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Cariou B, Wargny M, Boureau AS, Smati S, Tramunt B, Desailloud R, Lebeault M, Amadou C, Ancelle D, Balkau B, Bordier L, Borot S, Bourgeon M, Bourron O, Cosson E, Eisinger M, Gonfroy-Leymarie C, Julla JB, Marchand L, Meyer L, Seret-Bégué D, Simon D, Sultan A, Thivolet C, Vambergue A, Vatier C, Winiszewski P, Saulnier PJ, Bauduceau B, Gourdy P, Hadjadj S. Impact of diabetes on COVID-19 prognosis beyond comorbidity burden: the CORONADO initiative. Diabetologia 2022; 65:1436-1449. [PMID: 35701673 PMCID: PMC9197674 DOI: 10.1007/s00125-022-05734-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Accepted: 04/06/2022] [Indexed: 12/11/2022]
Abstract
AIMS/HYPOTHESIS Diabetes has been recognised as a pejorative prognostic factor in coronavirus disease 2019 (COVID-19). Since diabetes is typically a disease of advanced age, it remains unclear whether diabetes remains a COVID-19 risk factor beyond advanced age and associated comorbidities. We designed a cohort study that considered age and comorbidities to address this question. METHODS The Coronavirus SARS-CoV-2 and Diabetes Outcomes (CORONADO) initiative is a French, multicentric, cohort study of individuals with (exposed) and without diabetes (non-exposed) admitted to hospital with COVID-19, with a 1:1 matching on sex, age (±5 years), centre and admission date (10 March 2020 to 10 April 2020). Comorbidity burden was assessed by calculating the updated Charlson comorbidity index (uCCi). A predefined composite primary endpoint combining death and/or invasive mechanical ventilation (IMV), as well as these two components separately, was assessed within 7 and 28 days following hospital admission. We performed multivariable analyses to compare clinical outcomes between patients with and without diabetes. RESULTS A total of 2210 pairs of participants (diabetes/no-diabetes) were matched on age (mean±SD 69.4±13.2/69.5±13.2 years) and sex (36.3% women). The uCCi was higher in individuals with diabetes. In unadjusted analysis, the primary composite endpoint occurred more frequently in the diabetes group by day 7 (29.0% vs 21.6% in the no-diabetes group; HR 1.43 [95% CI 1.19, 1.72], p<0.001). After multiple adjustments for age, BMI, uCCi, clinical (time between onset of COVID-19 symptoms and dyspnoea) and biological variables (eGFR, aspartate aminotransferase, white cell count, platelet count, C-reactive protein) on admission to hospital, diabetes remained associated with a higher risk of primary composite endpoint within 7 days (adjusted HR 1.42 [95% CI 1.17, 1.72], p<0.001) and 28 days (adjusted HR 1.30 [95% CI 1.09, 1.55], p=0.003), compared with individuals without diabetes. Using the same adjustment model, diabetes was associated with the risk of IMV, but not with risk of death, within 28 days of admission to hospital. CONCLUSIONS/INTERPRETATION Our results demonstrate that diabetes status was associated with a deleterious COVID-19 prognosis irrespective of age and comorbidity status. TRIAL REGISTRATION ClinicalTrials.gov NCT04324736.
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Grants
- the Fondation Francophone de Recherche sur le Diabète (FFRD), supported by Novo Nordisk, Merck Sharpe Dome (MSD), Abbott, AstraZeneca, Lilly and FFD (Fédération Française des Diabétiques) – CORONADO initiative emergency grant
- The CORONADO control leg of the study was supported by a grant from the French Ministry of Health
- Société Francophone du Diabète (SFD) – CORONADO initiative emergency grant
- Fonds de dotation du CHU de Nantes (CORONADO project: Sanofi, Air Liquid Healthcare, Novo Nordisk, NHC, Allergan, Lifescan)
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Affiliation(s)
- Bertrand Cariou
- CHU Nantes, CNRS, Inserm, l'institut du thorax, Nantes Université, Nantes, France.
