DBLHU was also significantly superior to PLGS in reducing hyperglycaemic excursions and improving almost all other secondary outcomes, including glucose variability and satisfaction score. No adverse event could be related to the experimental treatment. CONCLUSIONS DBLHU was superior to PLGS in improving the metabolic control of patients with highly unstable T1D who require an islet or pancreas transplant but who either have a contraindication or refuse to consent.
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Affiliation(s)
- Pierre-Yves Benhamou
- Department of Endocrinology, Grenoble University Hospital, Grenoble Alpes University, INSERM U1055, LBFA, Grenoble, France
| | - Sandrine Lablanche
- Department of Endocrinology, Grenoble University Hospital, Grenoble Alpes University, INSERM U1055, LBFA, Grenoble, France
| | - Anne Vambergue
- Department of Endocrinology, Lille University Hospital, Lille, France
| | - Maeva Doron
- University Grenoble Alpes, CEA, LETI, Grenoble, France
| | - Sylvia Franc
- CERITD (Center for Study and Research for Improvement of the Treatment of Diabetes), Bioparc-Genopole Evry-Corbeil, Evry, France
| | - Guillaume Charpentier
- CERITD (Center for Study and Research for Improvement of the Treatment of Diabetes), Bioparc-Genopole Evry-Corbeil, Evry, France
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21
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Bourry J, Courteville H, Ramdane N, Drumez E, Duhamel A, Subtil D, Deruelle P, Vambergue A. Progression of Diabetic Retinopathy and Predictors of Its Development and Progression During Pregnancy in Patients With Type 1 Diabetes: A Report of 499 Pregnancies. Diabetes Care 2021; 44:181-187. [PMID: 33177172 DOI: 10.2337/dc20-0904] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Accepted: 10/19/2020] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Pregnancy has been associated with development and progression of diabetic retinopathy (DR), but incidence of DR remains unclear. We assessed DR progression rate and its predictors during pregnancies in patients with type 1 diabetes. RESEARCH DESIGN AND METHODS We report the retrospective data from pregnancies in patients with type 1 diabetes followed in Lille, France (1997-2015). Eye examination was performed every 3 months or every month in case of severe nonproliferative retinopathy or progression. Progression was defined by DR degradation (≥1 stage of the Early Treatment Diabetic Retinopathy Study [ETDRS] classification); it included DR development and worsening in patients without and with prepregnancy DR, respectively. RESULTS A total of 499 pregnancies in 375 patients were included; prepregnancy retinopathy was present in 30.3%. Progression, development, and worsening rates were 21.8%, 24.4% of those without retinopathy, and 15.9% of those with retinopathy, respectively. Development of sight-threatening retinopathy was rare. Progression mainly occurred in early or midpregnancy. Elevated prepregnancy HbA1c and duration of diabetes ≥10 years were predictors of DR progression. Among pregnancies with prepregnancy DR, continuous subcutaneous insulin infusion (CSII) tended to decrease the risk of DR progression. Among CSII-treated patients, those with prepregnancy DR had a significantly decreased risk of DR progression. Among the 270 pregnancies of women with any DR during pregnancy who returned for a postpartum ophthalmologic examination, the rate of progression was only 4.1% and the rate of regression was 9.3%. CONCLUSIONS This study provides epidemiologic data on progression of retinopathy during pregnancy and will be useful for future guidelines for retinopathy screening.
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Affiliation(s)
- Julien Bourry
- Department of Diabetology, Endocrinology and Metabolism, Lille University Hospital, Lille, France
| | | | - Nassima Ramdane
- EA 2694 - Santé publique: épidémiologie et qualité des soins, CHU Lille, University Lille, Lille, France
| | - Elodie Drumez
- EA 2694 - Santé publique: épidémiologie et qualité des soins, CHU Lille, University Lille, Lille, France
| | - Alain Duhamel
- EA 2694 - Santé publique: épidémiologie et qualité des soins, CHU Lille, University Lille, Lille, France.,European Genomic Institute for Diabetes, University School of Medicine, Lille, France
| | - Damien Subtil
- European Genomic Institute for Diabetes, University School of Medicine, Lille, France.,Department of Gynecology and Obstetrics, Lille University Hospital, Lille, France
| | - Philippe Deruelle
- European Genomic Institute for Diabetes, University School of Medicine, Lille, France.,Department of Gynecology and Obstetrics, Lille University Hospital, Lille, France
| | - Anne Vambergue
- Department of Diabetology, Endocrinology and Metabolism, Lille University Hospital, Lille, France .,European Genomic Institute for Diabetes, University School of Medicine, Lille, France.,Department of Gynecology and Obstetrics, Lille University Hospital, Lille, France
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22
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Ghesquière L, Garabedian C, Drumez E, Lemaître M, Cazaubiel M, Bengler C, Vambergue A. Effects of COVID-19 pandemic lockdown on gestational diabetes mellitus: A retrospective study. Diabetes Metab 2020; 47:101201. [PMID: 33069845 PMCID: PMC7557293 DOI: 10.1016/j.diabet.2020.09.008] [Citation(s) in RCA: 43] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Revised: 07/15/2020] [Accepted: 08/14/2020] [Indexed: 11/19/2022]
Abstract
Objective The objective of our study was to evaluate the impact of the lockdown period on the glycemic balance in patients with GDM. Methods A retrospective study in one center (Lille, France) compared two periods: the COVID-19 lockdown of 18 March 2020 to 7 May 2020 versus the same period during 2019. Glucose targets were defined by a capillary fasting glucose target < 5.1mmol/L and/or a 2-hour postprandial capillary glucose < 6.6 mmol/L. GDM control was defined as: good (< 20% of the glycemic values were not within the target range), acceptable (20 to 40% of the glycemic values were not within the target range) or poor (> 40% of the glycemic values were not within the target range). Results Two hundred twenty-nine patients were included in 2019 and 222 in 2020. The same mean number of capillary blood sugar tests was performed by the two groups. Postprandial blood sugar was significantly less well controlled in 2020, with a lower rate of good control (61.6% vs 69.4%) and higher rates of acceptable (24.7% vs 21.8%) and poor control (13.7% and 8.7%) (p < 0.05). Use of insulin therapy was significantly higher in 2020 compared with 2019 (47.7% and 36.2%, respectively; p < 0.05). Conclusion Diabetes control was lower during the COVID-19 pandemic lockdown, even if follow-up was not impacted. This may be explained by reduced physical activity, modified dietary habits and anxiety during this period.
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Affiliation(s)
- L Ghesquière
- CHU Lille, Department of Obstetrics, F-59000 Lille, France; University of Lille, CHU Lille, ULR 2694 - METRICS: Assessment of Health Technologies and Medical Practices, F-59000 Lille, France.
| | - C Garabedian
- CHU Lille, Department of Obstetrics, F-59000 Lille, France; University of Lille, CHU Lille, ULR 2694 - METRICS: Assessment of Health Technologies and Medical Practices, F-59000 Lille, France
| | - E Drumez
- University of Lille, CHU Lille, ULR 2694 - METRICS: Assessment of Health Technologies and Medical Practices, F-59000 Lille, France; CHU Lille, Department of Biostatistics, F-59000 Lille, France
| | - M Lemaître
- CHU Lille, Department of Endocrinology, Diabetology, Metabolism and Nutrition, F-59000 Lille, France
| | - M Cazaubiel
- CHU Lille, Department of Endocrinology, Diabetology, Metabolism and Nutrition, F-59000 Lille, France
| | - C Bengler
- CHU Lille, Department of Obstetrics, F-59000 Lille, France
| | - A Vambergue
- CHU Lille, Department of Endocrinology, Diabetology, Metabolism and Nutrition, F-59000 Lille, France; University of Lille, European Genomics Institute for Diabetes (EGID), F-59000 Lille, France
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23
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Mailliez A, Ternynck C, Duhamel A, Ploquin A, Desauw C, Bertrand N, Vambergue A, Turpin A. 1840P Impact of diabetes mellitus in cancer patients treated by chemotherapy: A real-life study. Ann Oncol 2020. [DOI: 10.1016/j.annonc.2020.08.1487] [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] Open
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Vambergue A, Jacqueminet S, Lamotte MF, Lamiche-Lorenzini F, Brunet C, Deruelle P, Vayssière C, Cosson E. Three alternative ways to screen for hyperglycaemia in pregnancy during the COVID-19 pandemic. Diabetes Metab 2020; 46:507-510. [PMID: 32387699 PMCID: PMC7202320 DOI: 10.1016/j.diabet.2020.04.003] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Accepted: 04/29/2020] [Indexed: 11/30/2022]
Affiliation(s)
- A Vambergue
- Endocrinology, Diabetology, Metabolism and Nutrition Department, Lille University Hospital, European Genomics Institute for Diabetes, University of Lille, France; Francophone Society of Diabetes (SFD), France.
