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Doucet J, Verny C, Bordier L, Rekik A, Zulfiqar AA, Bezerra CB, Bauduceau B. Evolution in geriatric syndromes and association with survival over 5 years in the GERODIAB cohort of older French diabetic patients. Eur Geriatr Med 2020; 12:619-625. [PMID: 33225383 DOI: 10.1007/s41999-020-00425-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Accepted: 10/20/2020] [Indexed: 12/16/2022]
Abstract
PURPOSE Although one in three patients with diabetes in Western countries is over 70 years-old, geriatric syndromes and their relationship with survival remain seldom studied. The present aim of the GERODIAB study was to examine the evolution of geriatric disorders and their relationship with survival in older type 2 patients with diabetes with initial sufficient autonomy. METHODS We performed a prospective, observational study over 5 years in patients with diabetes aged 70 years or above. A total of 987 consecutive type 2 patients with diabetes (mean age 77 years, range 70-94 years, 65.2% were 75 years and above, 52.1% women) were included from 56 French diabetic centres. Individual characteristics, diabetes parameters and geriatric parameters (autonomy, nutrition, cognitive alteration, depression, orthostatic hypotension, falls) were annually recorded. Survival was analysed using the Kaplan-Meier method and proportional hazards regression models. RESULTS Institutional living, impaired activity and difficulties in instrumental daily activity, cognitive disorders, malnutrition, depression, orthostatic hypotension and hypoglycaemia strongly increased during the follow-up. Institutional living, impaired activity and difficulties in instrumental daily activity, cognitive disorders and hypoglycaemia were strongly associated with reduced survival, but not falls. In hazard ratio models, living in an institution (HR = 2.39; CI = 1.77-3.24; p < 0.0001) and impaired Activity of Daily Living scale score were the most significant and independent predictors of death (HR = 1.59; CI = 1.19-2.13; p = 0.0016), associated with HbA1c ≥ 70 mmol/mol (HR = 1.62; CI = 1.12-2.36; p = 0.011). CONCLUSION Our findings show the considerable alteration of geriatric parameters and their relationship with decreased survival after a 5-year follow-up in type 2 patients with diabetes, independent of HbA1c and age. They, therefore, confirm the prognostic interest of using yearly geriatric markers in older diabetic patient management, especially the ADL, IADL and MMSE scales. Taking into account these prognostic parameters should contribute to target appropriate HbA1c goals. TRIAL REGISTRATION Registered at clinicaltrials.gov (21/01/2011): NCT01282060.
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Affiliation(s)
- J Doucet
- Service de Médecine Interne Polyvalente, Hôpital Saint Julien, CHU de Rouen - Normandy University, 76031, Rouen cedex, France.
| | - Ch Verny
- Service de Gérontologie, CHU de Bicêtre, 12 rue Séverine, 94276, Le Kremlin Bicêtre cedex, France
| | - L Bordier
- Service D'Endocrinologie, Hôpital Bégin, 69 avenue de Paris, 94160, Saint Mandé, France
| | - A Rekik
- Service de Médecine Interne Polyvalente, Hôpital Saint Julien, CHU de Rouen - Normandy University, 76031, Rouen cedex, France
| | - A A Zulfiqar
- Service de Médecine Gériatrique, Hôpital Saint Julien, CHU de Rouen - Normandy University, 76031, Rouen cedex, France
| | - C Bandeira Bezerra
- School of Medicine, University of Fortaleza - Unifor, Fortaleza, Ceara, Brazil
| | - B Bauduceau
- Service D'Endocrinologie, Hôpital Bégin, 69 avenue de Paris, 94160, Saint Mandé, France
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Doucet J, Verny C, Balkau B, Scheen A, Bauduceau B. Haemoglobin A1c and 5-year all-cause mortality in French type 2 diabetic patients aged 70 years and older: The GERODIAB observational cohort. Diabetes & Metabolism 2018; 44:465-472. [DOI: 10.1016/j.diabet.2018.05.003] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/23/2017] [Revised: 05/04/2018] [Accepted: 05/12/2018] [Indexed: 01/21/2023]
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Bucher S, Panjo H, Al-Salameh A, Bauduceau B, Benattar-Zibi L, Bertin P, Berrut G, Corruble E, Danchin N, Derumeaux G, Doucet J, Falissard B, Forette F, Hanon O, Ourabah R, Pasquier F, Piedvache C, Pinget M, Becquemont L, Ringa V. Relationship between achieved personalized glycaemic targets and monitoring of clinical events in elderly diabetic patients. Diabetes Metab 2017; 43:59-68. [PMID: 27316980 DOI: 10.1016/j.diabet.2016.05.008] [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: 12/29/2015] [Revised: 04/29/2016] [Accepted: 05/14/2016] [Indexed: 06/06/2023]
Abstract
AIM Recent guidelines for the management of type 2 diabetes (T2DM) in the elderly recommend adjusting the therapeutic target (HbA1c) according to the patient's health. Our study aimed to explore the association between achieving the recommended personalized HbA1c target and the occurrence of major clinical events under real-life conditions. METHODS The T2DM S.AGES cohort was a prospective multicentre study into which 213 general practitioners recruited 983 non-institutionalized T2DM patients aged>65 years. The recommended personalized HbA1c targets were<7%, <8% and <9% for healthy, ill and very ill patients, respectively. Major clinical events (death from any cause, major vascular events and/or hospitalization) were recorded during the 3-year follow-up. Mixed-effects logistic regression models were used for the analyses. RESULTS Of the 747 patients analyzed at baseline, 551 (76.8%) were at their recommended personalized HbA1c target. During follow-up, 391 patients (52.3%) experienced a major clinical event. Of the patients who did not achieve their personalized HbA1c target (compared with those who did), the risk (OR) of a major clinical event was 0.95 (95% CI: 0.69-1.31; P=0.76). The risk of death, major vascular event and hospitalization were 0.88 (95% CI: 0.40-1.94; P=0.75), 1.14 (95% CI: 0.7-1.83; P=0.59) and 0.84 (95% CI: 0.60-1.18; P=0.32), respectively. CONCLUSION Over a 3-year follow-up period, our results showed no difference in risk of a major clinical event among patients, regardless of whether or not they achieved their personalized recommended HbA1c target. These results need to be confirmed before implementing a more permissive strategy for treating T2DM in elderly patients.
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Affiliation(s)
- S Bucher
- CESP, Inserm, University Paris-Sud, UVSQ, University Paris-Saclay, 94275 Kremlin-Bicêtre, France; General Practice Department, Paris-Sud Faculty of Medicine, University of Paris-Sud, 63, rue Gabriel-Peri, 94275 Le Kremlin-Bicêtre, France.
| | - H Panjo
- CESP, Inserm, University Paris-Sud, UVSQ, University Paris-Saclay, 94275 Kremlin-Bicêtre, France
| | - A Al-Salameh
- Pharmacology Department, Faculty of Medicine Paris-Sud, University Paris Sud, UMR 1184, CEA, DSV/iMETI, Division of Immuno-virology, IDMIT, Inserm Center for immunology of viral infections and autoimmune diseases, Assistance publique-Hôpitaux de Paris, Hôpital Bicêtre, Le Kremlin-Bicêtre, France
| | - B Bauduceau
- Endocrinology department, Begin hospital, Saint-Mandé, France
| | | | - P Bertin
- Rheumatology Department, Limoges University Hospital, Limoges, France
| | - G Berrut
- Clinical Gerontology, Nantes University Hospital, Nantes, France
| | - E Corruble
- Inserm U 1178, Paris-Sud Faculty of Medicine, University of Paris-Sud, Psychiatry Department, Bicêtre University Hospital, Assistance publique-Hôpitaux de Paris, Le Kremlin- Bicêtre, France
| | - N Danchin
- HEGP, Coronary Diseases, Paris, France
| | - G Derumeaux
- Cardiovascular Functional Exploration, Louis-Pradel Hospital, Hospices Civils de Lyon, Bron, France
| | - J Doucet
- Internal medicine, Geriatry and therapeutics, Saint-Julien university Hospital, Rouen University, Rouen, France
| | - B Falissard
- CESP, Inserm, University Paris-Sud, UVSQ, University Paris-Saclay, 94800 Villejuif, France
| | - F Forette
- University of Paris Descartes, National Foundation of Gerontology, Paris, France
| | - O Hanon
- University of Paris Descartes, EA 4468, Assistance publique-Hôpitaux de Paris, Broca Hospital, Geriatrics Department, Paris, France
| | - R Ourabah
- General Practice Department, Paris-Sud Faculty of Medicine, University of Paris-Sud, 63, rue Gabriel-Peri, 94275 Le Kremlin-Bicêtre, France
| | - F Pasquier
- University of Lille Nord de France, UDSL, EA 1046, CHU de Lille, Lille, France
| | - C Piedvache
- Pharmacology Department, Faculty of Medicine Paris-Sud, University Paris Sud, UMR 1184, CEA, DSV/iMETI, Division of Immuno-virology, IDMIT, Inserm Center for immunology of viral infections and autoimmune diseases, Assistance publique-Hôpitaux de Paris, Hôpital Bicêtre, Le Kremlin-Bicêtre, France
| | - M Pinget
- Endocrinology, Diabetes and Nutrition-Related Diseases (NUDE Unit), Strasbourg University Hospital and the European Centre for the Study of Diabetes (CeeD), University of Strasbourg, Strasbourg, France
| | - L Becquemont
- Pharmacology Department, Faculty of Medicine Paris-Sud, University Paris Sud, UMR 1184, CEA, DSV/iMETI, Division of Immuno-virology, IDMIT, Inserm Center for immunology of viral infections and autoimmune diseases, Assistance publique-Hôpitaux de Paris, Hôpital Bicêtre, Le Kremlin-Bicêtre, France
| | - V Ringa
- CESP, Inserm, University Paris-Sud, UVSQ, University Paris-Saclay, 94275 Kremlin-Bicêtre, France
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Bucher S, Panjo H, Al-Salameh A, Bauduceau B, Benattar-Zibi L, Bertin P, Berrut G, Corruble E, Danchin N, Derumeaux G, Doucet J, Falissard B, Forette F, Hanon O, Ourabah R, Pasquier F, Piedvache C, Pinget M, Becquemont L, Ringa V. Atteinte de la cible thérapeutique personnalisée et la survenue d’événements cliniques chez des patients âgés diabétiques. Rev Epidemiol Sante Publique 2016. [DOI: 10.1016/j.respe.2016.10.033] [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: 11/26/2022] Open
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Verny C, Doucet J, Bauduceau B, Constans T, Mondon K, Le Floch JP. Prevalence of cognitive decline and associated factors in elderly type 2 diabetic patients at inclusion in the GERODIAB cohort. Eur Geriatr Med 2015. [DOI: 10.1016/j.eurger.2014.10.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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Bouhanick B, Meliani S, Doucet J, Bauduceau B, Verny C, Chamontin B, Le Floch JP. Orthostatic hypotension is associated with more severe hypertension in elderly autonomous diabetic patients from the French Gerodiab study at inclusion. Ann Cardiol Angeiol (Paris) 2014; 63:176-182. [PMID: 24958527 DOI: 10.1016/j.ancard.2014.05.013] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2014] [Accepted: 05/22/2014] [Indexed: 06/03/2023]
Abstract
UNLABELLED Orthostatic hypotension (OH) has deleterious effects on patients' cardiovascular prognoses. The combination of increased age and diabetes adds to the risk of OH. The aim of the study was to describe the elderly diabetic population relative to the degree of hypertension, the occurrence of complications, medications and cognitive function. METHODS In the Gerodiab study (a 5-year French multicentre, prospective, observational study), a total of 987 type 2 diabetic autonomous patients, aged 77±5 years, were recruited between June 2009 and July 2010. Clinical blood pressure measurements were taken supine and then after 1, 3 and 5minutes in a standing position. OH was defined as a decrease in systolic blood pressure (SBP) of at least 20mmHg and/or a decrease in diastolic blood pressure (DBP) of at least 10mmHg at any of the measurements while standing. RESULTS At inclusion 301 (30.5%) patients had OH; SBP and DBP at rest were higher in patients with OH than in those without (146±21/78±11mmHg vs. 138±17/72±10mmHg; P<0.001). Individuals with OH exhibited higher pulse pressure (PP) than individuals without (68±18 vs. 65±15mmHg; P<0.05). A significant increase in waist-to-hip ratio was recorded in those with OH versus patients without (P<0.01). Despite more severe hypertension (SBP>160mmHg at inclusion; P<0.01), no significant difference was recorded in the mean number of antihypertensive drugs (1.7±1.1), or in the class of antihypertensive drugs, including beta-blockers (P=0.19) and diuretics (P=0.84). Patients with OH were more likely to have a history of peripheral arterial disease and amputations (31% vs. 24%, P<0.05, and 3.3% vs. 1.5%, P=0.056). There was no significant association between OH and history of peripheral neuropathy (P=0.37), stroke, heart failure or ischemic heart disease. In multivariate analysis, OH remained associated with severe hypertension (P<0.01), increased waist-to-hip ratio (P<0.05) and amputations (P<0.05). CONCLUSION About one-third of elderly, autonomous diabetic patients had OH. They had more severe hypertension, with higher SBP, DBP and PP at rest. However, the number of anti-hypertensive drugs did not differ compared to patients without OH. This could reflect the medical teams' fears about intensifying treatment.