| | - Matthieu Wargny
- CHU Nantes, CNRS, Inserm, l'institut du thorax, Nantes Université, Nantes, France
- CHU Nantes, Inserm CIC 1413, Pôle Hospitalo-Universitaire 11 : Santé Publique, Clinique des données, Nantes, France
| | - Anne-Sophie Boureau
- CHU Nantes, CNRS, Inserm, l'institut du thorax, Nantes Université, Nantes, France
- CHU Nantes, Pôle de Gérontologie Clinique, Nantes, France
| | - Sarra Smati
- CHU Nantes, CNRS, Inserm, l'institut du thorax, Nantes Université, Nantes, France
| | - Blandine Tramunt
- Service de Diabétologie, Maladies Métaboliques & Nutrition, CHU Toulouse, Institut des Maladies Métaboliques & Cardiovasculaires, UMR1297 Inserm/UT3, Université de Toulouse, Toulouse, France
| | - Rachel Desailloud
- Department of Endocrinology, Diabetes Mellitus and Nutrition, Amiens University Hospital, Amiens, France; PériTox UMR_I 01, University of Picardie Jules Verne, Amiens, France
| | - Maylis Lebeault
- Département de Diabétologie, Centre Hospitalier Universitaire, Angers, France
| | - Coralie Amadou
- Département de Diabétologie, Centre Hospitalier Sud Francilien, Corbeil Essonne, France
- Université Paris-Saclay, Le Kremlin-Bicêtre, Paris, France
| | - Deborah Ancelle
- Service endocrinologie-diabétologie-nutrition, CH Le Havre, Montivilliers, France
| | - Beverley Balkau
- Épidémiologie Clinique, Centre de Recherche en Épidémiologie et Santé des Populations, Inserm U1018, Université Paris-Saclay, USVQ, Université Paris-Sud, Villejuif, France
| | - Lyse Bordier
- Service d'endocrinologie et maladies métaboliques, H.I.A Bégin, Saint-Mandé, France
| | - Sophie Borot
- Department of Endocrinology, Diabetology and Nutrition, Besançon University Hospital, Besançon, France
| | - Muriel Bourgeon
- Department of Endocrinology, Diabetology and Nutrition, Assistance Publique Hôpitaux de Paris, Paris-Saclay University, Antoine Béclère Hospital, Clamart, Bicêtre Hospital, Le Kremlin-Bicêtre, France
| | - Olivier Bourron
- Assistance Publique Hôpitaux de Paris, Département de Diabétologie, CHU La Pitié-Salpêtrière - Charles-Foix; Inserm, UMR_S 1138, Centre de Recherche des Cordeliers, Paris 06; Institute of Cardiometabolism and Nutrition ICAN, Sorbonne Université, Paris, France
| | - Emmanuel Cosson
- Assistance Publique Hôpitaux de Paris, Avicenne Hospital, Paris 13 University, Sorbonne Paris Cité, Department of Endocrinology, Diabetology and Nutrition, CRNH-IdF, CINFO, Bobigny, France
- Paris 13 University, Sorbonne Paris Cité, UMR U557 Inserm / U11125 INRAE / CNAM / Paris13 University, Nutritional Epidemiological Research Unit, Bobigny, France
| | - Martin Eisinger
- Hôpital de la Conception, Service d'Endocrinologie, Maladies Métaboliques et Nutrition, Marseille, France
- Inserm, INRAE, C2VN, Aix Marseille Univ, Marseille, France
| | | | - Jean-Baptiste Julla
- Département Diabète et Endocrinologie, Hôpital Lariboisière, Assistance Publique Hôpitaux de Paris, Paris, France
- Inserm UMRS 1138, Université Paris Diderot-Paris VII, Sorbonne Paris Cité, Paris, France
| | | | - Laurent Meyer
- Département d'Endocrinologie, Diabétologie et Nutrition, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - Dominique Seret-Bégué
- Unité de Diabétologie, Endocrinologie et Nutrition, Centre Hospitalier de Gonesse, Gonesse, France
| | | | - Ariane Sultan
- Department of Endocrinology-Diabetology-Nutrition, CHU Montpellier, University of Montpellier, Montpellier, France
- PhyMedExp, CHU Montpellier, Inserm, CNRS, University of Montpellier, Montpellier, France
| | - Charles Thivolet