| | - S Jacqueminet
- Diabetology Department, Cardiometabolism and Nutrition Institute (ICAN), AP-HP6, Hôpitaux Universitaires Pitié Salpêtrière-Charles Foix, 75013 Paris, France; Francophone Society of Diabetes (SFD), France
| | - M-F Lamotte
- Nutrition, Endocrinology, Metabolic Diseases, Department ENDO, Assistance Publique Hôpitaux de Marseille (AP-HM), France; Francophone Society of Diabetes (SFD), France
| | - F Lamiche-Lorenzini
- CH Jura Sud, Lons-Le-Saunier, France; Francophone Society of Diabetes (SFD), France
| | - C Brunet
- Endocrinology Diseases Department, CHU Montpellier, France; Francophone Society of Diabetes (SFD), France
| | - P Deruelle
- Department of Obstetrics and Gynecology, University Hospital of Strasbourg, France; French National College of Obstetricians and Gynecologists (CNGOF), France
| | - C Vayssière
- Department of Obstetrics and Gynecology, Paule de Viguier Hospital, CHU Toulouse, France, UMR 1027 Inserm, Team SPHERE, Toulouse III University, Toulouse, France; French National College of Obstetricians and Gynecologists (CNGOF), France
| | - E Cosson
- AP-HP, Avicenne Hospital, Paris 13 University, Sorbonne Paris Cité, Department of Endocrinology-Diabetology-Nutrition, CRNH-IdF, CINFO, UMR U557 Inserm/U11125 INRAE/CNAM/Université Paris13, Unité de Recherche Epidémiologique Nutritionnelle, Bobigny, France; Francophone Society of Diabetes (SFD), France
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Delsart P, Vambergue A, Ninni S, Machuron F, Lelievre B, Ledieu G, Fontaine P, Merlen E, Frimat M, Glowacki F, Montaigne D, Mounier-Vehier C. Prognostic significance of the renal resistive index in the primary prevention of type II diabetes. J Clin Hypertens (Greenwich) 2020; 22:223-230. [PMID: 32003935 DOI: 10.1111/jch.13819] [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] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2019] [Revised: 11/21/2019] [Accepted: 12/02/2019] [Indexed: 12/20/2022]
Abstract
The renal resistive index has been demonstrated to predict the progression of renal disease and recurrence of major cardiac events in high-risk cardiovascular patients, in addition to other comorbidities. We aimed to assess the prognostic significance of the renal resistive index in type 2 diabetic patients for primary prevention. From 2008 to 2011, patients with type 2 diabetes underwent cardiovascular evaluation, including renal resistive index assessment by renal Doppler ultrasound. The incidence of all-cause death, cardiovascular events, dialysis requirement or a twofold increase in creatinine was recorded. Survival curves were estimated by the Kaplan-Meier method. Two hundred sixty-six patients were included; 50% of the patients were men, an HbA1C level of 8.1 ± 1.7% (65 ± 13.6 mmol/mol) and a serum creatinine level of 8 [7-9] mg/L. The mean 24-hour systolic blood pressure, 24-hour diastolic blood pressure, and 24-hour pulse pressure were 133.4 ± 16.7, 76.5 ± 9.4, and 56.9 ± 12.4 mm Hg, respectively. The median renal resistive index was 0.7 [0.6-0.7] with a threshold of 0.7 predictive of monitored events. After adjustment of the 24-hour pulse pressure, age and 24-hour heart rate, a renal resistive index ≥0.70 remained associated with all-cause death (hazard ratio: 3.23 (1.16-8.98); P = .025) and the composite endpoint of major clinical events (hazard ratio: 2.37 (1.34-4.18); P = .003). An elevated renal resistive index with a threshold of 0.7 is an independent predictor of a first cardiovascular or renal event in type 2 diabetic patients. This simple index should be implemented in the multiparametric staging of diabetes.
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Affiliation(s)
| | - Anne Vambergue
- CHU Lille, University of Lille, Lille, France.,Endocrinology, Diabetology and Metabolism, CHU Lille, Lille, France
| | - Sandro Ninni
- Institut Cœur Poumon, CHU Lille, Lille, France.,CHU Lille, University of Lille, Lille, France
| | - François Machuron
- CHU Lille, EA 2694 - Santé Publique: Épidémiologie et Qualité des Soins, Department of Biostatistics, Univ. Lille, Lille, France
| | | | | | - Pierre Fontaine
- CHU Lille, University of Lille, Lille, France.,Endocrinology, Diabetology and Metabolism, CHU Lille, Lille, France
| | - Emilie Merlen
- CHU Lille, University of Lille, Lille, France.,Endocrinology, Diabetology and Metabolism, CHU Lille, Lille, France
| | - Marie Frimat
- CHU Lille, University of Lille, Lille, France.,CHU Lille, EA4483 IMPECS, Department of Nephrology, Univ. Lille, Lille, France
| | - François Glowacki
- CHU Lille, University of Lille, Lille, France.,CHU Lille, EA4483 IMPECS, Department of Nephrology, Univ. Lille, Lille, France
| | - David Montaigne
- Institut Cœur Poumon, CHU Lille, Lille, France.,CHU Lille, University of Lille, Lille, France.,Institut Pasteur de Lille, EGID. Inserm U1011, Lille, France
| | - Claire Mounier-Vehier
- Institut Cœur Poumon, CHU Lille, Lille, France.,CHU Lille, University of Lille, Lille, France
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Meghelli L, Vambergue A, Drumez E, Deruelle P. Complications of pregnancy in morbidly obese patients: What is the impact of gestational diabetes mellitus? J Gynecol Obstet Hum Reprod 2019; 49:101628. [PMID: 31499286 DOI: 10.1016/j.jogoh.2019.101628] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [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: 04/25/2018] [Revised: 07/17/2019] [Accepted: 09/05/2019] [Indexed: 12/31/2022]
Abstract
OBJECTIVES The synergistic role of severe obesity and gestational diabetes mellitus (GDM) on pregnancy complications has been poorly studied. We aim to analyze the impact of GDM on pregnancy complications in women with class III obesity. MATERIAL AND METHODS we performed a retrospective monocentric study including women with a pregestational BMI≥40kg/m2 with a singleton pregnancy from January 1996 to December 2014. We compared the risks of maternal, fetal and neonatal complications between patients with GDM and those without GDM. RESULTS We included 354 patients, 121 (34.3%) had GDM and 63 needed insulin treatment (52.9% of the GDM women). Patients with GDM were older (30.4±5.1 vs 28.9±4.8 years,p=0.008) and had more frequently a history of GDM (24.8% vs 6.1%; p<0.0001). Patients with GDM were more often hospitalized (47.8% vs 29.8%, p=0.001) and were more likely to have premature birth (11.7% vs. 5.3%, p=0.031). Neonates from mothers with GDM were more frequently large for gestational age (31.6% vs 19.4%, p=0.011), and had a higher rate of transfers to neonatal intensive unit (9.2% vs 4.0%, p=0.047). There was no difference for preeclampsia, C-section, shoulder dystocia, neonatal hypoglycemia or postpartum complications. Outcomes were comparable in women with or without insulin therapy. CONCLUSION The rate of GDM is particularly high in class III obese women. Morbidly obese women with GDM were more at risk for complications and needed more often insulin therapy. Our results suggest to pay a particular attention in this high-risk population.
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Affiliation(s)
- Leila Meghelli
- Univ. Lille, CHU Lille, EA 4489 - Environnement Périnatal et Santé, F-59000, Lille, France
| | - Anne Vambergue
- Pôle médico-chirurgical, Hôpital Huriez, CHRU de Lille, France/EGID-UMR 8199, Univ. Lille, France
| | - Elodie Drumez
- Univ. Lille, CHU Lille, Department of biostatistics, EA2694 - Santé publique: épidémiologie et qualité des soins, F-59000, Lille, France
| | - Philippe Deruelle
- Univ. Lille, CHU Lille, EA 4489 - Environnement Périnatal et Santé, F-59000, Lille, France.