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Affiliation(s)
- B Bouhanick
- Department of Internal Medicine and Hypertension, University Hospital Rangueil, TSA 50032, 31059 Toulouse cedex 9, France.
| | - S Meliani
- Department of Internal Medicine and Hypertension, University Hospital Rangueil, TSA 50032, 31059 Toulouse cedex 9, France
| | - J Doucet
- Internal Medicine, Geriatrics and Therapeutics, Saint Julien Hospital, Rouen University Hospital, 76031 Rouen cedex, France
| | - B Bauduceau
- Endocrinology, Begin Hospital, 69, avenue de Paris, 94160 Saint-Mandé, France
| | - C Verny
- Gerontology, Bicêtre University Hospital, 12, rue Séverine, 94276 Le Kremlin-Bicêtre cedex, France
| | - B Chamontin
- Department of Internal Medicine and Hypertension, University Hospital Rangueil, TSA 50032, 31059 Toulouse cedex 9, France
| | - J-P Le Floch
- Diabetology-Endocrinology, Villecresnes Medical Hospital, 8, boulevard Richerand, 94440 Villecresnes, France
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Scheen AJ, Paquot N, Bauduceau B. [Diabetes mellitus in the elderly: from the epidemiological challenge to a personalized approach]. Rev Med Liege 2014; 69:323-328. [PMID: 25065240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Diabetes mellitus is a common chronic disease in the elderly, being either a known disease with a long history (type 1 or even more often type 2 diabetes) and then frequently associated with various diabetic complications, or a recently diagnosed diabetes that may, however, have been ignored for a rather long time. In this latter case, diabetes may present as the occurrence or aggravation of one or several geriatric syndromes that overall result in a loss of autonomy. The global geriatric assessment, the estimation of life expectancy and the justification of glucose-lowering treatments should be performed at regular intervals in elderly diabetic people as they determine the right choice of glucose target levels and the best selection of glucose-lowering agents. Medications that can induce hypoglycaemia should ideally be avoided, especially in the frailty older population. The benefit-risk ratio of the proposed therapies should be analyzed first, and then regularly reassessed because of a potentially rapidly progressing condition. The recommended approach is a tailored management of diabetes that should integrate the clinical, functional and psycho-social aspects of elderly individuals.
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Bordier L, Doucet J, Boudet J, Bauduceau B. Update on cognitive decline and dementia in elderly patients with diabetes. Diabetes Metab 2014; 40:331-7. [PMID: 24703603 DOI: 10.1016/j.diabet.2014.02.002] [Citation(s) in RCA: 71] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/26/2013] [Revised: 02/04/2014] [Accepted: 02/05/2014] [Indexed: 12/19/2022]
Abstract
AIM This article is an update of the relationship between type 2 diabetes (T2D), cognitive dysfunction and dementia in older people. METHODS AND RESULTS The number of older patients consulting for diabetes who also exhibit cognitive difficulties is consistently growing because of the increased longevity of the population as a whole and, according to a number of studies, the increased risk of cognitive impairment and dementia in older diabetic patients. Many studies have demonstrated a link between poor glucose control and deteriorated cognitive function in diabetic patients. A history of severe hypoglycaemic episodes has also been associated with a greater risk of late-in-life cognitive deficits and dementia in patients with T2D. Several processes are thought to promote cognitive decline and dementia in diabetics. Based on both clinical and non-clinical findings, the factors most likely to alter brain function and structure are cerebrovascular complications of diabetes, alterations in glucose and insulin, and recurrent hypoglycaemia. Together with other diabetes complications, cognitive deficits contribute to functional impairment, increased frequency of depression-related symptoms, greater incidence of recurrent hypoglycaemia, poorer adherence to treatment and, finally, poorer prognosis, as evidenced by recent longitudinal studies. CONCLUSION Clinical guidelines have recently been devised for older diabetic patients, particularly those with cognitive deficits and a reduced capacity to self-manage. In the most vulnerable patients, specific treatment strategies have been proposed for glycaemic control to limit metabolic decompensation and avoid the risk of hypoglycaemia. Educational measures, provided mainly to maintain patient autonomy and avoid hospital admission, have also been adapted according to patients' cognitive and functional status.
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Affiliation(s)
- L Bordier
- Endocrinology Department, hôpital Bégin, 69, avenue de Paris, 94160 Saint-Mandé, France.
| | - J Doucet
- Geriatric Therapy and Internal Medicine Department, hôpital Saint-Julien, CHU de Rouen, 76031 Rouen cedex, France
| | - J Boudet
- Medical Endocrinology Department, Lilly France, boulevard Vital-Bouhot, 92521 Neuilly-sur-Seine cedex, France
| | - B Bauduceau
- Endocrinology Department, hôpital Bégin, 69, avenue de Paris, 94160 Saint-Mandé, France
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Le Floch JP, Doucet J, Bauduceau B, Verny C. Retinopathy, nephropathy, peripheral neuropathy and geriatric scale scores in elderly people with Type 2 diabetes. Diabet Med 2014; 31:107-11. [PMID: 24111927 DOI: 10.1111/dme.12327] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2013] [Revised: 08/09/2013] [Accepted: 09/19/2013] [Indexed: 12/26/2022]
Abstract
AIMS To analyse the relationships between retinopathy, nephropathy, peripheral neuropathy and geriatric scale scores in elderly people with Type 2 diabetes. METHODS GERODIAB is the first French multi-centre, prospective, observational study designed to assess the influence of glycaemic control on mortality and morbidity through a 5-year follow-up study in people with Type 2 diabetes aged 70 years and older. In this report the relationships at baseline between retinopathy, nephropathy and peripheral neuropathy, and five geriatric scale scores in 987 people, using bivariate and multivariate analyses are analysed. RESULTS Retinopathy (26%) was significantly associated with impaired scores on the Mini Geriatric Depression Scale, the Mini Nutritional Assessment and the Instrumental Activities of Daily Living scale. Logistic regression showed that the duration of diabetes, BMI, Mini Geriatric Depression Scale, hypoglycaemia and HbA1c were associated with retinopathy (concordance 69.1%; P < 0.001). Nephropathy (47.4%, including 34.8% with Modification of Diet in Renal Disease < 60 ml/min) was significantly associated with impaired Activities of Daily Living and Instrumental Activities of Daily Living scale scores. Using the logistic model, the most significant factors were age, duration of diabetes, triglycerides, HDL cholesterol, hypoglycaemia, hypertension and BMI (concordance 66.3%; P < 0.001). Peripheral neuropathy (28.2%) was associated with impaired scores on the Mini Mental State Examination, Activities of Daily Living, Instrumental Activities of Daily Living and Mini Geriatric Depression Scales. In the logistic model, diastolic blood pressure, duration of diabetes and the Instrumental Activities of Daily Living, Mini Geriatric Depression Scale and Mini Mental State Examination scales were included (concordance 69.8%; P < 0.001). CONCLUSION In this specific sample, classical microvascular complications of diabetes were found to be associated with impaired geriatric scale scores. This highlights the benefits of systematic assessment in elderly people with Type 2 diabetes.