- Centre du Diabète DIAB-eCARE, Hospices Civils de Lyon et Laboratoire CarMeN, Inserm, INRA, INSA, Université Claude Bernard Lyon 1, Lyon, France
- Société Francophone du Diabète (SFD), Paris, France
| | - Anne Vambergue
- Department of Diabetology, Endocrinology, Metabolism and Nutrition Lille University Hospital, Lille, France
- European Genomic Institute of Diabetes, University School of Medicine, Lille, France
| | - Camille Vatier
- Assistance Publique Hôpitaux de Paris, Saint-Antoine Hospital, Reference Center of Rare Diseases of Insulin Secretion and Insulin Sensitivity (PRISIS), Department of Endocrinology, Paris, France
- Inserm UMRS 938, Saint-Antoine Research Center, Sorbonne University, Paris, France
| | - Patrice Winiszewski
- Service d'Endocrinologie, Diabétologie et Nutrition, Hôpital Nord Franche-Comté, Trévenans, France
| | - Pierre-Jean Saulnier
- Clinical Investigation Centre CIC1402, University of Poitiers, Inserm, CHU Poitiers, Poitiers, France
| | - Bernard Bauduceau
- Service d'endocrinologie et maladies métaboliques, H.I.A Bégin, Saint-Mandé, France
- Fondation Francophone pour la Recherche sur le Diabète (FFRD), Paris, France
| | - Pierre Gourdy
- Service de Diabétologie, Maladies Métaboliques & Nutrition, CHU Toulouse, Institut des Maladies Métaboliques & Cardiovasculaires, UMR1297 Inserm/UT3, Université de Toulouse, Toulouse, France
| | - Samy Hadjadj
- CHU Nantes, CNRS, Inserm, l'institut du thorax, Nantes Université, Nantes, France
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Maione L, Sarfati J, Gonfroy-Leymarie C, Salenave S, Brailly-Tabard S, Chanson P, Trabado S, Kaiser UB, Young J. Reproductive Phenotypes in Men With Acquired or Congenital Hypogonadotropic Hypogonadism: A Comparative Study. J Clin Endocrinol Metab 2022; 107:e2812-e2824. [PMID: 35358314 DOI: 10.1210/clinem/dgac194] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Indexed: 11/19/2022]
Abstract
CONTEXT In men with congenital hypogonadotropic hypogonadism (CHH), gonadotropin deficiency and testicular impairment exist since fetal development and persist throughout life. In a few reported cases of acquired HH (AHH), HH onset occurs mainly post pubertally. OBJECTIVE This work aimed to compare the natural history and reproductive status in large series of CHH and lesional AHH evaluated in a single expert academic center. METHODS We included 172 controls, 668 male HH patients (CHH: n = 201 [age 16.9 ± 9.0 years], lesional AHH: n = 467 [age 45.6 ± 18.4 years]) caused by hypothalamic and/or pituitary tumors (mainly adenomas and craniopharyngiomas) or infiltrative/traumatic diseases. RESULTS At diagnosis, CHH were significantly younger, with 52.9% diagnosed before age 18 years, compared to only 9.6% of AHH patients. Cryptorchidism (21.9% vs 0.3%) and micropenis were more prevalent in CHH than AHH patients. Low testicular volume (TV) was present in 97% of patients with CHH (mean TV: 3.4 ± 2.7 mL) but in only 30% of those with AHH (mean TV: 20.8 ± 5.0 mL). Whereas no men with persistent CHH had spontaneous fertility, 70.4% of AHH men fathered at least one child without medical therapy. Total testosterone was lower both in CHH and AHH patients than in controls. Compared to controls, circulating gonadotropins and testicular peptides (insulin-like factor-3 and inhibin B) were decreased both in CHH and AHH, but were significantly higher in patients with AHH. CONCLUSION In AHH patients, the HH has later onset and is less severe than in CHH and the phenotype can overlap with that of individuals with normal laboratory values. Our data suggest that age at diagnosis is a predictor of the reproductive phenotype in AHH.