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Hamoud Y, de Jonckheere J, Vambergue A, Houfflin-Debarge V, Storme L, Flocteil M, Deruelle P, Garabedian C. Heart rate variability in fetuses of type 1 diabetes pregnancies. Diabetes & Metabolism 2019; 45:308-310. [DOI: 10.1016/j.diabet.2017.07.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/25/2017] [Accepted: 07/02/2017] [Indexed: 12/27/2022]
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Dumas M, Machuron F, Coudert L, Dujardin K, Deplanque D, Vambergue A, Bombois S. Fréquence des troubles cognitifs et facteurs associés dans une cohorte de patients diabétiques. Rev Neurol (Paris) 2017. [DOI: 10.1016/j.neurol.2017.01.006] [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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Tagougui S, Leclair E, Fontaine P, Matran R, Marais G, Aucouturier J, Descatoire A, Vambergue A, Oussaidene K, Baquet G, Heyman E. Muscle oxygen supply impairment during exercise in poorly controlled type 1 diabetes. Med Sci Sports Exerc 2016; 47:231-9. [PMID: 24983346 PMCID: PMC4323553 DOI: 10.1249/mss.0000000000000424] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [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] [Indexed: 12/03/2022]
Abstract
Purpose Aerobic fitness, as reflected by maximal oxygen (O2) uptake (V˙O2max), is impaired in poorly controlled patients with type 1 diabetes. The mechanisms underlying this impairment remain to be explored. This study sought to investigate whether type 1 diabetes and high levels of glycated hemoglobin (HbA1c) influence O2 supply including O2 delivery and release to active muscles during maximal exercise. Methods Two groups of patients with uncomplicated type 1 diabetes (T1D-A, n = 11, with adequate glycemic control, HbA1c <7.0%; T1D-I, n = 12 with inadequate glycemic control, HbA1c >8%) were compared with healthy controls (CON-A, n = 11; CON-I, n = 12, respectively) matched for physical activity and body composition. Subjects performed exhaustive incremental exercise to determine V˙O2max. Throughout the exercise, near-infrared spectroscopy allowed investigation of changes in oxyhemoglobin, deoxyhemoglobin, and total hemoglobin in the vastus lateralis. Venous and arterialized capillary blood was sampled during exercise to assess arterial O2 transport and factors able to shift the oxyhemoglobin dissociation curve. Results Arterial O2 content was comparable between groups. However, changes in total hemoglobin (i.e., muscle blood volume) was significantly lower in T1D-I compared with that in CON-I. T1D-I also had impaired changes in deoxyhemoglobin levels and increase during high-intensity exercise despite normal erythrocyte 2,3-diphosphoglycerate levels. Finally, V˙O2max was lower in T1D-I compared with that in CON-I. No differences were observed between T1D-A and CON-A. Conclusions Poorly controlled patients displayed lower V˙O2max and blunted muscle deoxyhemoglobin increase. The latter supports the hypotheses of increase in O2 affinity induced by hemoglobin glycation and/or of a disturbed balance between nutritive and nonnutritive muscle blood flow. Furthermore, reduced exercise muscle blood volume in poorly controlled patients may warn clinicians of microvascular dysfunction occurring even before overt microangiopathy.
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Affiliation(s)
- Semah Tagougui
- 1Physical Activity, Muscle and Health, Lille, EA 4488, University of Lille 2, FRANCE; 2Department of Kinesiology and Health Science, Faculty of Health, York University, Toronto, Ontario, CANADA; 3Department of Diabetology, Lille University Hospital, EA 4489, Lille, FRANCE; 4Department of Physiology, EA 2689 and IFR 22, Lille, FRANCE; and 5Regional Hospital Centre of Roubaix, FRANCE
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Abstract
Located at the feto-maternal interface, the placenta is involved in exchange, endocrine and immune functions, which impact fetal development. In contact with the maternal environment, this organ is sensitive to metabolic disorders as over-nutrition, obesity or diabetes. The alteration of blood parameters associated with these pathologies affects placental histology, vascularization and nutrient transfers and, according to the types of troubles, induces local inflammation or hypoxia. These placental changes lead to disturbance of development and fetal growth, which increase the risk of pathologies in offspring in adulthood. The placenta thus appears as a crucial player in the fetal programming.
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Affiliation(s)
- Anne Gabory
- Inra, UMR 1198 biologie du développement et reproduction, Domaine de Vilvert, F-78350 Jouy-en-Josas, France
| | - Pascale Chavatte-Palmer
- Inra, UMR 1198 biologie du développement et reproduction, Domaine de Vilvert, F-78350 Jouy-en-Josas, France - Fondation PremUp, 4, avenue de l'Observatoire, F-75006 Paris, France
| | - Anne Vambergue
- Hôpital Claude Huriez, CHRU Lille, université Lille2, EA 4489 environnement périnatal et croissance, Faculté de médecine, place de Verdun, F-59000 Lille, France
| | - Anne Tarrade
- Inra, UMR 1198 biologie du développement et reproduction, Domaine de Vilvert, F-78350 Jouy-en-Josas, France - Fondation PremUp, 4, avenue de l'Observatoire, F-75006 Paris, France
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Bartolo S, Vambergue A, Deruelle P. [Screening for gestational diabetes: Still many unsolved issues]. ACTA ACUST UNITED AC 2016; 45:105-11. [PMID: 26780845 DOI: 10.1016/j.jgyn.2015.12.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [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: 08/01/2015] [Revised: 11/25/2015] [Accepted: 12/16/2015] [Indexed: 12/13/2022]
Abstract
For many years, there is a debate on gestational diabetes screening, including what screening test and thresholds to use. The purpose of this literature review is to determine whether gestational diabetes screening in France meets the 10 definition criteria of the WHO. The DG is a public health problem, with a natural history partially known and detectable at an early stage. Currently, there is no data showing that there is a benefit to treat patient screens by the new criteria. The one-step approach-screening test can only detect fetal complications and not maternal complications. It seems to be acceptable for the population of pregnant women. The diagnostic test and treatment also seem to be acceptable to us. To this day, its reproducibility is uncertain. Screening leads to an increase in obstetric interventions. Several studies found that screening for gestational diabetes is cost-effective but in a different context of care than in France.
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Affiliation(s)
- S Bartolo
- Clinique d'obstétrique, pôle femme-mère-nouveau-né, CHU de Lille, 59037 Lille cedex, France.
| | - A Vambergue
- Pôle d'endocrinologie, CHU de Lille, 59037 Lille cedex, France; UMR 8199, université Lille 2, EGID, 59037 Lille cedex, France
| | - P Deruelle
- Clinique d'obstétrique, pôle femme-mère-nouveau-né, CHU de Lille, 59037 Lille cedex, France; EA 4489, environnement périnatal et santé, CHU de Lille, université de Lille, 59000 Lille, France
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Bouvier D, Rouzaire M, Marceau G, Prat C, Pereira B, Lemarié R, Deruelle P, Fajardy I, Gallot D, Blanchon L, Vambergue A, Sapin V. Aquaporins and Fetal Membranes From Diabetic Parturient Women: Expression Abnormalities and Regulation by Insulin. J Clin Endocrinol Metab 2015. [PMID: 26207951 DOI: 10.1210/jc.2015-2057] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [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: 12/18/2022]
Abstract
CONTEXT During pregnancy, aquaporins (AQPs) expressed in fetal membranes are essential for controlling the homeostasis of the amniotic volume, but their regulation by insulin was never explored in diabetic women. OBJECTIVE The aim of our study was to investigate the involvement of AQPs 1, 3, 8, and 9 expressed in fetal membranes in diabetic parturient women and the control of their expression by insulin. DESIGN AND PARTICIPANTS From 129 fetal membranes in four populations (controls, type 1, type 2 [T2D], and gestational diabetes [GD]), we established an expression AQP profile. In a second step, the amnion was used to study the control of the expression and functions of AQPs 3 and 9 by insulin. MAIN OUTCOMES AND MEASURES The expression of transcripts and proteins of AQPs was studied by quantitative RT-PCR and ELISA. We analyzed the regulation by insulin of the expression of AQPs 3 and 9 in the amnion. A tritiated glycerol test enabled us to measure the impact of insulin on the functional characteristics. Using an inhibitor of phosphatidylinositol 3-kinase, we analyzed the insulin intracellular signaling pathway. RESULTS The expression of AQP3 protein was significantly weaker in groups T2D and GD. In nondiabetic fetal membranes, we showed for the amnion (but not for the chorion) a significant repression by insulin of the transcriptional expression of AQPs 3 and 9, which was blocked by a phosphatidylinositol 3-kinase inhibitor. CONCLUSION In fetal membranes, the repression of AQP3 protein expression and functions observed in vivo is allowed by the hyperinsulinism described in pregnant women with T2D or GD.