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Affiliation(s)
- J-P Le Floch
- Diabetology-Endocrinology, Villecresnes Medical Hospital, Villecresnes
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Doucet J, Le Floch JP, Bauduceau B, Verny C. Étude GERODIAB : des différences sensibles existent entre hommes et femmes chez les diabétiques de plus de 70ans. Rev Med Interne 2012. [DOI: 10.1016/j.revmed.2012.10.318] [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: 10/27/2022]
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Yajnik CS, Kantikar V, Pande A, Deslypere JP, Dupin J, Calvet JH, Bauduceau B. Screening of cardiovascular autonomic neuropathy in patients with diabetes using non-invasive quick and simple assessment of sudomotor function. Diabetes Metab 2012; 39:126-31. [PMID: 23159130 DOI: 10.1016/j.diabet.2012.09.004] [Citation(s) in RCA: 55] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/26/2012] [Revised: 09/24/2012] [Accepted: 09/24/2012] [Indexed: 02/07/2023]
Abstract
AIM Cardiovascular autonomic neuropathy (CAN) is a common but often overlooked complication of diabetes. Sympathetic C-fibers innervating sweat glands can be impaired early on in patients with diabetes. In this study, SUDOSCAN, a new non-invasive device that assesses sudomotor function was compared to methods generally used for the investigation of CAN. PATIENTS A total of 232 patients with diabetes were measured for heart rate variability (HRV) at rest and during moderate activity. Time and frequency domain analysis techniques, including measurement of the low-frequency (LF) domain component, were assessed during HRV testing. Ewing tests, as recommended by the French Health Authority, were also done. Electrochemical sweat conductance (ESC) was measured on the hands and feet, and a risk-score was calculated. RESULTS Using two abnormal Ewing tests as a reference for the area under the curve (AUC) of the receiver operating characteristics (ROC) curve for SUDOSCAN, the risk-score was 0.74, with a sensitivity of 92% and specificity of 49% for a risk-score cut-off value of 35%. For the ROC curve analysis using the LF power component during moderate activity at a threshold of 90 ms(2) (first quartile) as reference, the AUC was higher for the SUDOSCAN risk-score (0.77) compared with the standard Ewing tests [E:I ratio (0.62), 30:15 ratio (0.76) and blood pressure change on standing (0.55)]. Using a cut-off value of 35%, risk-score sensitivity and specificity were 88 and 54%, respectively. CONCLUSION SUDOSCAN, which allows quick quantitative assessment of sudomotor function, may be used for early screening of CAN in everyday clinical practice before resorting to the more sophisticated and specific, but ultimately more time-consuming, Ewing tests.
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Affiliation(s)
- C S Yajnik
- Diabetes Unit, King Edward Memorial Hospital Research Centre, Pune, India
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Doucet J, Le Floch JP, Bauduceau B, Verny C. GERODIAB: Glycaemic control and 5-year morbidity/mortality of type 2 diabetic patients aged 70 years and older: 1. Description of the population at inclusion. Diabetes Metab 2012; 38:523-30. [PMID: 23062595 DOI: 10.1016/j.diabet.2012.07.001] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/17/2012] [Revised: 07/06/2012] [Accepted: 07/06/2012] [Indexed: 01/21/2023]
Abstract
AIMS The GERODIAB study is the first French multicentre, prospective, observational study that aims, through a 5-year cohort follow-up, to evaluate the link between glycaemic control and morbidity/mortality of type 2 diabetic (T2D) patients aged 70 years and older. This first report describes the study population at inclusion. PATIENTS AND METHODS A total of 987 T2D autonomous patients, aged ≥70 years, were recruited between June 2009 and July 2010 at 56 investigator centres. Their general parameters, diabetes characteristics and standard geriatric parameters were recorded. RESULTS The patients' mean age was 77±5 years, with 65.2% aged 75 years or more. The mean BMI was close to 30 kg/m(2). Hypertension was found in 89.7% of patients, and 85.0% had at least one cholesterol abnormality. The mean duration of the diabetes was around 18 years, and the mean HbA(1c) level was about 7.5%. During the previous six months, 33.6% of patients had experienced one or several hypoglycaemias. Also, 26% of patients presented with diabetic retinopathy, 37.3% had a GFR<60 mL/min, 31.2% had coronary insufficiency, 10.1% had heart failure, 15.8% had cerebrovascular involvement and 25.6% had peripheral vascular disease of the lower extremities. In addition, 30.5% of patients had orthostatic hypotension, 12.4% had malnutrition and 28.8% had cognitive impairment, all of which were often diagnosed at inclusion. Three-quarters of patients were taking an oral antidiabetic drug and nearly six in every 10 patients were using insulin. CONCLUSION This population can be considered representative of elderly, autonomous T2D patients, and its follow-up should clarify the link between glycaemic control and mortality/morbidity.
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Affiliation(s)
- J Doucet
- Service de Médecine Interne Gériatrie Thérapeutique, Hôpital Saint-Julien, Rouen University, CHU de Rouen, 76031 Rouen cedex, France.
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Abstract
Diabetes and dementia, which have a complex relationship between them, are undergoing extensive growth in their fields. The occurrence of hypoglycaemia, the potential severity of which has just been pointed out in some recent studies, must be included in these relationships. In fact, diabetes is the cause of decline in cognitive functions and most certainly is involved in the occurrence of vascular dementia. The brain, which is highly dependent on glucose for its metabolism, is particularly vulnerable to hypoglycaemia in children and the elderly. Animal studies and pathoanatomical observations confirm the clinical impression of the reality of genuine post-hypoglycaemic encephalopathy. The impact of mild hypoglycaemia however is being debated. Lastly, the existence of dementia promotes the occurrence of hypoglycaemia due to disorders related to eating habits or poor treatment management. This hypoglycaemic risk however must not constitute a pretext for exaggerated laxity in achieving the blood glucose objectives.
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Affiliation(s)
- B Bauduceau
- Service d'Endocrinologie, Hôpital d'Instruction des Armées Bégin, Saint-Mandé, France.
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Bauduceau B. [Twelfth national meeting of residents in endocrinology]. Ann Endocrinol (Paris) 2011; 72:1-2. [PMID: 21211787 DOI: 10.1016/j.ando.2010.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
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Garcia C, Feve B, Ferré P, Halimi S, Baizri H, Bordier L, Guiu G, Dupuy O, Bauduceau B, Mayaudon H. Diabetes and inflammation: fundamental aspects and clinical implications. Diabetes Metab 2010; 36:327-38. [PMID: 20851652 DOI: 10.1016/j.diabet.2010.07.001] [Citation(s) in RCA: 103] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/10/2010] [Revised: 07/21/2010] [Accepted: 07/22/2010] [Indexed: 02/06/2023]
Abstract
AIM The aim of this paper is to provide the fundamental background of the inflammation theory associated with type 2 diabetes, to discuss the clinical consequences of low-grade inflammation, particularly in terms of cardiovascular risk, and to infer some clinical therapeutic strategies deriving from drugs that already exist or are in development. METHODS This non-exhaustive work is the result of a Pubmed(®) research, based on requests including the following keywords: diabetes, inflammation, innate immunity, obesity, reticulum endoplasmic stress, cytokines, endothelial dysfunction. RESULTS Obesity and type 2 diabetes are linked with a low-grade inflammation state that reflects the activation of innate immunity where metabolic, environmental and genetic factors are implicated. The role of endoplasmic reticulum stress and unfold protein response is underlined. Inflammation markers are predictive for the risk to develop diabetes, and are associated with an increased cardiovascular risk. While lifestyle modifications are followed by an improvement in inflammation markers, treatments inferred from the inflammation theory are of great interest, although quite moderate effects on glycaemic control have been observed with some of them. CONCLUSION The development of molecules targeting different inflammatory mechanisms could lead in diabetic patients to improvement of both glycaemia and cardiovascular prognosis.
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Affiliation(s)
- C Garcia
- Service d'endocrinologie-diabétologie, hôpital d'instruction des armées Bégin, 69, avenue de Paris, 94160 St.-Mandé, France.
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16
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Baïzri H, Bordier L, Garcia C, Gaëtan G, De Kérangal X, Durand X, Dupuy O, Bauduceau B, Mayaudon H. [Thyroid metastasis of kidney cancer]. Rev Med Interne 2010; 32:e37-9. [PMID: 20591540 DOI: 10.1016/j.revmed.2010.04.016] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2010] [Revised: 03/30/2010] [Accepted: 04/11/2010] [Indexed: 11/18/2022]
Abstract
Thyroid metastasis of solid tumors is rare and often asymptomatic. Differential diagnosis with malignant thyroid tumor is difficult. We report a 65-year-old man who presented with a solitary intrathoracic thyroid nodule of the left lobe, inaccessible to fine needle biopsy. His past medical history was remarkable for a nephrectomy for a kidney clear cell carcinoma one year before. The PET-scan did not show any abnormal fixation. A left lobo-isthmectomy was performed. Histologic examination revealed an intrathyroid metastasis of kidney carcinoma.
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Affiliation(s)
- H Baïzri
- Service d'endocrinologie, hôpital d'Instruction des Armées Bégin, 69 avenue de Paris, Saint-Mandé, France.
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Dupuy O, Aubert P, Dumuis ML, Bordier L, Mayaudon H, Bauduceau B. [Hyperparathyroidism during pregnancy: dangerous association for the mother and her infant]. Rev Med Interne 2010; 31:e9-10. [PMID: 20554087 DOI: 10.1016/j.revmed.2010.04.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2009] [Revised: 03/11/2010] [Accepted: 04/11/2010] [Indexed: 11/25/2022]
Abstract
Hypercalcaemia during pregnancy is rare but requires a systematic approach for its diagnosis and its treatment. We report a 32-year-old pregnant female at 32 weeks of gestation who presented a severe hypercalcaemia, due to primary hyperparathyroidism. The delivery allowed the birth of a healthy child who had a serum calcium level in the normal range. Eight days later, the mother was operated from a parathyroid adenoma allowing normalisation of calcaemia. Hyperparathyroidism during pregnancy is rarely reported; it can lead to severe complications for both the mother and the infant. The newborn can present tetania due to hypocalcaemia and hypoparathyroidism can be definitive. Surgery should be discussed when serum calcium level of the mother is markedly elevated.
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Affiliation(s)
- O Dupuy
- Service d'endocrinologie et maladies métaboliques, HIA Bégin, Saint-Mandé, France.