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Affiliation(s)
- Luigi Maione
- University Paris-Saclay, F-91405 Orsay, France
- Department of Reproductive Endocrinology, Assistance Publique-Hôpitaux de Paris, Bicêtre Hospital, F-94275, Le Kremlin-Bicêtre, France
- INSERM UMR-S 1185, Paris-Saclay University, Le Kremlin Bicêtre, F-94276, France
- Division of Endocrinology, Diabetes and Hypertension, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts 02115, USA
| | - Julie Sarfati
- Department of Reproductive Endocrinology, Assistance Publique-Hôpitaux de Paris, Bicêtre Hospital, F-94275, Le Kremlin-Bicêtre, France
| | - Céline Gonfroy-Leymarie
- Department of Reproductive Endocrinology, Assistance Publique-Hôpitaux de Paris, Bicêtre Hospital, F-94275, Le Kremlin-Bicêtre, France
| | - Sylvie Salenave
- Department of Reproductive Endocrinology, Assistance Publique-Hôpitaux de Paris, Bicêtre Hospital, F-94275, Le Kremlin-Bicêtre, France
- INSERM UMR-S 1185, Paris-Saclay University, Le Kremlin Bicêtre, F-94276, France
| | - Sylvie Brailly-Tabard
- University Paris-Saclay, F-91405 Orsay, France
- INSERM UMR-S 1185, Paris-Saclay University, Le Kremlin Bicêtre, F-94276, France
- Service de Génétique Moléculaire, Pharmacogénétique et Hormonologie, Assistance Publique-Hôpitaux de Paris, Bicêtre Hospital, F-94275, Le Kremlin-Bicêtre, France
| | - Philippe Chanson
- University Paris-Saclay, F-91405 Orsay, France
- Department of Reproductive Endocrinology, Assistance Publique-Hôpitaux de Paris, Bicêtre Hospital, F-94275, Le Kremlin-Bicêtre, France
- INSERM UMR-S 1185, Paris-Saclay University, Le Kremlin Bicêtre, F-94276, France
| | - Séverine Trabado
- University Paris-Saclay, F-91405 Orsay, France
- INSERM UMR-S 1185, Paris-Saclay University, Le Kremlin Bicêtre, F-94276, France
- Service de Génétique Moléculaire, Pharmacogénétique et Hormonologie, Assistance Publique-Hôpitaux de Paris, Bicêtre Hospital, F-94275, Le Kremlin-Bicêtre, France
| | - Ursula B Kaiser
- Division of Endocrinology, Diabetes and Hypertension, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts 02115, USA
| | - Jacques Young
- University Paris-Saclay, F-91405 Orsay, France
- Department of Reproductive Endocrinology, Assistance Publique-Hôpitaux de Paris, Bicêtre Hospital, F-94275, Le Kremlin-Bicêtre, France
- INSERM UMR-S 1185, Paris-Saclay University, Le Kremlin Bicêtre, F-94276, France
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3
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Tramunt B, Smati S, Coudol S, Wargny M, Pichelin M, Guyomarch B, Al-Salameh A, Amadou C, Barraud S, Bigot E, Bordier L, Borot S, Bourgeon M, Bourron O, Charrière S, Chevalier N, Cosson E, Fève B, Flaus-Furmaniuk A, Fontaine P, Galioot A, Gonfroy-Leymarie C, Guerci B, Lablanche S, Lalau JD, Larger E, Lasbleiz A, Laviolle B, Marre M, Munch M, Potier L, Prevost G, Renard E, Reznik Y, Seret-Bégué D, Sibilia P, Thuillier P, Vergès B, Gautier JF, Hadjadj S, Cariou B, Mauvais-Jarvis F, Gourdy P. Sex disparities in COVID-19 outcomes of inpatients with diabetes: insights from the CORONADO study. Eur J Endocrinol 2021; 185:299-311. [PMID: 34085949 PMCID: PMC9494335 DOI: 10.1530/eje-21-0068] [Citation(s) in RCA: 8] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2021] [Accepted: 06/03/2021] [Indexed: 11/14/2022]
Abstract
OBJECTIVE Male sex is one of the determinants of severe coronavirus diseas-e-2019 (COVID-19). We aimed to characterize sex differences in severe outcomes in adults with diabetes hospitalized for COVID-19. METHODS We performed a sex-stratified analysis of clinical and biological features and outcomes (i.e. invasive mechanical ventilation (IMV), death, intensive care unit (ICU) admission and home discharge at day 7 (D7) or day 28 (D28)) in 2380 patients with diabetes hospitalized for COVID-19 and included in the nationwide CORONADO observational study (NCT04324736). RESULTS The study population was predominantly male (63.5%). After multiple adjustments, female sex was negatively associated with the primary outcome (IMV and/or death, OR: 0.66 (0.49-0.88)), death (OR: 0.49 (0.30-0.79)) and ICU admission (OR: 0.57 (0.43-0.77)) at D7 but only with ICU admission (OR: 0.58 (0.43-0.77)) at D28. Older age and a history of microvascular complications were predictors of death at D28 in both sexes, while chronic obstructive pulmonary disease (COPD) was predictive of death in women only. At admission, C-reactive protein (CRP), aspartate amino transferase (AST) and estimated glomerular filtration rate (eGFR), according to the CKD-EPI formula predicted death in both sexes. Lymphocytopenia was an independent predictor of death in women only, while thrombocytopenia and elevated plasma glucose concentration were predictors of death in men only. CONCLUSIONS In patients with diabetes admitted for COVID-19, female sex was associated with lower incidence of early severe outcomes, but did not influence the overall in-hospital mortality, suggesting that diabetes mitigates the female protection from COVID-19 severity. Sex-associated biological determinants may be useful to optimize COVID-19 prevention and management in women and men.