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Affiliation(s)
- Damien Bouvier
- Retinoids, Reproduction Developmental Diseases (D.B., M.R., G.M., C.P., D.G., L.B., V.S.), School of Medicine, Clermont Université, Université d'Auvergne, F-63000 Clermont-Ferrand, France; Biochemistry and Molecular Biology Department (D.B., G.M., R.L. V.S.), CHU Clermont-Ferrand, F-63000 Clermont-Ferrand, France; Biostatistics Unit Department (B.P.), CHU Clermont-Ferrand, F-63000 Clermont-Ferrand, France; School of Medicine Henri-Warembourg (P.D., I.F.), Université Lille 2, PRES Lille Nord de France, F-59000 Lille, France; and Integrative Genomics and Modelization of Metabolic Diseases (A.V.), EGID, School of Medicine Henri-Warembourg, Université Lille 2, PRES Lille Nord de France, F-59000 Lille, France
| | - Marion Rouzaire
- Retinoids, Reproduction Developmental Diseases (D.B., M.R., G.M., C.P., D.G., L.B., V.S.), School of Medicine, Clermont Université, Université d'Auvergne, F-63000 Clermont-Ferrand, France; Biochemistry and Molecular Biology Department (D.B., G.M., R.L. V.S.), CHU Clermont-Ferrand, F-63000 Clermont-Ferrand, France; Biostatistics Unit Department (B.P.), CHU Clermont-Ferrand, F-63000 Clermont-Ferrand, France; School of Medicine Henri-Warembourg (P.D., I.F.), Université Lille 2, PRES Lille Nord de France, F-59000 Lille, France; and Integrative Genomics and Modelization of Metabolic Diseases (A.V.), EGID, School of Medicine Henri-Warembourg, Université Lille 2, PRES Lille Nord de France, F-59000 Lille, France
| | - Geoffroy Marceau
- Retinoids, Reproduction Developmental Diseases (D.B., M.R., G.M., C.P., D.G., L.B., V.S.), School of Medicine, Clermont Université, Université d'Auvergne, F-63000 Clermont-Ferrand, France; Biochemistry and Molecular Biology Department (D.B., G.M., R.L. V.S.), CHU Clermont-Ferrand, F-63000 Clermont-Ferrand, France; Biostatistics Unit Department (B.P.), CHU Clermont-Ferrand, F-63000 Clermont-Ferrand, France; School of Medicine Henri-Warembourg (P.D., I.F.), Université Lille 2, PRES Lille Nord de France, F-59000 Lille, France; and Integrative Genomics and Modelization of Metabolic Diseases (A.V.), EGID, School of Medicine Henri-Warembourg, Université Lille 2, PRES Lille Nord de France, F-59000 Lille, France
| | - Cécile Prat
- Retinoids, Reproduction Developmental Diseases (D.B., M.R., G.M., C.P., D.G., L.B., V.S.), School of Medicine, Clermont Université, Université d'Auvergne, F-63000 Clermont-Ferrand, France; Biochemistry and Molecular Biology Department (D.B., G.M., R.L. V.S.), CHU Clermont-Ferrand, F-63000 Clermont-Ferrand, France; Biostatistics Unit Department (B.P.), CHU Clermont-Ferrand, F-63000 Clermont-Ferrand, France; School of Medicine Henri-Warembourg (P.D., I.F.), Université Lille 2, PRES Lille Nord de France, F-59000 Lille, France; and Integrative Genomics and Modelization of Metabolic Diseases (A.V.), EGID, School of Medicine Henri-Warembourg, Université Lille 2, PRES Lille Nord de France, F-59000 Lille, France
| | - Bruno Pereira
- Retinoids, Reproduction Developmental Diseases (D.B., M.R., G.M., C.P., D.G., L.B., V.S.), School of Medicine, Clermont Université, Université d'Auvergne, F-63000 Clermont-Ferrand, France; Biochemistry and Molecular Biology Department (D.B., G.M., R.L. V.S.), CHU Clermont-Ferrand, F-63000 Clermont-Ferrand, France; Biostatistics Unit Department (B.P.), CHU Clermont-Ferrand, F-63000 Clermont-Ferrand, France; School of Medicine Henri-Warembourg (P.D., I.F.), Université Lille 2, PRES Lille Nord de France, F-59000 Lille, France; and Integrative Genomics and Modelization of Metabolic Diseases (A.V.), EGID, School of Medicine Henri-Warembourg, Université Lille 2, PRES Lille Nord de France, F-59000 Lille, France
| | - Romain Lemarié
- Retinoids, Reproduction Developmental Diseases (D.B., M.R., G.M., C.P., D.G., L.B., V.S.), School of Medicine, Clermont Université, Université d'Auvergne, F-63000 Clermont-Ferrand, France; Biochemistry and Molecular Biology Department (D.B., G.M., R.L. V.S.), CHU Clermont-Ferrand, F-63000 Clermont-Ferrand, France; Biostatistics Unit Department (B.P.), CHU Clermont-Ferrand, F-63000 Clermont-Ferrand, France; School of Medicine Henri-Warembourg (P.D., I.F.), Université Lille 2, PRES Lille Nord de France, F-59000 Lille, France; and Integrative Genomics and Modelization of Metabolic Diseases (A.V.), EGID, School of Medicine Henri-Warembourg, Université Lille 2, PRES Lille Nord de France, F-59000 Lille, France
| | - Philippe Deruelle
- Retinoids, Reproduction Developmental Diseases (D.B., M.R., G.M., C.P., D.G., L.B., V.S.), School of Medicine, Clermont Université, Université d'Auvergne, F-63000 Clermont-Ferrand, France; Biochemistry and Molecular Biology Department (D.B., G.M., R.L. V.S.), CHU Clermont-Ferrand, F-63000 Clermont-Ferrand, France; Biostatistics Unit Department (B.P.), CHU Clermont-Ferrand, F-63000 Clermont-Ferrand, France; School of Medicine Henri-Warembourg (P.D., I.F.), Université Lille 2, PRES Lille Nord de France, F-59000 Lille, France; and Integrative Genomics and Modelization of Metabolic Diseases (A.V.), EGID, School of Medicine Henri-Warembourg, Université Lille 2, PRES Lille Nord de France, F-59000 Lille, France
| | - Isabelle Fajardy
- Retinoids, Reproduction Developmental Diseases (D.B., M.R., G.M., C.P., D.G., L.B., V.S.), School of Medicine, Clermont Université, Université d'Auvergne, F-63000 Clermont-Ferrand, France; Biochemistry and Molecular Biology Department (D.B., G.M., R.L. V.S.), CHU Clermont-Ferrand, F-63000 Clermont-Ferrand, France; Biostatistics Unit Department (B.P.), CHU Clermont-Ferrand, F-63000 Clermont-Ferrand, France; School of Medicine Henri-Warembourg (P.D., I.F.), Université Lille 2, PRES Lille Nord de France, F-59000 Lille, France; and Integrative Genomics and Modelization of Metabolic Diseases (A.V.), EGID, School of Medicine Henri-Warembourg, Université Lille 2, PRES Lille Nord de France, F-59000 Lille, France
| | - Denis Gallot
- Retinoids, Reproduction Developmental Diseases (D.B., M.R., G.M., C.P., D.G., L.B., V.S.), School of Medicine, Clermont Université, Université d'Auvergne, F-63000 Clermont-Ferrand, France; Biochemistry and Molecular Biology Department (D.B., G.M., R.L. V.S.), CHU Clermont-Ferrand, F-63000 Clermont-Ferrand, France; Biostatistics Unit Department (B.P.), CHU Clermont-Ferrand, F-63000 Clermont-Ferrand, France; School of Medicine Henri-Warembourg (P.D., I.F.), Université Lille 2, PRES Lille Nord de France, F-59000 Lille, France; and Integrative Genomics and Modelization of Metabolic Diseases (A.V.), EGID, School of Medicine Henri-Warembourg, Université Lille 2, PRES Lille Nord de France, F-59000 Lille, France
| | - Loïc Blanchon
- Retinoids, Reproduction Developmental Diseases (D.B., M.R., G.M., C.P., D.G., L.B., V.S.), School of Medicine, Clermont Université, Université d'Auvergne, F-63000 Clermont-Ferrand, France; Biochemistry and Molecular Biology Department (D.B., G.M., R.L. V.S.), CHU Clermont-Ferrand, F-63000 Clermont-Ferrand, France; Biostatistics Unit Department (B.P.), CHU Clermont-Ferrand, F-63000 Clermont-Ferrand, France; School of Medicine Henri-Warembourg (P.D., I.F.), Université Lille 2, PRES Lille Nord de France, F-59000 Lille, France; and Integrative Genomics and Modelization of Metabolic Diseases (A.V.), EGID, School of Medicine Henri-Warembourg, Université Lille 2, PRES Lille Nord de France, F-59000 Lille, France
| | - Anne Vambergue
- Retinoids, Reproduction Developmental Diseases (D.B., M.R., G.M., C.P., D.G., L.B., V.S.), School of Medicine, Clermont Université, Université d'Auvergne, F-63000 Clermont-Ferrand, France; Biochemistry and Molecular Biology Department (D.B., G.M., R.L. V.S.), CHU Clermont-Ferrand, F-63000 Clermont-Ferrand, France; Biostatistics Unit Department (B.P.), CHU Clermont-Ferrand, F-63000 Clermont-Ferrand, France; School of Medicine Henri-Warembourg (P.D., I.F.), Université Lille 2, PRES Lille Nord de France, F-59000 Lille, France; and Integrative Genomics and Modelization of Metabolic Diseases (A.V.), EGID, School of Medicine Henri-Warembourg, Université Lille 2, PRES Lille Nord de France, F-59000 Lille, France