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Doucet J, Le Floch JP, Bauduceau B, Hanaire H, Lorcy Y, Courrèges JP, Alexandre B, Sinclair A. Évaluation de la tolérance d’un traitement par insuline detemir ou NPH chez des patients diabétiques de type 2 de 70 ans et plus : « l’étude 3L ». Rev Med Interne 2010. [DOI: 10.1016/j.revmed.2010.03.216] [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: 10/19/2022]
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Le Berre JP, Bellanné-Chantelot C, Bordier L, Garcia C, Dupuy O, Mayaudon H, Bauduceau B. [Type 2 diabetes mellitus associated with pancreatic and renal malformations]. Rev Med Interne 2010; 31:e5-6. [PMID: 20206420 DOI: 10.1016/j.revmed.2009.04.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2009] [Revised: 03/31/2009] [Accepted: 04/07/2009] [Indexed: 10/19/2022]
Abstract
A 55-year-old woman presented with a recent diabetes mellitus associated with pancreatic and renal malformations. This atypical diabetes raised the possibility of maturity onset diabetes of the young (MODY) and a genetic research was performed. These malformations led to MODY5 diagnosis that was confirmed by the presence of HNF1beta gene mutation.
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Affiliation(s)
- J-P Le Berre
- Service d'endocrinologie, hôpital d'instruction des armées Bégin, 69, avenue de Paris, 94160 Saint-Mandé, France.
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Bourdel Marchasson I, Doucet J, Bauduceau B, Berrut G, Blickle JF, Brocker P, Constans T, Fagot Campagna A, Kaloustian E, Lassmann Vague V, Lecomte P, Simon D, Tessier D, Verny C, Vischer UM. Key priorities in managing glucose control in older people with diabetes. J Nutr Health Aging 2009; 13:685-91. [PMID: 19657551 DOI: 10.1007/s12603-009-0198-3] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Older people with diabetes represent a major and increasing proportion of our elderly population and their care requires better organisation. Targets for risk factor control and pathways of care must be adjusted to the subject's general health status. It is thus advisable to screen for frailty. We have carried out a detailed literature review of the studies published on diabetes in older people since 1990. Studies were considered if they included groups or subgroups of diabetic patients > 65 years old. This review discusses the elaboration of general targets for care, the approach to risk factor control, the screening and the specific prevention or management of complications, the integration of geriatric concepts in diabetes care and the specificity of education with respect to frailty status.
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Affiliation(s)
- I Bourdel Marchasson
- Pôle de gérontologie Clinique, Hôpital Xavier Arnozan, 33604 Pessac cédex, France.
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Laloi-Michelin M, Meas T, Ambonville C, Bellanné-Chantelot C, Beaufils S, Massin P, Vialettes B, Gin H, Timsit J, Bauduceau B, Bernard L, Bertin E, Blickle JF, Cahen-Varsaux J, Cailleba A, Casanova S, Cathebras P, Charpentier G, Chedin P, Crea T, Delemer B, Dubois-Laforgue D, Duchemin F, Ducluzeau PH, Bouhanick B, Dusselier L, Gabreau T, Grimaldi A, Guerci B, Jacquin V, Kaloustian E, Larger E, Lecleire-Collet A, Lorenzini F, Louis J, Mausset J, Murat A, Nadler-Fluteau S, Olivier F, Paquis-Flucklinger V, Paris-Bockel D, Raynaud I, Reznik Y, Riveline JP, Schneebeli S, Sonnet E, Sola-Gazagnes A, Thomas JL, Trabulsi B, Virally M, Guillausseau PJ. The clinical variability of maternally inherited diabetes and deafness is associated with the degree of heteroplasmy in blood leukocytes. J Clin Endocrinol Metab 2009; 94:3025-30. [PMID: 19470619 DOI: 10.1210/jc.2008-2680] [Citation(s) in RCA: 61] [Impact Index Per Article: 4.1] [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: 01/01/2023]
Abstract
CONTEXT Maternally inherited diabetes and deafness (MIDD) is a rare form of diabetes with a matrilineal transmission, sensorineural hearing loss, and macular pattern dystrophy due to an A to G transition at position 3243 of mitochondrial DNA (mtDNA) (m.3243A>G). The phenotypic heterogeneity of MIDD may be the consequence of different levels of mutated mtDNA among mitochondria in a given tissue. OBJECTIVE The aim of the present study was thus to ascertain the correlation between the severity of the phenotype in patients with MIDD and the level of heteroplasmy in the blood leukocytes. PARTICIPANTS The GEDIAM prospective multicenter register was initiated in 1995. Eighty-nine Europid patients from this register, with MIDD and the mtDNA 3243A>G mutation, were included. Patients with MELAS (mitochondrial encephalomyopathy, lactic acidosis, and stroke-like episodes) or with mitochondrial diabetes related to other mutations or to deletions of mtDNA were excluded. RESULTS A significant negative correlation was found between levels of heteroplasmy and age of the patients at the time of sampling for molecular analysis, age at the diagnosis of diabetes, and body mass index. After adjustment for age at sampling for molecular study and gender, the correlation between heteroplasmy levels and age at the diagnosis of diabetes was no more significant. The two other correlations remained significant. A significant positive correlation between levels of heteroplasmy and HbA(1c) was also found and remained significant after adjustment for age at molecular sampling and gender. CONCLUSIONS These results support the hypothesis that heteroplasmy levels are at least one of the determinants of the severity of the phenotype in MIDD.
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Affiliation(s)
- M Laloi-Michelin
- Department of Internal Medicine B, Hôpital Lariboisière, 2 Rue Ambroise Paré, Paris Cedex 10, France
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Cugnet-Anceau C, Bauduceau B. Glycaemic control and cardiovascular morbi-mortality: the contribution of the 2008 studies. Ann Endocrinol (Paris) 2009; 70:48-54. [PMID: 19193363 DOI: 10.1016/j.ando.2008.12.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/01/2008] [Accepted: 12/17/2008] [Indexed: 10/21/2022]
Abstract
The year 2008 was rich in teachings and suspense in diabetology. Past studies, i.e. United Kingdom Prospective Diabetes Study (UKPDS) in type 2 diabetic patients and Diabetes Control and Complications Trial (DCCT) in type 1 diabetic patients, have shown that in the short term, intensive treatment reduces the incidence of microvascular complications linked to diabetes and in the long term that of both microvascular and macrovascular ones. The in-the-raw conclusions of the recent Action to Control Cardiovascular risk in Diabetes (ACCORD) study note an increase in mortality in type 2 diabetic patients treated intensively, while the Action in Diabetes and Vascular disease, Perindopril and Indapamide Controlled Evaluation (ADVANCE) study evidences a reduction in microvascular complications and the Veterans Affairs Diabetes Trial (VADT) study shows that intensive treatment has no significant effect. A well thought-out analysis of the studies published in 2008 (ACCORD, STENO 2 post-trial, ADVANCE, VADT, UKPDS post-trial, Epidemiology of Diabetes Interventions and Complications [EDIC]) is particularly instructive and highlights the existence of glycaemic memory, the non-existence of blood pressure memory, the need to control all cardiovascular risk factors and to treat diabetes early while avoiding hypoglycaemic incidents. The glycaemic target based on HbA1c must take into account the patient's age and the duration of his diabetes, as well as his cardiovascular risk factors and previous glycaemic control. All in all, the intensive treatment of type 2 diabetes must begin early; it must not be too rapid and must avoid hypoglycaemic incidents and be combined with a strict control of other cardiovascular risk factors.
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Affiliation(s)
- C Cugnet-Anceau
- Fédération d'endocrinologie, diabète et nutrition, hôpital cardiovasculaire et pneumologique Louis-Pradel, 69677 Bron cedex, France.
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Massin P, Dubois-Laforgue D, Meas T, Laloi-Michelin M, Gin H, Bauduceau B, Bellanné-Chantelot C, Bertin E, Blickle JF, Bouhanick B, Cahen-Varsaux J, Casanova S, Charpentier G, Chedin P, Dupuy O, Grimaldi A, Guerci B, Kaloustian E, Lecleire-Collet A, Lorenzini F, Murat A, Narbonne H, Olivier F, Paquis-Flucklinger V, Virally M, Vincenot M, Vialettes B, Timsit J, Guillausseau PJ. Retinal and renal complications in patients with a mutation of mitochondrial DNA at position 3,243 (maternally inherited diabetes and deafness). A case-control study. Diabetologia 2008; 51:1664-70. [PMID: 18581092 DOI: 10.1007/s00125-008-1073-1] [Citation(s) in RCA: 27] [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] [Received: 02/28/2008] [Accepted: 05/19/2008] [Indexed: 11/25/2022]
Abstract
AIMS/HYPOTHESIS We assessed the prevalence and determinants of retinal and renal complications in patients with maternally inherited diabetes and deafness (MIDD). METHODS This was a multicentre prospective study comparing the prevalence of retinopathy and renal disease in 74 patients with MIDD and 134 control patients matched for sex, age and clinical presentation at onset of diabetes, duration of diabetes and current treatment. Comparisons were adjusted for HbA(1c) and hypertension. RESULTS In MIDD patients, HbA(1c) (7.6 +/- 1.6 vs 8.5 +/- 2.0%, p < 0.002), systolic blood pressure (126.6 +/- 16.2 vs 133.1 +/- 17.3 mmHg, p < 0.007) and prevalence of hypertension (33.8 vs 64.2%, p < 0.0001) were lower than in control patients. Prevalence of diabetic retinopathy was 3.7-fold lower in MIDD patients (6/74, 8 vs 40/134, 29.6%, p < 0.0001). Differences between groups remained significant after adjustment for hypertension, systolic blood pressure and HbA(1c). In MIDD, urinary albumin excretion (314.8 vs 80.1 mg/24 h, p = 0.035) and creatinine plasma levels (103.5 vs 82.2 micromol/l, p = 0.0178) were higher and GFR was lower. Impaired renal function (GFR <60 ml/min) was four- to sixfold more frequent in MIDD. Differences between MIDD and control diabetic patients further increased when adjusted for HbA(1c) and systolic blood pressure (p < 0.0001). Adjustment for treatment with an ACE inhibitor or angiotensin II receptor antagonist did not modify the results. CONCLUSIONS/INTERPRETATION This study indicates that diabetic retinopathy is less prevalent in MIDD than in control diabetes. This suggests that retinal alterations due to mitochondrial disease may have a protective role. By contrast, nephropathy is far more frequent in MIDD, suggesting the presence of a specific renal disease independent of diabetic nephropathy.