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Affiliation(s)
- Blandine Tramunt
- Department of Diabetology, Metabolic Diseases and Nutrition, Toulouse University Hospital, Institute of Metabolic and Cardiovascular Diseases, UMR1297 INSERM/UPS, Toulouse University, Toulouse, France
| | - Sarra Smati
- Nantes University, Nantes University Hospital, CNRS, INSERM, L’Institut du Thorax, Nantes, France
| | | | - Matthieu Wargny
- Nantes University, Nantes University Hospital, CNRS, INSERM, L’Institut du Thorax, Nantes, France
- CIC-EC 1413, Data Clinic, France
| | - Matthieu Pichelin
- Nantes University, Nantes University Hospital, CNRS, INSERM, L’Institut du Thorax, Nantes, France
| | - Béatrice Guyomarch
- Research Department, Methodology and Biostatistics Platform, Nantes University Hospital, Nantes, France
| | - Abdallah Al-Salameh
- Department of Endocrinology, Diabetes Mellitus and Nutrition, Amiens University Hospital, Amiens, France
- PériTox=UMR_I 01, University of Picardie Jules Verne, Amiens, France
| | - Coralie Amadou
- Department of Diabetology, Sud Francilien Hospital Center, Corbeil Essonne, France
| | - Sara Barraud
- CRESTIC EA 3804, University of Reims Champagne Ardenne, UFR Sciences Exactes et Naturelles, Moulin de la Housse, Reims, France
- Department of Endocrinology-Diabetes-Nutrition, Reims University Hospital, Avenue du Général Koenig, Reims, France
| | - Edith Bigot
- Department of Biochemistry, Nantes University Hospital, G et R Laënnec Hospital, Bd Jacques Monod, Nantes, France
| | - Lyse Bordier
- Department of Endocrinology, Bégin Hospital, Saint-Mandé, France
| | - Sophie Borot
- Department of Endocrinology, Diabetology and Nutrition, Besançon University Hospital, Besançon, France
| | - Muriel Bourgeon
- Department of Endocrinology, Diabetology and Nutrition, Assistance Publique Hôpitaux de Paris, Paris Saclay University, Antoine Béclère Hospital, Clamart, Bicêtre Hospital, Le Kremlin Bicêtre, France
| | - Olivier Bourron
- Department of Diabetology, Sorbonne University, Assistance Publique Hôpitaux de Paris, La Pitié Salpêtrière-Charles Foix University Hospital, Inserm, UMR_S 1138, Cordeliers Research Center, Paris 06, Institute of Cardiometabolism and Nutrition ICAN, Paris, France
| | - Sybil Charrière
- Federation of Endocrinology – Louis Pradel Cardiovascular Hospital, Hospices Civils de Lyon, INSERM UMR 1060 Carmen, Claude Bernard Lyon 1 University, Lyon, France
| | - Nicolas Chevalier
- University of Côte d’Azur, University Hospital, Inserm U1065, C3M, Nice, France
| | - Emmanuel Cosson
- Department of Endocrinology, Diabetology and Nutrition, Assistance Publique Hôpitaux de Paris, Avicenne Hospital, Paris 13 University, Sorbonne Paris Cité, CRNH-IdF, CINFO, Bobigny, France
- Paris 13 University, Sorbonne Paris Cité, UMR U557 Inserm/U11125 INRAE/CNAM/Paris13 University, Nutritional Epidemiological Research Unit, Bobigny, France
| | - Bruno Fève
- Department of Endocrinology, Assistance Publique Hôpitaux de Paris, Saint-Antoine Hospital, Reference Center of Rare Diseases of Insulin Secretion and Insulin Sensitivity (PRISIS), Paris, France
- Sorbonne University, Inserm UMRS 938, Saint-Antoine Research Center, Paris, France
| | - Anna Flaus-Furmaniuk
- Department of Endocrinology-Diabetology, Felix Guyon Site, University Hospital of la Réunion, Saint-Denis de la Réunion, France
| | - Pierre Fontaine
- Department of Endocrinology, Diabetology and Nutrition, Hospital of Huriez, Lille University Hospital, Lille, France
| | - Amandine Galioot
- Department of Endocrinology, Diabetology and Nutrition, Bordeaux University Hospital and University of Bordeaux, Bordeaux, France
| | | | - Bruno Guerci
- Lorraine University and Endocrinology, Diabetology, Metabolic Diseases and Nutrition, Nancy University Hospital, Nancy, France
| | - Sandrine Lablanche