| | - Vincent Sapin
- Retinoids, Reproduction Developmental Diseases (D.B., M.R., G.M., C.P., D.G., L.B., V.S.), School of Medicine, Clermont Université, Université d'Auvergne, F-63000 Clermont-Ferrand, France; Biochemistry and Molecular Biology Department (D.B., G.M., R.L. V.S.), CHU Clermont-Ferrand, F-63000 Clermont-Ferrand, France; Biostatistics Unit Department (B.P.), CHU Clermont-Ferrand, F-63000 Clermont-Ferrand, France; School of Medicine Henri-Warembourg (P.D., I.F.), Université Lille 2, PRES Lille Nord de France, F-59000 Lille, France; and Integrative Genomics and Modelization of Metabolic Diseases (A.V.), EGID, School of Medicine Henri-Warembourg, Université Lille 2, PRES Lille Nord de France, F-59000 Lille, France
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Tagougui S, Fontaine P, Leclair E, Aucouturier J, Matran R, Oussaidene K, Descatoire A, Prieur F, Mucci P, Vambergue A, Baquet G, Heyman E. Regional cerebral hemodynamic response to incremental exercise is blunted in poorly controlled patients with uncomplicated type 1 diabetes. Diabetes Care 2015; 38:858-67. [PMID: 25665816 DOI: 10.2337/dc14-1792] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2014] [Accepted: 01/11/2015] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Cerebral vasoreactivity to pharmacologically induced hypercapnia is impaired in poorly controlled patients with type 1 diabetes but otherwise free from microangiopathy. However, whether this response is also compromised during exercise, a daily-life physiological condition challenging regional cerebral hemodynamics, is unknown. We aimed to investigate prefrontal cortex hemodynamics during incremental maximal exercise in patients with uncomplicated type 1 diabetes, taking into account long-term glycemic control as well as exercise- and diabetes-influenced vasoactive stimuli. RESEARCH DESIGN AND METHODS Two groups of patients (type 1 diabetes with adequate glycemic control [T1D-A], n = 8, HbA1c 6.8 ± 0.7% [51 ± 7.7 mmol/mol]; type 1 diabetes with inadequate glycemic control [T1D-I], n = 10, HbA1c 9.0 ± 0.7% [75 ± 7.7 mmol/mol]) were compared with 18 healthy control subjects (CON-A and CON-I) matched for physical activity and body composition. Throughout exercise, near-infrared spectroscopy allowed investigation of changes in oxyhemoglobin (O2Hb), deoxyhemoglobin (HHb), and total hemoglobin (THb) in the prefrontal cortex. Venous and arterialized capillary blood was sampled during exercise to assess for factors that may alter prefrontal cortex hemodynamics and oxygenation. RESULTS No differences were observed between T1D-A and CON-A, but VO2max was impaired (P < 0.05) and cerebral blood volume (THb) increase blunted (P < 0.05) in T1D-I compared with CON-I. Nonetheless, O2Hb appeared unaltered in T1D-I probably partly due to blunting of simultaneous neuronal oxygen extraction (i.e., a lower HHb increase; P < 0.05). There were no intergroup differences in arterial oxygen content, Paco2, pH, [K(+)], and free insulin levels. CONCLUSIONS Maximal exercise highlights subtle disorders of both hemodynamics and neuronal oxygenation in the prefrontal cortex of poorly controlled patients with type 1 diabetes. These findings may warn clinicians of brain endothelial dysfunction occurring even before overt microangiopathy during exercise.
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Affiliation(s)
- Semah Tagougui
- University of Lille, URePSSS, "Physical Activity, Muscle, Health" Research Team, Lille, France
| | - Pierre Fontaine
- Department of Diabetology, Lille University Hospital, EA 4489, Lille, France
| | - Erwan Leclair
- School of Kinesiology and Health Science, Faculty of Health, York University, Toronto, ON, Canada
| | - Julien Aucouturier
- University of Lille, URePSSS, "Physical Activity, Muscle, Health" Research Team, Lille, France
| | - Régis Matran
- Department of Physiology, EA 2689 and IFR 22, Lille, France
| | - Kahina Oussaidene
- University of Lille, URePSSS, "Physical Activity, Muscle, Health" Research Team, Lille, France
| | | | - Fabrice Prieur
- University Paris Sud-University of Orléans, EA 4532 CIAMS, Orléans, France
| | - Patrick Mucci
- University of Lille, URePSSS, "Physical Activity, Muscle, Health" Research Team, Lille, France
| | - Anne Vambergue
- Department of Diabetology, Lille University Hospital, EA 4489, Lille, France
| | - Georges Baquet
- University of Lille, URePSSS, "Physical Activity, Muscle, Health" Research Team, Lille, France
| | - Elsa Heyman
- University of Lille, URePSSS, "Physical Activity, Muscle, Health" Research Team, Lille, France
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Poulain C, Duhamel A, Garabedian C, Cazaubiel M, Rejou MC, Vambergue A, Deruelle P. Outcome of twin pregnancies associated with glucose intolerance. Diabetes Metab 2015; 41:387-92. [PMID: 25636580 DOI: 10.1016/j.diabet.2014.12.005] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/06/2014] [Revised: 12/07/2014] [Accepted: 12/08/2014] [Indexed: 01/22/2023]
Abstract
OBJECTIVES There is little information about the impact of hyperglycaemia in twin pregnancies. The objective of our study was to evaluate the maternal, foetal and neonatal complications in patients with twin pregnancy and glucose intolerance defined by gestational diabetes mellitus and gestational mild hyperglycaemia. STUDY DESIGN We performed a single-centre retrospective study. Screening for gestational diabetes was achieved by a two-step method. Patients were managed according to the French guidelines. After matching for age and body mass index, outcomes were compared in 177 patients with glucose intolerance and 509 controls. Macrosomia was defined as birth weight above the 90th percentile of gestational age adjusted for parity, foetal sex and maternal biometrics. RESULTS Prevalence of glucose intolerance was 17.5% in our population. Complications of pregnancy and mode of delivery were similar between the two groups. Caesarean section was associated with age >35 years, vascular complications of pregnancy and non-cephalic presentation of the first twin. Rate of macrosomia was not different between the two groups. The only risk factor for macrosomia was a history of macrosomia in a previous pregnancy (odds ratio = 5.9, 95% confidence interval = 1.8-19.2). CONCLUSION Twin pregnancies complicated by glucose intolerance were not associated with an increased risk of macrosomia or Caesarean section. Further studies should assess the value of screening gestational diabetes mellitus in twin pregnancies.
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Affiliation(s)
- C Poulain
- GEM-JDF Project, Pôle femme, mère, nouveau-né, Maternité Jeanne-de-Flandre, CHRU de Lille, Lille, France
| | - A Duhamel
- Department of biostatistics, EA2694, Faculté de médecine Henri-Warembourg, Université Lille 2, PRES Lille Nord de France, Lille, France
| | - C Garabedian
- GEM-JDF Project, Pôle femme, mère, nouveau-né, Maternité Jeanne-de-Flandre, CHRU de Lille, Lille, France; UPRES EA 4489, Environnement périnatal et croissance, Faculté de médecine Henri-Warembourg, Université Lille 2, PRES Lille Nord de France, Lille, France
| | - M Cazaubiel
- Pôle médico-chirurgical, Hôpital Huriez, CHRU de Lille, Lille, France
| | - M C Rejou
- Pôle médico-chirurgical, Hôpital Huriez, CHRU de Lille, Lille, France
| | - A Vambergue
- Pôle médico-chirurgical, Hôpital Huriez, CHRU de Lille, Lille, France; UPRES EA 4489, Environnement périnatal et croissance, Faculté de médecine Henri-Warembourg, Université Lille 2, PRES Lille Nord de France, Lille, France
| | - P Deruelle
- GEM-JDF Project, Pôle femme, mère, nouveau-né, Maternité Jeanne-de-Flandre, CHRU de Lille, Lille, France; UPRES EA 4489, Environnement périnatal et croissance, Faculté de médecine Henri-Warembourg, Université Lille 2, PRES Lille Nord de France, Lille, France.