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Affiliation(s)
- P Massin
- APHP, Department of Ophthalmology, Lariboisiere Hospital, University Paris 7 Denis-Diderot, Paris, France
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Bordier L, Garcia C, Goasdoué P, Mayaudon H, Dupuy O, Guiraudet O, Bauduceau B. What is the role of computed tomographic coronary angiography in diabetic patients? Diabetes & Metabolism 2008; 34:26-32. [DOI: 10.1016/j.diabet.2007.08.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/18/2007] [Revised: 07/26/2007] [Accepted: 08/16/2007] [Indexed: 11/26/2022]
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Garcia C, Bordier L, Garcia-Hejl C, Ceppa F, Mayaudon H, Dupuy O, Bauduceau B. Prise en charge du syndrome de Nelson: données actuelles. Rev Med Interne 2007; 28:766-9. [PMID: 17574308 DOI: 10.1016/j.revmed.2007.05.018] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2007] [Accepted: 05/23/2007] [Indexed: 11/16/2022]
Abstract
PURPOSE Nelson's syndrome is a severe complication of bilateral adrenalectomy performed in the treatment of some Cushing's diseases, and its management remains difficult. Trough the observation of a patient suffering from a severe form of Nelson's syndrome for more than 10 years, the authors review the literature and discuss the main current therapeutic possibilities. CURRENT KNOWLEDGE AND KEY POINTS Many molecules have been used with variable results. In our observation cabergoline at 2 mg per week seems to be efficient after a 3 and a half years follow-up, in accordance with some recent publications. More than bromocriptine, this dopamine agonist provides interesting prospects for this disease's management. Moreover, if the conventional treatments as valproic acid or cyproheptadine are not very efficient, somatostatin analogs seem to be of some therapeutic interest. FUTURE PROSPECTS AND PROJECTS New molecules are currently evaluated, but studies are difficult to conduct because of the low disease prevalence. Tumour receptors analysis undoubtedly constitutes an attractive way to find new therapeutic targets.
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Affiliation(s)
- C Garcia
- Service d'endocrinologie, hôpital d'instruction des armées Bégin, 69, avenue de Paris, 94160 Saint-Mandé, France.
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Garcia C, Mayaudon H, Bordier L, Le Berre JP, Dupuy O, Bauduceau B. [Role of nocturnal blood pressure in the onset of diabetic nephropathy]. Arch Mal Coeur Vaiss 2007; 100:668-672. [PMID: 17928773] [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] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
UNLABELLED The aim of this study was to assess the responsibility of night-time blood pressure in the onset of nephropathy in diabetic patients. PATIENTS AND METHODS This study included 98 diabetic patients (mean age: 54 +/- 15 years, diabetes duration: 15 +/- 10 years). An evaluation of diabetes and a 24-h ambulatory blood pressure were performed at the initial evaluation (Y0) and about five years later (Y5). At Y0, all patients had normal urinary albumin excretion (UAE) (<30 mg/24h). They were separated into two groups according to urinary albumin excretion at Y5: group (N +): UAE>30 mg/24h and group (N-): UAE<30 mg/24h. Twenty four hours ambulatory blood pressure, clinical and biological parameters recorded at Y0 were compared in both. RESULTS At Y5, there was 18 patients in group (N +) and 78 in group (N-). Patients of group (N +) were older than those of group (N-): 62.9 +/- 9.5 vs. 52.6 +/- 15.7 years, p<0.01, and their BMI was higher (28 +/- 5 vs. 25 +/- 4 kg/m2, p<0.03). Diabetes duration and Hb A1c levels did not differ from significant manner in both. At Y0, UAE was significantly higher in group (N +) than in group (N-): 13 +/- 7 vs. 8 +/- 6 mg/24h, p<0.01. At the initial evaluation, daytime systolic and diastolic blood pressures did not differ from significant manner in both. Systolic and diastolic BP night-time were higher in diabetic patients who developed microalbuminuria (SBP: 122 +/- 19 vs. 113 +/- 13 mmHg, p<0.05 and DBP: 70 +/- 6 vs. 65 +/- 10 mmHg, p<0.03). UAE collected at Y5 was correlated to night-time BP recorded at Y0 (SBP: r=0.381, p=0.001 and PAD: r=0.294, p=0.004) and night-time systolic BP explained 12.3% of the UAE variance. Progression of UAE between the two evaluations was found to be correlated to the night-time systolic BP recorded at Y0 (r=0.335, p=0.0008) and night-time systolic BP explained 11.7% of the progression variance. There was a negative correlation between UAE at A5 and the difference between daytime and night-time BP recorded during the same evaluation (r=- 0.230, p=0.024 with SBP and r=- 0.243, p=0.017 with DBP). CONCLUSION The results underlign the resposability of night-time blood pressure, and more especially of nighttime systolic blood pressure, for the onset of nephropathy in diabetic patients.
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Affiliation(s)
- C Garcia
- Service d'Endocrinologie, hôpital d'instruction des armées - Bégin, Saint Mandé
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27
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Dupuy O, Petrossian T, Bordier L, Mayaudon H, Bauduceau B. [Hypertension and acromegaly in the elderly: French Registry Data]. Arch Mal Coeur Vaiss 2007; 100:660-663. [PMID: 17928771] [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] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
UNLABELLED Multi centre registries such as the French Acromegaly Registry created in 1999 provide data on rare disorders that are otherwise difficult to obtain. This study focuses on the characteristics of high blood pressure in people aged of over 70 years old. PATIENTS AND METHODS The data were obtained from the thirty centres where patients had been recorded on the Acromegaly Registry since 1999. RESULTS The Register listed a total of 644 patients with acromegaly at January 1st 2005, of whom 68 (22 men and 46 women) were aged over 70 years old (10.6%). Their mean age was 76.8 +/- 5 years (range 70 - 95) and they had been presenting acromegaly for 11 +/- 6 years (compared to 7 years in those aged less than 70). Their BMI were 27.9 +/- 4 kg/m2 for men, 27.7 +/- 4 for women (respectively 28.4 +/- 4.3 and 26.7 +/- 4.4 in those aged less than 70 years). Hypertension was particularly frequent in this population, reaching 80% vs. 27% under 70 years (p=0.0001). Prevalence was then higher than in general population (referring to FLAHS study). Mean blood pressure was 143 +/- 12 / 84 +/- 15 mmHg for men and 141 +/- 17 / 79 +/- 9 for women. 46% of men and 30% of women treated or not, had blood pressure over 140 / 90 mmHg. Data showed 12% of arrhythmic cardiopathy, 8% of cardiac insufficiency, 12% of ischemic cardiopathy and 12% of patients suffering from arteritis or stroke. Although various therapeutic strategies had been applied for young and elderly patients, 51% in each group were in remission one year after inclusion. DISCUSSION More than 10% of patients are aged over 70 years in the French Acromegaly Registry and hypertension is very frequently observed in this population. The increasing life expectancy due to currently available treatments justifies a strict management of patients in order to reduce cardiovascular risks, which stay the main cause of morbidity and mortality.
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Affiliation(s)
- O Dupuy
- Service d'Endocrinologie, HIA Bégin, Saint-Mandé
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Bordier L, Baigts F, Mayaudon H, Dupuy O, Le Berre JP, Garcia C, Bauduceau B. [Recommendations of the French National Health Authority for management of high blood pressure in clinical practice]. Arch Mal Coeur Vaiss 2007; 100:605-608. [PMID: 17928760] [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] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
UNLABELLED The new recommendations of the French national authority for health (or Haute Autorité de Santé: HAS) concerning management of high blood pressure (HBP) deserve to be compared with real clinical practices in a large population. MATERIAL AND METHODS [corrected] EPIMIL is a prospective epidemiological study designed to assess the prevalence of the metabolic syndrome and the risk factors in a 2045 French male military personnel coming from Paris area. The different recommendations of the HAS have been applied to these subjects, and the aim of this work is to compare these theoretical objectives to what is done in real practice. RESULTS Among these 2045 subjects aged of mean 38,6 +/- 8,8 years, 78 (4%) are known and treated for HPB. Although half of them present more than two associated risk factors, the means of systolic blood pressure and diastolic blood pressure stay at high levels. The blood pressure (BP) targets established at 140/90 mmHg are only reached by 33 patients (42%). Among the 1967 subjects considered to have normal BP, the BP considered as optimal (120/80 mmHg) is only found in 695 subjects (35.3%) and 428 (21.7%) do present ignored or neglected HBP, in spite of the presence of important associated risk factors. Then, the cardiovascular risk stratification into levels, as recommended by the HAS, shows that for these subjects considered to have normal BP, risk is finally low for 6%, moderate for 12%, and high for 3.5%. COMMENTS In a selected and in theory regularly followed population, the recommendations of the HAS are insufficiently applied, as well for detection or treatment of HBP. Then, information of both medical personnel and also the interested parties should be necessary, in order to see these recommendations applied in real practice.
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Affiliation(s)
- L Bordier
- Service d'endocrinologie, Hôpital Bégin, Saint Mandé.
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Garcia C, Mayaudon H, Bordier L, Le Berre JP, Dupuy O, Bauduceau B. [Modifications of 24-h blood pressure profile associated with reduction of the heart rate variability in type 1 diabetic patients]. Arch Mal Coeur Vaiss 2007; 100:699-703. [PMID: 17928780] [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] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
UNLABELLED The purpose of this study was to assess the blood pressure modifications in type 1 diabetic patients who present reduction of heart rate variability. PATIENTS AND METHODS This study included 70 type 1 diabetic patients (mean age: 42 +/- 13 years, diabetes duration: 13.2 +/- 9 years. They were free for complications and did not receive other treatment than insulin. Heart rate variability was evaluated using 24-h continuous ECG record spectral analysis. Patients were divided into two groups according to whether log high frequency power was lower (group 1, N=36) or higher (group 2, N=3 4) than 70 patients'mean. Clinical and biological features and 24-h ambulatory blood pressure measurement were compared in both groups. RESULTS Patients of group 1 were older than group 2 (47.8 +/- 11.2 vs. 35.7 +/- 12.2 years, p<0.0001) and diabetes duration was higher (16.9 +/- 8.4 vs. 9.4 +/- 8 years, p<0.001). BMI and Hb A1c did not differ from significant in both. Night-time blood pressure was upper in group 1 (SBP: 112 +/- 13 vs. 103 +/- 11 mmHg, p<0.01 and DBP: 66 +/- 8 vs. 60 +/- 7 mmHg, p<0.001). The difference between blood pressures during day and night (DeltaBP) were lower in group 1 than in group 2 (DeltaSBP: 10 +/- 9 vs. 15 +/- 7 mmHg, p<0.02 and DeltaDeltaBP: 9 +/- 7 vs. 12 +/- 5 mmHg, p<0.04). DSBP and DDBP were found to be correlated with log HF power (r=0.356, p<0.003), which could explain 11.8% and 12% of their variance. Urinary albumin excretion rate was higher in group 1 (8 +/- 4 vs. 5 +/- 3 mg/24h, p<0.01). CONCLUSION In type 1 diabetic patients free for complications, reduction in heart rate variability linked to age and diabetes duration is associated with a reduction in nighttime BP fall. These two parameters of autonomic neuropathy could have a pathogenic role in the development of incipient nephropathy.