- Grenoble Alpes University, INSERM U1055, LBFA, Endocrinology, Grenoble Alpes University Hospital, France
| | - Jean-Daniel Lalau
- Department of Endocrinology, Diabetes Mellitus and Nutrition, Amiens University Hospital, Amiens, France
- PériTox=UMR_I 01, University of Picardie Jules Verne, Amiens, France
| | - Etienne Larger
- Department of Diabetology, Cochin Hospital, AP-HP, Paris University, Paris, France
| | - Adèle Lasbleiz
- Department of Endocrinology, Diabetology and Nutrition, Hospital of la Conception, Assistance Publique-Hôpitaux de Marseille, Marseille, France
- Aix Marseille University, INSERM, INRA, C2VN, Marseille, France
| | - Bruno Laviolle
- Rennes University, Rennes University Hospital, Inserm, CIC 1414 (Clinical Investigation Center), Rennes, France
| | - Michel Marre
- Ambroise Paré Neuilly-sur-Seine Hospital, Cordeliers Research Center, Paris Diderot University, Paris, France
| | - Marion Munch
- Department of Endocrinology, Diabetology and Nutrition, Strasbourg University Hospitals, Strasbourg, France
| | - Louis Potier
- Department of Endocrinology, Diabetology and Nutrition, Bichat Hospital, Assistance Publique Hôpitaux de Paris, Paris, France
- Cordeliers Research Center, Inserm, U-1138, Paris University, Paris, France
| | - Gaëtan Prevost
- Department of Endocrinology, Diabetes and Metabolic Diseases, Normandie University, UNIROUEN, Rouen University Hospital, Rouen, France
| | - Eric Renard
- Department of Endocrinology, Diabetes, Nutrition, Montpellier University Hospital, INSERM Clinical Investigation Centre, Institute of Functional Genomics, CNRS, INSERM, University of Montpellier, Montpellier, France
| | - Yves Reznik
- Department of Endocrinology and Diabetology, University Hospital of Côte de Nacre, Caen Cedex, France
| | | | - Paul Sibilia
- Department of Endocrinology, Diabetology and Nutrition, Angers University Hospital, Angers, France
| | - Philippe Thuillier
- Department of Endocrinology, Brest University Hospital, EA 3878 GETBO, Brest, France
| | - Bruno Vergès
- Department of Endocrinology, Diabetology and Metabolic Diseases, Hospital of Bocage, Dijon, France
| | - Jean-François Gautier
- Department of Diabetology and Endocrinology, Lariboisière Hospital, APHP, Paris, France
- INSERM UMRS 1138, Paris Diderot-Paris VII University, Sorbonne Paris Cité, Paris, France
| | - Samy Hadjadj
- Nantes University, Nantes University Hospital, CNRS, INSERM, L’Institut du Thorax, Nantes, France
| | - Bertrand Cariou
- Nantes University, Nantes University Hospital, CNRS, INSERM, L’Institut du Thorax, Nantes, France
| | - Franck Mauvais-Jarvis
- Section of Endocrinology, John W Deming Department of Medicine, Tulane University School of Medicine, New Orleans, Louisiana, USA
- Southeast Louisiana Veterans Health Care System Medical Center, New Orleans, Louisiana, USA
- Tulane Center of Excellence in Sex-Based Biology and Medicine, New Orleans, Louisiana, USA
- Correspondence should be addressed to F Mauvais-Jarvis;
| | - Pierre Gourdy
- Department of Diabetology, Metabolic Diseases and Nutrition, Toulouse University Hospital, Institute of Metabolic and Cardiovascular Diseases, UMR1297 INSERM/UPS, Toulouse University, Toulouse, France
- Correspondence should be addressed to P Gourdy;
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Borie-Swinburne C, Sola-Gazagnes A, Gonfroy-Leymarie C, Boillot J, Boitard C, Larger E. Effect of dietary protein on post-prandial glucose in patients with type 1 diabetes. J Hum Nutr Diet 2013; 26:606-11. [PMID: 23521532 DOI: 10.1111/jhn.12082] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND In flexible insulin therapy, determination of the prandial insulin dose only takes into account the carbohydrate content of the evening meal, and not the protein content. Protein can, however, contribute to gluconeogenesis. We compared the