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Perimenis P, Bouckenooghe T, Delplanque J, Moitrot E, Eury E, Lobbens S, Gosset P, Devisme L, Duvillie B, Abderrahmani A, Storme L, Fontaine P, Froguel P, Vambergue A. Placental antiangiogenic prolactin fragments are increased in human and rat maternal diabetes. Biochim Biophys Acta Mol Basis Dis 2014; 1842:1783-93. [DOI: 10.1016/j.bbadis.2014.06.026] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2014] [Revised: 06/20/2014] [Accepted: 06/23/2014] [Indexed: 12/17/2022]
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Wery E, Vambergue A, Le Goueff F, Vincent D, Deruelle P. Impact des nouveaux critères de dépistage sur la prévalence du diabète gestationnel. ACTA ACUST UNITED AC 2014; 43:307-13. [DOI: 10.1016/j.jgyn.2013.01.005] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2012] [Revised: 01/12/2013] [Accepted: 01/23/2013] [Indexed: 11/16/2022]
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Garabedian C, Vambergue A, Salleron J, Deruelle P. Prediction of macrosomia by serial sonographic measurements of fetal soft-tissues and the liver in women with pregestational diabetes. Diabetes & Metabolism 2013; 39:511-8. [DOI: 10.1016/j.diabet.2013.03.004] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/22/2012] [Revised: 03/03/2013] [Accepted: 03/12/2013] [Indexed: 12/27/2022]
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Franc S, Borot S, Ronsin O, Quesada JL, Dardari D, Fagour C, Renard E, Leguerrier AM, Vigeral C, Moreau F, Winiszewski P, Vambergue A, Mosnier-Pudar H, Kessler L, Reffet S, Guerci B, Millot L, Halimi S, Thivolet C, Benhamou PY, Penfornis A, Charpentier G, Hanaire H. Telemedicine and type 1 diabetes: is technology per se sufficient to improve glycaemic control? Diabetes Metab 2013; 40:61-66. [PMID: 24139705 DOI: 10.1016/j.diabet.2013.09.001] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/26/2013] [Revised: 08/15/2013] [Accepted: 09/02/2013] [Indexed: 11/26/2022]
Abstract
AIM In the TELEDIAB-1 study, the Diabeo system (a smartphone coupled to a website) improved HbA1c by 0.9% vs controls in patients with chronic, poorly controlled type 1 diabetes. The system provided two main functions: automated advice on the insulin doses required; and remote monitoring by teleconsultation. The question is: how much did each function contribute to the improvement in HbA1c? METHODS Each patient received a smartphone with an insulin dose advisor (IDA) and with (G3 group) or without (G2 group) the telemonitoring/teleconsultation function. Patients were classified as "high users" if the proportion of "informed" meals using the IDA exceeded 67% (median) and as "low users" if not. Also analyzed was the respective impact of the IDA function and teleconsultations on the final HbA1c levels. RESULTS Among the high users, the proportion of informed meals remained stable from baseline to the end of the study 6months later (from 78.1±21.5% to 73.8±25.1%; P=0.107), but decreased in the low users (from 36.6±29.4% to 26.7±28.4%; P=0.005). As expected, HbA1c improved in high users from 8.7% [range: 8.3-9.2%] to 8.2% [range: 7.8-8.7%] in patients with (n=26) vs without (n=30) the benefit of telemonitoring/teleconsultation (-0.49±0.60% vs -0.52±0.73%, respectively; P=0.879). However, although HbA1c also improved in low users from 9.0% [8.5-10.1] to 8.5% [7.9-9.6], those receiving support via teleconsultation tended to show greater improvement than the others (-0.93±0.97 vs -0.46±1.05, respectively; P=0.084). CONCLUSION The Diabeo system improved glycaemic control in both high and low users who avidly used the IDA function, while the greatest improvement was seen in the low users who had the motivational support of teleconsultations.
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Affiliation(s)
- S Franc
- Department of Diabetes, Sud-Francilien Hospital, Corbeil-Essonnes, France; Centre d'Études et de Recherches pour l'Intensification du Traitement du Diabète (CERITD), Corbeil-Essonnes, France.
| | - S Borot
- Department of Endocrinology-Metabolism and Diabetology-Nutrition, Jean-Minjoz Hospital, Besançon, France
| | - O Ronsin
- Department of Diabetes, Sainte-Marguerite University Hospital, Marseille, France
| | - J-L Quesada
- Department of Biostatistics, CIC-Inserm, University Hospital, Grenoble, France
| | - D Dardari
- Centre d'Études et de Recherches pour l'Intensification du Traitement du Diabète (CERITD), Corbeil-Essonnes, France
| | - C Fagour
- Department of Endocrinology, University Hospital Pessac, Pessac, France
| | - E Renard
- Department of Endocrinology, University Hospital, Montpellier, France
| | - A-M Leguerrier
- Department of Endocrinology, University Hospital, Rennes, France
| | - C Vigeral
- Department of Diabetes, Hôtel-Dieu University Hospital, Paris, France
| | - F Moreau
- Department of Endocrinology, University Hospital, Strasbourg, France
| | - P Winiszewski
- Department of Endocrinology, Belfort Hospital, Belfort, France
| | - A Vambergue
- Clinique Marc Linquette, Department of Endocrinology and Diabetology, Lille, France
| | | | - L Kessler
- Department of Endocrinology, University Hospital, Strasbourg, France
| | - S Reffet
- Department of Endocrinology, Édouard-Herriot Hospital, Lyon, France
| | - B Guerci
- Diabetology, Nutrition, Metabolic disorders, Brabois Hospital and Center of Clinical Investigation ILCV, University Hospital, Nancy, France
| | - L Millot
- Department of Endocrinology, Bellevue Hospital, Saint-Étienne, France
| | - S Halimi
- Department of Endocrinology, Diabetology, Nutrition University Hospital, Grenoble, France; University J Fourier 1, Grenoble, France
| | - C Thivolet
- Department of Endocrinology, Édouard-Herriot Hospital, Lyon, France
| | - P-Y Benhamou
- Department of Endocrinology, Diabetology, Nutrition University Hospital, Grenoble, France
| | - A Penfornis
- Department of Endocrinology-Metabolism and Diabetology-Nutrition, Jean-Minjoz Hospital, Besançon, France
| | - G Charpentier
- Department of Diabetes, Sud-Francilien Hospital, Corbeil-Essonnes, France; Centre d'Études et de Recherches pour l'Intensification du Traitement du Diabète (CERITD), Corbeil-Essonnes, France
| | - H Hanaire
- Department of Diabetes, Rangueil University Hospital, Toulouse, France
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Sisino G, Bouckenooghe T, Aurientis S, Fontaine P, Storme L, Vambergue A. Diabetes during pregnancy influences Hofbauer cells, a subtype of placental macrophages, to acquire a pro-inflammatory phenotype. Biochim Biophys Acta Mol Basis Dis 2013; 1832:1959-68. [PMID: 23872577 DOI: 10.1016/j.bbadis.2013.07.009] [Citation(s) in RCA: 63] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2013] [Revised: 06/25/2013] [Accepted: 07/10/2013] [Indexed: 12/22/2022]
Abstract
Growing evidence indicates that maternal pathophysiological conditions, such as diabetes, influence fetal growth and could program metabolic disease in adulthood. Placental cells, particularly Hofbauer cells (HBCs), which are placental macrophages characterized by an anti-inflammatory profile (M2), can sense the modified maternal environment. The goal of this study was to investigate the direct effect of hyperglycemia on HBCs. We studied, at mRNA and protein levels, some markers of M2 and M1 (pro-inflammatory) macrophages in placentae from control and diabetic patients to assess the balance between pro- and anti-inflammatory macrophages: an imbalance of M2 to M1 macrophages has been observed in humans. We used pregnant rats, receiving a single injection of streptozotocin (STZ), as a model of maternal diabetes. We noticed a M2-to-M1 macrophage unbalance as we observed in human. An in vitro model of isolated rat HBCs was used to identify the direct effects of high glucose. We found that high glucose stimulation activated genes belonging to TLR (Toll-Like Receptor)-dependent inflammatory pathways. Moreover, the HBCs stimulated by high glucose switched their M2 profile towards M1, with increased expression of pro-inflammatory cytokines and markers. We also noticed that the oxidative-stress pathway was activated in response to high glucose driven by Hif-1α. In this study, we demonstrated that diabetes/hyperglycemia affect the anti-inflammatory profile of HBCs, by stimulating these cells to acquire an inflammatory profile leading to adverse consequences for the fetal-placental-maternal axis.
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Affiliation(s)
- Giorgia Sisino
- EA4489, Lille F-59000, France; Université Lille Nord de France, Lille F-59000, France; UDSL, Lille F-59000, France.
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Garabedian C, Saleron J, Vambergue A, Deruelle P. 251: Prediction of macrosomia in pregnancies with pre-gestational diabetes with serial fetal sonographic measurements of soft tissues and liver. Am J Obstet Gynecol 2013. [DOI: 10.1016/j.ajog.2012.10.416] [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: 11/25/2022]
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Edson-Heredia E, Rohwer RD, Wong M, Wang P, Vambergue A, Koivisto V. Studies assessing risk of treatments for diabetes mellitus and adverse pregnancy outcomes should control for known risk factors. Diabetes Technol Ther 2012; 14:1183-4; author reply 1185-6. [PMID: 23126581 DOI: 10.1089/dia.2012.0200] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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Gabory A, Ferry L, Fajardy I, Jouneau L, Gothié JD, Vigé A, Fleur C, Mayeur S, Gallou-Kabani C, Gross MS, Attig L, Vambergue A, Lesage J, Reusens B, Vieau D, Remacle C, Jais JP, Junien C. Maternal diets trigger sex-specific divergent trajectories of gene expression and epigenetic systems in mouse placenta. PLoS One 2012; 7:e47986. [PMID: 23144842 PMCID: PMC3489896 DOI: 10.1371/journal.pone.0047986] [Citation(s) in RCA: 138] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2012] [Accepted: 09/19/2012] [Indexed: 12/20/2022] Open
Abstract
Males and females responses to gestational overnutrition set the stage for subsequent sex-specific differences in adult onset non communicable diseases. Placenta, as a widely recognized programming agent, contibutes to the underlying processes. According to our previous findings, a high-fat diet during gestation triggers sex-specific epigenetic alterations within CpG and throughout the genome, together with the deregulation of clusters of imprinted genes. We further investigated the impact of diet and sex on placental histology, transcriptomic and epigenetic signatures in mice. Both basal gene expression and response to maternal high-fat diet were sexually dimorphic in whole placentas. Numerous genes showed sexually dimorphic expression, but only 11 genes regardless of the diet. In line with the key role of genes belonging to the sex chromosomes, 3 of these genes were Y-specific and 3 were X-specific. Amongst all the genes that were differentially expressed under a high-fat diet, only 16 genes were consistently affected in both males and females. The differences were not only quantitative but remarkably qualitative. The biological functions and networks of genes dysregulated differed markedly between the sexes. Seven genes of the epigenetic machinery were dysregulated, due to effects of diet, sex or both, including the Y- and X-linked histone demethylase paralogues Kdm5c and Kdm5d, which could mark differently male and female epigenomes. The DNA methyltransferase cofactor Dnmt3l gene expression was affected, reminiscent of our previous observation of changes in global DNA methylation. Overall, this striking sexual dimorphism of programming trajectories impose a considerable revision of the current dietary interventions protocols.