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Affiliation(s)
- C Garcia
- Service d'Endocrinologie, HIA Bégin, Saint Mandé
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Bauduceau B, Vachey E, Mayaudon H, Burnat P, Dupuy O, Garcia C, Ceppa F, Bordier L. Should we have more definitions of metabolic syndrome or simply take waist measurement? Diabetes Metab 2007; 33:333-9. [PMID: 17611137 DOI: 10.1016/j.diabet.2007.04.001] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/16/2007] [Accepted: 04/03/2007] [Indexed: 11/22/2022]
Abstract
The disorder now known as metabolic syndrome has been recognized for 50 years, but its multiple definitions have led to some confusion and even doubt about its very nature. Metabolic syndrome is directly linked to the presence of android obesity, which indicates insulin resistance and lies at the root of all risk factors and early indications of type 2 diabetes. It is diagnosed by systematic measurements of waist size and its direct interpretation taking ethnic origin into account. This pragmatic approach avoids the uncertainties generated by differing definitions and is subtler than the presence or absence of metabolic syndrome in a given patient. Drug-free treatment of an android obese patient is inexpensive and effective, but this apparently simple approach masks difficulties of application. However, these are sociological problems.
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Affiliation(s)
- B Bauduceau
- Service d'Endocrinologie, Hôpital d'Instruction des Armées Bégin, 69, avenue de Paris, 94160, Saint-Mandé, France.
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Chanudet X, Bonnevie L, Bauduceau B. Coronary heart disease and cardiovascular autonomic neuropathy in the elderly diabetic. Diabetes & Metabolism 2007; 33 Suppl 1:S19-31. [PMID: 17702096 DOI: 10.1016/s1262-3636(07)80054-1] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Diabetes and old age come together to increase the frequency and severity of coronary heart disease. Often clinically nearly silent, symptoms frequently manifest dramatically, to such an extent that the question of screening should be raised, as in younger subjects. Preventing these manifestations relies on better management of the cardiovascular risk factors and obtaining good blood glucose control, but here progress remains necessary, which also requires adapting to the older patient's clinical and psychological condition. Cardiovascular autonomic neuropathy is a frequent degenerative complication in diabetics, particularly in the oldest subjects. The most severe types have serious clinical consequences, thus a higher mortality factor, but the mechanisms remain poorly understood. As for coronary heart disease, the therapeutic tools have expanded these last few years and should be thought out in relation to the geriatric evaluation, with the objective of improving these patients' quality of life. Therefore, a necessary distinction should be made between subjects who have aged successfully, whose management, ultimately, differs little from younger subjects, and frail elderly individuals for whom exploratory techniques and treatment should be adapted.
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Affiliation(s)
- X Chanudet
- Service de Cardiologie, Hôpital d'Instruction des Armées Bégin, 69 avenue de Paris, Saint Mandé, France
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Garcia C, Mayaudon H, Dupuy O, Le Berre JP, Bordier L, Bauduceau B. [Silent thyroiditis in a patient under lithium therapy]. Rev Med Interne 2006; 28:46-7. [PMID: 17166635 DOI: 10.1016/j.revmed.2006.09.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2006] [Revised: 07/30/2006] [Accepted: 09/08/2006] [Indexed: 10/24/2022]
Abstract
While hypothyroidism secondary to treatments by lithium are well known, cases of hyperthyroidism are less common. A 48 years old patient under lithium carbonate from about 10 years ago presents hyperthyroidism without any auto-immunity biological markers, associated with a very low thyroid tracer uptake on scintigraphy. Treatments by anti thyroid agents will be necessary during months in order to normalize the hormone level, whereas lithium is maintained. Only few tens of cases of hyperthyroidism related to lithium have been reported in the literature. This observation shows the importance of the thyroid hormonal follow up for patients under lithium, in order to treat them before the outbreak of a thyroid dysfunction. The causal toxic mechanism is still unclear, and may be related with a direct damage of lithium to follicular cells.
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Affiliation(s)
- C Garcia
- Service d'endocrinologie, hôpital d'instruction des Armées-Bégin, 69, avenue de Paris, 94160 Saint-Mandé, France
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Garcin JM, Cremades S, Garcia-Hejl C, Bordier L, Dupuy O, Mayaudon H, Bauduceau B. Is Hyperhomocysteinemia an Additional Risk Factor of the Metabolic Syndrome? Metab Syndr Relat Disord 2006; 4:185-95. [DOI: 10.1089/met.2006.4.185] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- J.-M. Garcin
- Internal Medicine Department, Hôpital d'Instruction des Armées Bégin, 94163 Saint Mandé Cedex, France
| | - S. Cremades
- Internal Medicine Department, Hôpital d'Instruction des Armées Bégin, 94163 Saint Mandé Cedex, France
| | - C. Garcia-Hejl
- Biochemistry Laboratory Department, Hôpital d'Instruction des Armées Bégin, 94163 Saint Mandé Cedex, France
| | - L. Bordier
- Endocrinology and Diabetology Department, Hôpital d'Instruction des Armées Bégin, 94163 Saint Mandé Cedex, France
| | - O. Dupuy
- Endocrinology and Diabetology Department, Hôpital d'Instruction des Armées Bégin, 94163 Saint Mandé Cedex, France
| | - H. Mayaudon
- Endocrinology and Diabetology Department, Hôpital d'Instruction des Armées Bégin, 94163 Saint Mandé Cedex, France
| | - B. Bauduceau
- Endocrinology and Diabetology Department, Hôpital d'Instruction des Armées Bégin, 94163 Saint Mandé Cedex, France
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Bordier L, Le Berre JP, Garcia C, Dupuy O, Mayaudon H, Bauduceau B. [Influence of blood pressure level on urinary albumin excretion rate and erythropoietin production in diabetic patients]. Arch Mal Coeur Vaiss 2006; 99:701-4. [PMID: 17061448] [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] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
UNLABELLED The purpose of this study was to investigate blood pressure variations during diabetic incipient nephropathy and to evaluate theirs consequences for erythropoietin (EPO) production. PATIENTS AND METHODS This study included 94 diabetic patients (mean age: 59.9 +/- 15.3 years, diabetes duration: 13.8 +/- 15.3 years). Patients were divided in two groups according to urinary albumin excretion rate (UAE): group 1: UAE <30 mg/24 hrs, N=64 and group 2: 30<UAE <300 mg/24 hrs; N=30 EPO levels and 24 hrs ABPM where compared between these two groups. RESULTS patients' age and BMI, diabetes duration and Hb A1c levels, blood pressure and creatinine clairance did not differ from significant manner between the two groups. 24 hrs BP and daytime BP did not differ according to UAE rate. Night-time BP was significantly higher in group 2 than in group 1 (SBP: 126 +/- 17 vs. 118 +/- 15 mmHg, p<0.04 and DBP: 71 +/- 10 vs. 67 +/- 8 mmHg, p < 0.02). UAE was positively correlated nigh-time BP (r = 0.263, p = 0.01 for SBP and r = 0.273, p = 0.008 for DBP) and negatively with the difference between daytime and night-time SBP (delta SBP) (r = -0.205, p < 0.05). Hemoglobin levels did not differ significantly between the two groups. EPO levels of group 2 were significantly lower than those of group 1 (15.1 +/- 5.6 vs. 17.7 +/- 6.2 mU/ml, p < 0.05). A negative correlation between UAE and EPO was found (r = -0.266, p < 0.01). UAE and delta SBP explained 12.2% of EPO variance. CONCLUSION in diabetic patients, elevation of night-time BP and reduction in nightime BP fall participate to the installation of incipient nephropathy. A significant decrease in EPO production is noted in the same time.
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Affiliation(s)
- L Bordier
- Service d'endocrinologie, hôpital d'instruction des Armées Bégin, Saint-Mandé
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35
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Dupuy O, Garrabé E, Bordier L, Boyer B, Goasguen O, Mayaudon H, Bauduceau B. [Pasteurella dagmatis spondylodiscitis in a diabetic patient]. Rev Med Interne 2006; 27:803-4. [PMID: 16978746 DOI: 10.1016/j.revmed.2006.05.018] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2006] [Accepted: 05/31/2006] [Indexed: 11/17/2022]
Abstract
INTRODUCTION Healthy pets contact are able to induce unusual and severe diseases. CLINICAL CASE This case reports the medical history of a dorsal spondylodiscitis in a diabetic patient admitted for a chronic wound of his toes. He had a long-standing history of regular consumption of alcohol and tobacco. Blood bottles and biopsy of intervertebral disc infected discovered Pasteurella dagmatis, commonly colonizing the oropharynx of healthy dogs and cats. In this case, licking of his injured toe by his dog was the likely source of entry of the organism. DISCUSSION We found no identical cases in the medical literature. Diabetes mellitus and other immunocompromised disorders justify to change behaviours toward domestic animals.
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Affiliation(s)
- O Dupuy
- Service d'endocrinologie, HIA Bégin, 69, avenue de Paris, 94160 Saint-Mandé, France.
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36
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Bauduceau B, Charpentier G, Eschwege E. Dépistage du diabète en médecine du travail chez les salariés volontaires des sites de Sanofi-Aventis en France. ARCH MAL PROF ENVIRO 2006. [DOI: 10.1016/s1775-8785(06)78218-2] [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: 10/22/2022]
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Guerci B, Tubiana-Rufi N, Bauduceau B, Bresson R, Cuperlier A, Delcroix C, Durain D, Fermon C, Le Floch JP, Le Devehat C, Melki V, Monnier L, Mosnier-Pudar H, Taboulet P, Hanaire-Broutin H. Advantages to using capillary blood beta-hydroxybutyrate determination for the detection and treatment of diabetic ketosis. Diabetes Metab 2006; 31:401-6. [PMID: 16369204 DOI: 10.1016/s1262-3636(07)70211-2] [Citation(s) in RCA: 48] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Ketone body determination is indicated in all diabetic patients when the risk of ketotic decompensation exists. New methods of screening for ketosis, in particular capillary blood ketone body determination, provide analytical, technical and clinical advantages compared to the conventional ketonuria. It is proposed that a diabetic patient with hyperglycaemia (capillary blood glucose > 2.50 g.l(-1)) and capillary blood ketone bodies exceeding 0.5 mmol.l(-1) requires therapeutic management. For values greater than 3 mmol.l(-1) or in case of more serious clinical symptoms, hospitalisation is indicated, considering the high probability of ketoacidotic decompensation. The advantages of capillary blood ketone body determination including easy use, and rapid and objective results may improve management of the diabetic patient, especially in emergency situations. However, prescription by a physician of capillary blood ketone body determination should be offered to targeted populations that have a high risk of ketoacidotic decompensation, after providing education to patients that is above all aimed at preventing this metabolic complication. In this context of determining ketone bodies in capillary blood, the term "capillary blood ketone bodies" is therefore preferable to the term "capillary blood beta-hydroxybutyrate determination". Indeed, it appears more appropriate, simple, descriptive and significant both for health-care staff and for patients.
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Affiliation(s)
- B Guerci
- Service de Diabétologie, Maladies Métaboliques et Nutrition, Hôpital Jeanne d'Arc, Route Nationale 4, 54201 Dommartin lès Toul.
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Abstract
All available estimations agree that the French population is aging and that the proportion of diabetics in the elderly population is increasing. The prevalence of diabetes could be about 10% in the over 65 y population. The fact that diabetes has an effect on brain function is widely accepted, but there are very few studies providing pertinent details. Diabetes is known to affect brain function, potential consequences including cognitive decline, dementia, depression, and stroke. These complications are frequently associated, leading to poor quality-of-life with considerable social and economic impact. While the results of different studies can be contradictory, there is an overall trend towards the conclusion that diabetes, often associated with high blood pressure, contributes to cognitive decline in elderly diabetics as well as to an increased frequency and severity of cerebral vascular events. These considerations point out the importance of proper management of diabetes in the elderly population and the need for cooperative studies to determine the role of diabetes and different cardiovascular risk factors in the development of dementia, stroke, and depressive syndromes whose consequences are probably underestimated.
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Affiliation(s)
- B Bauduceau
- Service d'Endocrinologie, Hôpital d'Instruction des Armées Bégin, Saint-Mandé, France.
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39
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Bauduceau B, Baigts F, Bordier L, Burnat P, Ceppa F, Dumenil V, Dupuy O, Le Berre JP, Mayaudon H, Paillasson S. Epidemiology of the metabolic syndrome in 2045 French military personnel (EPIMIL study). Diabetes & Metabolism 2005; 31:353-9. [PMID: 16369197 DOI: 10.1016/s1262-3636(07)70204-5] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
CONTEXT The Metabolic syndrome is considered to be an important public health problem, but few epidemiological studies have defined the present situation in France. EPIMIL is a prospective epidemiological study that began on February 1, 2003. SUBJECTS AND METHODS This study was designed to identify the clinical and laboratory parameters of metabolic syndrome and cardiovascular risk factors in a population of 2045 male military personnel based in the Paris region. The initial 1-year cross-sectional study will be followed by a 10-year follow-up and patient care. RESULTS The 2045 subjects included 185 (9%) presented at least 3 of the 5 NCEP ATP III criteria defining metabolic syndrome. They were significantly older (42.2 +/- 8.5 yrs) than the other subjects (37.3 +/- 8.7 yrs, P<0.001), had a higher BMI (29.5 +/- 3.4 vs 24.8 +/- 2.9 kg/m2, P<0.001) and a greater body weight at age 20 (75.4 +/- 11 vs 70.4 +/- 8.5 kg, P<0.01). Smoking, little physical activity and family histories of diabetes and arterial hypertension were more frequent in these men. While levels of the cholesterol and CRP us were higher, Lp(a) and homocysteine concentrations were normal. Plasma insulin and BMI (r = 0.456 P<0.0001) and plasma insulin and waist circumference (r = 0.446 P<0.0001) were well correlated. Lastly, plasma insulin, free fatty acids and cardiovascular risk increased steadily with the increase in the number of metabolic syndrome criteria. CONCLUSIONS These results in a large and particularly uniform population of men show the prevalence of metabolic syndrome in adult men, and demonstrate its link with insulin resistance. Men with several risk factors require specific care, particularly for hypertension and dyslipidemia; the effectiveness of this care will be evaluated during the follow-up period.
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Affiliation(s)
- B Bauduceau
- Service d'Endocrinologie, hôpital d'Instruction des Armées Bégin, 69, avenue de Paris, 94160 Saint-Mandé, France.
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Garcin JM, Mayaudon H, Bauduceau B, Abouzahir A, Burnat P, Gardet V, Bordier L, Dupuy O, Baigts F. L'hyperhomocystéinémie est-elle un facteur de risque supplémentaire du syndrome métabolique ? Rev Med Interne 2005; 26:695-702. [PMID: 16026903 DOI: 10.1016/j.revmed.2005.06.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2005] [Accepted: 06/13/2005] [Indexed: 01/13/2023]
Abstract
INTRODUCTION Metabolic syndrome is a cardiovascular risk factors cluster and hyperhomocysteinemia an obvious independant risk factor. OBJECTIVE To ascertain if hyperhomocysteinemia is associated with the metabolic syndrome. METHODS "Epimil" is a prospective epidemiologic survey, which began by a cross-sectionnal study of cardiovascular risk factors in a French population, which then will be followed for ten years for supervision and intervention. Initial data collection, blood pressure measurement, ECG and blood samples (biology and DNA) have been performed. For the metabolic syndrome, we used the criterias of the third report of the national cholesterol education program expert panel on detection, evaluation, and treatment of high blood cholesterol in adults (NCEP ATP III). RESULTS Out of 2045 men aged from 20 to 58 years (37.7+/-8.7 years), 185 (9%) have metabolic syndrome (at least three criterias), 587 (29%) a blood homocysteine>or=12 micromol/L and 202 (10%)>or=15 micromol/L. Homocysteinemia is 10.97+/-5.01 micromol/L for the whole population and doesn't differ with (11.4+/-6 micromol/L) or without (10.9+/-5 micromol/L) the metabolic syndrome, as does its values distribution. It's not correlate with the body mass index, waist and hip measurements, nor with glycemia, HbA1c, insulin resistance and cardiovascular risk markers (CRPus, microalbuminuria). It weakly correlates with systolic and diastolic blood pressure, creatinine clearance, tobacco use, cholesterolemia, triglycerides and free fatty acids but not with HDL and LDL fractions, nor lipoprotein (a). Among this population, it slightly contributes to the ten years vascular risk evaluated according to Framingham equations or Score system. CONCLUSIONS Homocysteinemia and the prevalence of hyperhomocysteinemia don't differ with or without the metabolic syndrome and doesn't correlate its main criterias.
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Affiliation(s)
- J-M Garcin
- Service de médecine interne, hôpital d'instruction des armées Bégin, 94163 Saint-Mandé cedex, France.
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Margery J, Hauret L, Mennecier D, Dupuy O, Poyet R, Mayaudon H, Bordier L, Bauduceau B. Tumeur intracanalaire papillaire mucineuse du pancréas révélée par une pancréatite aiguë et un diabète. Presse Med 2005; 34:1009-10. [PMID: 16225255 DOI: 10.1016/s0755-4982(05)84102-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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: 10/22/2022] Open
Abstract
INTRODUCTION Imaging of the pancreas soon after diagnosis of diabetes can help screen for tumors. CASE A 45 year-old man with recently diagnosed insulin-dependent diabetes and no other notable history was found to have intraductal papillary mucinous tumour of the pancreas (IPMTP), a month after an unexplained and benign acute pancreatitis. DISCUSSION The histology of IPMTP differs from that of the adenocarcinomas usually described in these circumstances, and they are far rarer. Because they carry the risk of malignant degeneration, early diagnosis is important. Surgery is the only curative treatment and should therefore be discussed.
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Affiliation(s)
- J Margery
- Service d'endocrinologie, Hôpital d'Instruction des Armées Bégin, Saint-Mandé.
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Bauduceau B, Dupuy O, Mayaudon H, Bordier L, Margery J, Le Berre JP. [Atherosclerosis: butter on the arteries?]. Rev Infirm 2005:16-20. [PMID: 15853074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
Affiliation(s)
- B Bauduceau
- Service d'endocrinologie, hôpital d'instruction des Armées Bégin, 69, avenue de Paris, 94160 Saint-Mandé, France
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Manic H, Marechaud R, Leroux S, Petit Paris I, Mauco G, Boissonnot M, Bauduceau B, Guerci B, Hadjadj S, Marre M. 263 Variants génétiques du transporteur de glucose GLUT 1 et sévérité de la rétinopathie chez le sujet diabétique de type 2. J Fr Ophtalmol 2005. [DOI: 10.1016/s0181-5512(05)74661-1] [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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Le Berre JP, Rousseau C, Dupuy O, Bordier L, Mayaudon H, Bauduceau B. [Unusual evolution of autoimmune hypothyroidism: occurrence of Grave's disease]. Rev Med Interne 2005; 25:841-3. [PMID: 15501358 DOI: 10.1016/j.revmed.2004.07.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2004] [Accepted: 07/12/2004] [Indexed: 11/27/2022]
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Damiano J, Bordier L, Le Berre JP, Margery J, Dupuy O, Mayaudon H, Bauduceau B. Should pancreas imaging be recommanded in patients over 50 years when diabetes is discovered because of acute symptoms? Diabetes Metab 2004; 30:203-7. [PMID: 15223996 DOI: 10.1016/s1262-3636(07)70111-8] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
The relationship between diabetes mellitus and cancer of the pancreas is complex and incompletely understood. Nevertheless, it is generally agreed that new-onset diabetes in a patient over 50 Years old is a classical indication of pancreatic cancer. But there is no official directive in France that a scan should routinely be performed in such cases. We have studied 115 patients aged over 50 who were hospitalized for new-onset diabetes (fewer than 30 days) whose instability required insulin treatment. Routine imaging revealed abdominal disorders in 14 patients, 6 (5.2%) of whom were suffering from pancreatic adenocarcinomas. No clinical indication or laboratory test, apart from an unusually severe anorexia, suggested the discovered disorders. We therefore routinely carry out a pancreas scan, preferably by MRI, on all patients over 50 Years old presenting with new-onset diabetes, even if there are not clinical or laboratory indications of cancer. This is the only way in which small pancreatic cancers can be detected, thus providing the best hopes for successful treatment. Unfortunately, too often, this approach also detects only tumors that are already well developed. However, nowadays, it is not conceivable for a clinical team to discharge a patient from hospital with such a serious disease undiagnosed.