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Affiliation(s)
- Anne Gabory
- INRA, UMR1198 Biologie du Développement et Reproduction, Jouy-en-Josas, France
- L’Ecole Nationale Vétérinaire d’Alfort (ENVA), Maisons Alfort, France
- Inserm; AP-HP; Université Paris-Descartes, Faculté de Médecine, Hôpital Necker-Enfants Malades, U781, SBIM, Paris, France
| | - Laure Ferry
- INRA, UMR1198 Biologie du Développement et Reproduction, Jouy-en-Josas, France
- L’Ecole Nationale Vétérinaire d’Alfort (ENVA), Maisons Alfort, France
| | - Isabelle Fajardy
- EA 4489 Unité Environnement Périnatal et Croissance, Department of Diabetology, Biology and Pathology Center, Huriez Hospital, CHRU Lille, Lille, France
| | - Luc Jouneau
- INRA, UMR1198 Biologie du Développement et Reproduction, Jouy-en-Josas, France
- L’Ecole Nationale Vétérinaire d’Alfort (ENVA), Maisons Alfort, France
| | - Jean-David Gothié
- INRA, UMR1198 Biologie du Développement et Reproduction, Jouy-en-Josas, France
- L’Ecole Nationale Vétérinaire d’Alfort (ENVA), Maisons Alfort, France
| | - Alexandre Vigé
- Inserm; AP-HP; Université Paris-Descartes, Faculté de Médecine, Hôpital Necker-Enfants Malades, U781, SBIM, Paris, France
| | - Cécile Fleur
- INRA, UMR1198 Biologie du Développement et Reproduction, Jouy-en-Josas, France
- L’Ecole Nationale Vétérinaire d’Alfort (ENVA), Maisons Alfort, France
| | - Sylvain Mayeur
- EA 4489 Unité Environnement Périnatal et Croissance, Université de Lille 1, Bâtiment SN4, Villeneuve d’Ascq, France
| | - Catherine Gallou-Kabani
- Inserm; AP-HP; Université Paris-Descartes, Faculté de Médecine, Hôpital Necker-Enfants Malades, U781, SBIM, Paris, France
| | - Marie-Sylvie Gross
- Inserm; AP-HP; Université Paris-Descartes, Faculté de Médecine, Hôpital Necker-Enfants Malades, U781, SBIM, Paris, France
| | - Linda Attig
- INRA, UMR1198 Biologie du Développement et Reproduction, Jouy-en-Josas, France
- L’Ecole Nationale Vétérinaire d’Alfort (ENVA), Maisons Alfort, France
- Inserm; AP-HP; Université Paris-Descartes, Faculté de Médecine, Hôpital Necker-Enfants Malades, U781, SBIM, Paris, France
| | - Anne Vambergue
- EA 4489 Unité Environnement Périnatal et Croissance, Department of Diabetology, Biology and Pathology Center, Huriez Hospital, CHRU Lille, Lille, France
| | - Jean Lesage
- EA 4489 Unité Environnement Périnatal et Croissance, Université de Lille 1, Bâtiment SN4, Villeneuve d’Ascq, France
| | - Brigitte Reusens
- Laboratory of Cell Biology, Institute of Life Sciences, Université catholique de Louvain, Louvain-la-Neuve, Belgium
| | - Didier Vieau
- EA 4489 Unité Environnement Périnatal et Croissance, Université de Lille 1, Bâtiment SN4, Villeneuve d’Ascq, France
| | - Claude Remacle
- Laboratory of Cell Biology, Institute of Life Sciences, Université catholique de Louvain, Louvain-la-Neuve, Belgium
| | - Jean-Philippe Jais
- Service de Biostatistique et Informatique Médicale, Hôpital Necker-Enfants Malades, Paris, France
| | - Claudine Junien
- INRA, UMR1198 Biologie du Développement et Reproduction, Jouy-en-Josas, France
- L’Ecole Nationale Vétérinaire d’Alfort (ENVA), Maisons Alfort, France
- Inserm; AP-HP; Université Paris-Descartes, Faculté de Médecine, Hôpital Necker-Enfants Malades, U781, SBIM, Paris, France
- Université de Versailles Saint-Quentin-en-Yvelines, Versailles, France
- * E-mail:
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Gourdy P, Bachelot A, Catteau-Jonard S, Chabbert-Buffet N, Christin-Maître S, Conard J, Fredenrich A, Gompel A, Lamiche-Lorenzini F, Moreau C, Plu-Bureau G, Vambergue A, Vergès B, Kerlan V. Hormonal contraception in women at risk of vascular and metabolic disorders: Guidelines of the French Society of Endocrinology. Annales d'Endocrinologie 2012; 73:469-87. [DOI: 10.1016/j.ando.2012.09.001] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
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Guardia D, Bardin M, Rolland B, Issartel M, Vambergue A, Cottencin O. Mésusage d’insuline chez une adolescente souffrant de boulimie. Presse Med 2012; 41:1037-9. [DOI: 10.1016/j.lpm.2011.12.007] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2011] [Revised: 12/02/2011] [Accepted: 12/02/2011] [Indexed: 10/14/2022] Open
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Berkhout C, Vandaele-Bétancourt M, Robert S, Lespinasse S, Mitha G, Bradier Q, Vambergue A, Fontaine P. Enhancing field GP engagement in hospital-based studies. Rationale, design, main results and participation in the Diagest 3-GP motivation study. BMC Fam Pract 2012; 13:63. [PMID: 22721372 PMCID: PMC3441219 DOI: 10.1186/1471-2296-13-63] [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] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/11/2011] [Accepted: 05/31/2012] [Indexed: 11/29/2022]
Abstract
Background Diagest 3 was a study aimed at lowering the risk of developing type 2 diabetes within 3 years after childbirth. Women with gestational diabetes were enrolled in the study. After childbirth, the subjects showed little interest in the structured education programme and did not attend workshops. Their general practitioners (GPs) were approached to help motivate the subjects to participate in Diagest 3, but the GPs were reluctant. The present study aimed to understand field GPs’ attitudes towards hospital-based studies, and to develop strategies to enhance their involvement and reduce subject drop-out rates. Methods We used a three-step process: step one used a phenomenological approach exploring the beliefs, attitudes, motivations and environmental factors contributing to the GPs’ level of interest in the study. Data were collected in face-to-face interviews and coded by hand and with hermeneutic software to develop distinct GP profiles. Step two was a cross-sectional survey by questionnaire to determine the distribution of the profiles in the GP study population and whether completion of an attached case report form (CRF) was associated with a particular GP profile. In step three, we assessed the impact of the motivation study on participation rates in the main study. Results Fifteen interviews were conducted to achieve data saturation. Theorisation led to the definition of 4 distinct GP profiles. The response rate to the questionnaire was 73%, but dropped to 52% when a CRF was attached. The link between GP profiles and the rate of CRF completion remains to be verified. The GPs provided data on the CRF that was of comparable quality to those collected in the main trial. Our analysis showed that the motivation study increased overall participation in the main study by 23%, accounting for 16% (24/152) of all final visits for 536 patients who were initially enrolled in the Diagest 3 study. Conclusions When a hospital-led study explores issues in primary care, its design must anticipate GP participation early in the trial. Based on our questionnaire response rates, we found that one in two GPs were willing to participate in our hospital-led study, regardless of their initial attitudes.
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Affiliation(s)
- Christophe Berkhout
- Department of General Medicine, University of Lille Nord de France-Lille 2, Faculty of Medicine, 59045, Lille Cedex, France.