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Affiliation(s)
- J Damiano
- Service d'Endocrinologie, Hôpital d'Instruction des Armées Bégin, 94160 Saint-Mandé, France
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Mayaudon H, Rousseau C, Le Berre JP, Margery J, Bordier L, Dupuy O, Bauduceau B. [Evolution of circadian blood pressure and urinary albumin excretion according to the type of diabetes over a 10-year period]. Arch Mal Coeur Vaiss 2004; 97:799-802. [PMID: 15506069] [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] [Subscribe] [Scholar Register] [Indexed: 05/01/2023]
Abstract
UNLABELLED The aim of the present study was to evaluate the circadian blood pressure and rinary albumin excretion (UAE) according to the type of diabetes over a 10-year period. PATIENTS AND METHODS This study is based on 43 diabetic patients, 24 type 1 and 19 type 2. Ambulatory blood pressure monitoring was used to assess blood pressure at the initial evaluation (A0) and about 10 years later (A10). UAE was also checked at 10 years interval and was <30 mg/day at A0. RESULTS At A0, ABPM and UAE did not differ in a significant manner between type 1 and type 2 diabetics. Type 2 diabetic patients were older than type 1 (59.7 +/- 15.4 vs 42.9 +/- 12.9; p<0.0001) but the age of diabetes did not differ between the 2 groups. Between A0 and A10, there was an increase in 24 h SBP of type 1 and type 2 diabetics (type 1: 114 +/- 10 vs 124 +/- 12 mmHg; p<0.01 and type 2: 113 +/- 19 vs 135 +/- 13 mmHg; p<0.0001). 24 h DBP, as well as BP differences (day-night) did not differ between the 2 evaluations. At A10, 24 h SBP was higher in type 2 than in type 1 (135 +/- 13 vs 124 +/- 12 mmHg; p<0.001) but differences between day and night BP were not significant. In type 1 diabetes, progression of SBP was not associated with an increase in UAE rate, while this rate increased in type 2 betwwen A0 and A10 (9 +/- 7 vs 70 +/- 101 mg/24 h; p<0.01). AT A10, UAE was higher in type 2 than in type 1 diabetes (70 +/- 101 vs 14 +/- 31 mg/24 h; p<0.02). In type 2 diabetes, the progression of UAE was correlated with SBP at A10 (r=0.495; p<0.03). CONCLUSION The increase in BP levels and in UAE rate differ between type 1 and type 2 diabetes and these differnces are not due to patients age, nor to modifications in BP curves. They are probably linked to a physiopathology which could be more complex in type 2 than in type 1 diabetes.
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Affiliation(s)
- H Mayaudon
- Service d'endocrinologie, hôpital Bégin, Saint-Mandé
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Guillausseau PJ, Dubois-Laforgue D, Massin P, Laloi-Michelin M, Bellanné-Chantelot C, Gin H, Bertin E, Blickle JF, Bauduceau B, Bouhanick B, Cahen-Varsaux J, Casanova S, Charpentier G, Chedin P, Derrien C, Grimaldi A, Guerci B, Kaloustian E, Lorenzini F, Murat A, Olivier F, Paques M, Paquis-Flucklinger V, Tielmans A, Vincenot M, Vialettes B, Timsit J. Heterogeneity of diabetes phenotype in patients with 3243 bp mutation of mitochondrial DNA (Maternally Inherited Diabetes and Deafness or MIDD). Diabetes & Metabolism 2004; 30:181-6. [PMID: 15223991 DOI: 10.1016/s1262-3636(07)70105-2] [Citation(s) in RCA: 53] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE In patients with maternally inherited diabetes and deafness (MIDD), due to 3 243 A > G mutation of mitochondrial DNA (mtDNA), diabetes may present with variable phenotypes. OBJECTIVE To ascertain the existence of two distinct phenotypes, MIDD1 and MIDD2, in a series of patients with MIDD. DESIGN Multicenter prospective study. PATIENTS 77 patients with diabetes and the mtDNA 3243 mutation and 139 control patients with type 1 (T1D) or type 2 (T2D) diabetes, matched according to initial presentation of diabetes, age at onset, sex, and duration of diabetes (24 T1D and 115 T2D, including 55 treated with insulin). MEASUREMENTS Anthropometric characteristics (height, body weight, body mass index [BMI], sex), family history of diabetes, and characteristics of diabetes (age at onset, treatment, hemoglobin A1c [HbA1c]), extrapancreatic manifestations. RESULTS In 13 cases (17%, MIDD1), diabetes presented as insulin-dependent from the onset, with ketoacidosis in 6 cases. In 64 cases (83%, MIDD2), diabetes resembled T2D, and was treated with diet in 12 cases, oral hypoglycemic agents in 21 cases, or insulin in 31 cases. Compared with patients with MIDD2, patients with MIDD1 were characterized by lower age at onset of first manifestation of MIDD (25.4 +/- 9.6 vs 33.7 +/- 13.2 Years, P<0.0005), lower body weight (49.1 +/- 7.4 vs 56.3 +/- 10.9 kg, P<0.0025), lower BMI (18.2 +/- 2.3 vs 20.9 +/- 3.6 kg/m2, P<0.0005), and higher HbA1c levels (9.5 +/- 2.0 vs 7.5 +/- 1.6%, P<0.0005). Frequency of family history of diabetes and of extrapancreatic manifestations was the same in both MIDD subtypes. No difference was found within the MIDD2 subtype when comparing patients treated with or without insulin. Compared with matched controls, patients with MIDD had a lower BMI (MIDD1/T1D 18.2 +/- 2.3 vs 24.0 +/- 3.6 kg/m2 and MIDD2/T2D 20.9 +/- 3.6 vs 30.2 +/- 5.9 kg/m2, P<0.0025). Lastly, male patients with MIDD had a shorter height than controls (MIDD1/T1D: 166.1 +/- 3.2 vs 177.3 +/- 6.6 cm and MIDD2/T2D: 168.4 +/- 7.2 vs 173.6 +/- 6.6 cm P<0.025). CONCLUSIONS These results confirm the existence of two different phenotypes in MIDD, MIDD1 and MIDD2, which may be related to the severity of the mitochondrial disease. The role of other genetic and/or environmental factors in the variable phenotype of MIDD remains to be elucidated.
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Affiliation(s)
- P J Guillausseau
- Service de Médicine B, Hôpital Lariboisière, 2 rue Ambroise Paré, 75010 Paris, Université Paris 7-Denis Diderot, France.
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Desideri-Vaillant V, Bordier L, Gidenne S, Dupuy O, Ceppa F, Mayaudon H, Bauduceau B, Burnat P. [Value of non-esterified fatty acids quantification in diabetes]. Ann Biol Clin (Paris) 2004; 62:177-82. [PMID: 15047469] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/29/2023]
Abstract
Non-esterified fatty acids (NEFA) play a complex role in glucidic homeostasis. This role led us to investigate their quantification in diabetic patients. The plasmatic NEFA concentrations, measured with the FA115 kit of Randox, showed significant differences between control patients (0.42 +/- 0.14 mmol/L, N = 50) and diabetic patients (0.68 +/- 0.35 mmol/L, p < 0.01, 443 diabetic patients (70 with type l and 373 with type 2 diabetes)). NEFA concentrations were significantly higher in type 2 diabetics (0.70 +/- 0.32 mmol/L) when compared to type 1 diabetics (0.59 +/- 0.35 mmol/L, p < 0.05). In type 2 diabetics, a significant correlation was observed between NEFA and glucose concentrations at 8 hrs a.m., and the mean glucose concentrations along the day (p < 0.001). In contrast NEFA concentrations were less correlated to levels of HbA1c. NEFA were well correlated with cholesterol and triglycerides (p < 0.05) but not with Lp(a). They were also correlated with BMI but not with age or duration of the disease. Diabetic patients on metformin associated to lipolytic treatment, presented lower concentrations of NEFA and better glucidic control. The results confirm the role of NEFA in glucidic homeostasis and suggest an interest for their routine determination.
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Affiliation(s)
- V Desideri-Vaillant
- Service de biochimie, toxicologie et pharmacologie cliniques, HIA Begin, 69, avenue de Paris, 94163 Saint Mandé Armées
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Abstract
Amoebiasis is the second most common parasitic disease worldwIde. It occurs mainly in developing countries. A high percentage of people in countries where it is endemic are asymptomatic carriers. It results in severe disease that can be fatal in rare cases. Diabetics are at increased risk of exposure as travel to countries where it is endemic becomes more frequent, as indicated by the present case. This patient suffered from amoebiasis that produced an amoeboma which is most rare in cases of colonic amoebiasis. The clinical picture was that of an occluding gut tumor, but it was treated only with drugs. Retrospective studies show that diabetics are at increased risk of suffering severe complications after amoebic infection. The frequency and severity of this diabetes-amoeba association requires patients to take prophylactic measures, especially when travelling in developing countries.
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Affiliation(s)
- C Bredin
- Service de pathologie digestive, Hôpital d'Instruction des Armées Bégin, 94160 Saint Mandé, France
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50
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Bredin C, Margery J, Bordier L, Mayaudon H, Dupuis O, Vergeau B, Bauduceau B. [Diabetes and amoebiasis: a high-risk combination]. Med Trop (Mars) 2004; 64:195-8. [PMID: 15460154] [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] [Subscribe] [Scholar Register] [Indexed: 04/30/2023]
Abstract
Amoebiasis is the second most common parasitic disease in the world. It occurs mainly in developing countries. Many people in endemic countries are asymptomatic carriers. It results in severe disease that can be fatal in rare cases. The case described in this report illustrates the growing risk of exposure to amoebiasis for diabetic patients as travel to endemic countries becomes more and more frequent. In the patient described here amoebiasis led to amoeboma, a rare complication of the colonic presentation. Despite a clinical disease syndrome mimicking that of an occluding gut tumor, the patient was treated medically with drugs alone. Retrospective studies show that diabetics are at higher risk for severe complications after amoebic infection. Because of the high incidence and severity of concurrent diabetes and amoeba, prophylactic measures are necessary for diabetic patients traveling in developing countries.
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Affiliation(s)
- C Bredin
- Service de pathologie digestive, Hôpital d'Instruction des Armées Bégin, Saint Mandé, France
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