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Bonnefond A, Philippe J, Durand E, Dechaume A, Huyvaert M, Montagne L, Marre M, Balkau B, Fajardy I, Vambergue A, Vatin V, Delplanque J, Le Guilcher D, De Graeve F, Lecoeur C, Sand O, Vaxillaire M, Froguel P. Whole-exome sequencing and high throughput genotyping identified KCNJ11 as the thirteenth MODY gene. PLoS One 2012; 7:e37423. [PMID: 22701567 PMCID: PMC3372463 DOI: 10.1371/journal.pone.0037423] [Citation(s) in RCA: 136] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2012] [Accepted: 04/23/2012] [Indexed: 01/27/2023] Open
Abstract
Background Maturity-onset of the young (MODY) is a clinically heterogeneous form of diabetes characterized by an autosomal-dominant mode of inheritance, an onset before the age of 25 years, and a primary defect in the pancreatic beta-cell function. Approximately 30% of MODY families remain genetically unexplained (MODY-X). Here, we aimed to use whole-exome sequencing (WES) in a four-generation MODY-X family to identify a new susceptibility gene for MODY. Methodology WES (Agilent-SureSelect capture/Illumina-GAIIx sequencing) was performed in three affected and one non-affected relatives in the MODY-X family. We then performed a high-throughput multiplex genotyping (Illumina-GoldenGate assay) of the putative causal mutations in the whole family and in 406 controls. A linkage analysis was also carried out. Principal Findings By focusing on variants of interest (i.e. gains of stop codon, frameshift, non-synonymous and splice-site variants not reported in dbSNP130) present in the three affected relatives and not present in the control, we found 69 mutations. However, as WES was not uniform between samples, a total of 324 mutations had to be assessed in the whole family and in controls. Only one mutation (p.Glu227Lys in KCNJ11) co-segregated with diabetes in the family (with a LOD-score of 3.68). No KCNJ11 mutation was found in 25 other MODY-X unrelated subjects. Conclusions/Significance Beyond neonatal diabetes mellitus (NDM), KCNJ11 is also a MODY gene (‘MODY13’), confirming the wide spectrum of diabetes related phenotypes due to mutations in NDM genes (i.e. KCNJ11, ABCC8 and INS). Therefore, the molecular diagnosis of MODY should include KCNJ11 as affected carriers can be ideally treated with oral sulfonylureas.
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Affiliation(s)
- Amélie Bonnefond
- CNRS-UMR8199, Lille Pasteur Institute, Lille, France
- Lille Nord de France University, Lille, France
| | - Julien Philippe
- CNRS-UMR8199, Lille Pasteur Institute, Lille, France
- Lille Nord de France University, Lille, France
| | - Emmanuelle Durand
- CNRS-UMR8199, Lille Pasteur Institute, Lille, France
- Lille Nord de France University, Lille, France
| | - Aurélie Dechaume
- CNRS-UMR8199, Lille Pasteur Institute, Lille, France
- Lille Nord de France University, Lille, France
| | - Marlène Huyvaert
- CNRS-UMR8199, Lille Pasteur Institute, Lille, France
- Lille Nord de France University, Lille, France
| | - Louise Montagne
- CNRS-UMR8199, Lille Pasteur Institute, Lille, France
- Lille Nord de France University, Lille, France
- Department of Pediatrics, Saint Antoine Pediatric Hospital, Saint Vincent de Paul Hospital, Catholic University of Lille, Lille, France
| | - Michel Marre
- Department of Endocrinology, Diabetology and Nutrition, Bichat-Claude Bernard University Hospital, Assistance Publique des Hôpitaux de Paris (AP-HP), Paris, France
- Inserm-U695, Paris 7 University, Paris, France
| | - Beverley Balkau
- Inserm-U1018, Centre for research in Epidemiology and Population Health, Villejuif, France
- Paris-Sud 11 University, Villejuif, France
| | | | - Anne Vambergue
- Lille Nord de France University, Lille, France
- EA 4489 “Perinatal Environment and Fetal Growth”, Department of Diabetology, Huriez Hospital, CHRU Lille, Lille, France
| | - Vincent Vatin
- CNRS-UMR8199, Lille Pasteur Institute, Lille, France
- Lille Nord de France University, Lille, France
| | - Jérôme Delplanque
- CNRS-UMR8199, Lille Pasteur Institute, Lille, France
- Lille Nord de France University, Lille, France
| | - David Le Guilcher
- CNRS-UMR8199, Lille Pasteur Institute, Lille, France
- Lille Nord de France University, Lille, France
| | - Franck De Graeve
- CNRS-UMR8199, Lille Pasteur Institute, Lille, France
- Lille Nord de France University, Lille, France
| | - Cécile Lecoeur
- CNRS-UMR8199, Lille Pasteur Institute, Lille, France
- Lille Nord de France University, Lille, France
| | - Olivier Sand
- CNRS-UMR8199, Lille Pasteur Institute, Lille, France
- Lille Nord de France University, Lille, France
| | - Martine Vaxillaire
- CNRS-UMR8199, Lille Pasteur Institute, Lille, France
- Lille Nord de France University, Lille, France
| | - Philippe Froguel
- CNRS-UMR8199, Lille Pasteur Institute, Lille, France
- Lille Nord de France University, Lille, France
- Department of Genomics of Common Disease, School of Public Health, Imperial College London, Hammersmith Hospital, London, United Kingdom
- * E-mail:
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Bismuth E, Bouche C, Caliman C, Lepercq J, Lubin V, Rouge D, Timsit J, Vambergue A. Management of pregnancy in women with type 1 diabetes mellitus: Guidelines of the French-Speaking Diabetes Society (Société francophone du diabète [SFD]). Diabetes & Metabolism 2012; 38:205-16. [DOI: 10.1016/j.diabet.2012.02.010] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/16/2012] [Accepted: 02/17/2012] [Indexed: 12/11/2022]
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Bathaei S, Vitry J, Noel C, Vambergue A, Lemaire C, Romon M. P44 Évaluation des connaissances des médecins généralistes (MG) sur la microalbuminurie (MA). Diabetes & Metabolism 2012. [DOI: 10.1016/s1262-3636(12)71146-1] [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] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Vambergue A, Fajardy I. Consequences of gestational and pregestational diabetes on placental function and birth weight. World J Diabetes 2011; 2:196-203. [PMID: 22087356 PMCID: PMC3215769 DOI: 10.4239/wjd.v2.i11.196] [Citation(s) in RCA: 127] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2011] [Revised: 10/19/2011] [Accepted: 10/26/2011] [Indexed: 02/05/2023] Open
Abstract
Maternal diabetes constitutes an unfavorable environment for embryonic and fetoplacental development. Despite current treatments, pregnant women with pregestational diabetes are at increased risk for congenital malformations, materno-fetal complications, placental abnormalities and intrauterine malprogramming. The complications during pregnancy concern the mother (gravidic hypertension and/or preeclampsia, cesarean section) and the fetus (macrosomia or intrauterine growth restriction, shoulder dystocia, hypoglycemia and respiratory distress). The fetoplacental impairment and intrauterine programming of diseases in the offspring’s later life induced by gestational diabetes are similar to those induced by type 1 and type 2 diabetes mellitus. Despite the existence of several developmental and morphological differences in the placenta from rodents and women, there are similarities in the alterations induced by maternal diabetes in the placenta from diabetic patients and diabetic experimental models. From both human and rodent diabetic experimental models, it has been suggested that the placenta is a compromised target that largely suffers the impact of maternal diabetes. Depending on the maternal metabolic and proinflammatory derangements, macrosomia is explained by an excessive availability of nutrients and an increase in fetal insulin release, a phenotype related to the programming of glucose intolerance. The degree of fetal damage and placental dysfunction and the availability and utilisation of fetal substrates can lead to the induction of macrosomia or intrauterine growth restriction. In maternal diabetes, both the maternal environment and the genetic background are important in the complex and multifactorial processes that induce damage to the embryo, the placenta, the fetus and the offspring. Nevertheless, further research is needed to better understand the mechanisms that govern the early embryo development, the induction of congenital anomalies and fetal overgrowth in maternal diabetes.
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Affiliation(s)
- Anne Vambergue
- Anne Vambergue, EA 4489 "Perinatal Environment and Fetal Growth", Department of Diabetology, Huriez Hospital, 59800 CHRU Lille, France
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Abstract
OBJECTIVE To assess the safety of the use of insulin lispro during pregnancy on the basis of published literature and to report on any related efficacy findings. METHODS The National Center for Biotechnology Information Entrez Database PubMed (http://www.ncbi. nlm.nih.gov/pubmed/) was used to search for citations from MEDLINE in the November 2009 time frame that contained safety data and efficacy results on the use of insulin lispro during pregnancy. RESULTS From the MEDLINE search, we identified a total of 27 publications (with 1,265 pregnancies) with relevant information, which were included in this report. No statistically significant differences in the rates of occurrence of congenital anomalies or spontaneous abortions associated with the use of insulin lispro during pregnancy, in comparison with the use of human insulin, were reported. Moreover, in comparison with human insulin, insulin lispro was reported to result in improved glycemic control, as demonstrated by lower postprandial glucose concentrations and hemoglobin A1c levels. CONCLUSION The current review of the published literature indicates that insulin lispro is a safe alternative to human insulin with similar perinatal outcomes and potentially improved glycemic control in the management of diabetes during pregnancy.
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