glycaemic effect of a standard evening meal with that of a test evening meal enriched in protein. METHODS The present study was conducted in 28 C-peptide negative patients with type 1 diabetes. Two evening meals that were similar in content, except that one was enriched by the addition of 300 g of 0%-fat fromage frais, were taken on two consecutive days. Insulin doses were maintained exactly the same before both evening meals. Patients were monitored with a continuous glucose-monitoring device. RESULTS Patients ate similar quantities at both evening meals, except for protein (21.5 g more at the test evening meal). The preprandial insulin dose was 0.96 (0.4) U per 10 g carbohydrates. After correction for differences of interstitial glucose at the start of the evening meals, both interstitial and capillary glucose levels were similar after both evening meals, except for the late-post-prandial interstitial glucose level. CONCLUSIONS We found no effect of dietary protein on post-prandial-, overnight- or late-night glucose levels in patients with type 1 diabetes. This confirms that dietary proteins need not be included in the calculation of prandial insulin dose.
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Affiliation(s)
- C Borie-Swinburne
- Service de Diabétologie, Hôtel Dieu de Paris, APHP, Paris, France; Faculté de Médecine, Université René Descartes, Paris, France
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5
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Scotto M, Afonso G, Østerbye T, Larger E, Luce S, Raverdy C, Novelli G, Bruno G, Gonfroy-Leymarie C, Launay O, Lemonnier FA, Buus S, Carel JC, Boitard C, Mallone R. HLA-B7-restricted islet epitopes are differentially recognized in type 1 diabetic children and adults and form weak peptide-HLA complexes. Diabetes 2012; 61:2546-55. [PMID: 22997432 PMCID: PMC3447897 DOI: 10.2337/db12-0136] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
The cartography of β-cell epitopes targeted by CD8(+) T cells in type 1 diabetic (T1D) patients remains largely confined to the common HLA-A2 restriction. We aimed to identify β-cell epitopes restricted by the HLA-B7 (B*07:02) molecule, which is associated with mild T1D protection. Using DNA immunization on HLA-B7-transgenic mice and prediction algorithms, we identified GAD and preproinsulin candidate epitopes. Interferon-γ (IFN-γ) enzyme-linked immunospot assays on peripheral blood mononuclear cells showed that most candidates were recognized by new-onset T1D patients, but not by type 2 diabetic and healthy subjects. Some epitopes were highly immunodominant and specific to either T1D children (GAD(530-538); 44% T cell-positive patients) or adults (GAD(311-320); 38%). All epitopes displayed weak binding affinity and stability for HLA-B7 compared with HLA-A2-restricted ones, a general feature of HLA-B7. Single-cell PCR analysis on β-cell-specific (HLA-B7 tetramer-positive) T cells revealed uniform IFN-γ and transforming growth factor-β (TGF-β) mRNA expression, different from HLA-A2-restricted T cells. We conclude that HLA-B7-restricted islet epitopes display weak HLA-binding profiles, are different in T1D children and adults, and are recognized by IFN-γ(+)TGF-β(+)CD8(+) T cells. These features may explain the T1D-protective effect of HLA-B7. The novel epitopes identified should find valuable applications for immune staging of HLA-B7(+) individuals.
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Affiliation(s)
- Matthieu Scotto
- INSERM, U986, DeAR Lab Avenir, Cochin-Saint Vincent de Paul Hospital, Paris, France
- Faculté de Médecine, Paris Descartes University, Sorbonne Paris Cité, Paris, France
| | - Georgia Afonso
- INSERM, U986, DeAR Lab Avenir, Cochin-Saint Vincent de Paul Hospital, Paris, France
- Faculté de Médecine, Paris Descartes University, Sorbonne Paris Cité, Paris, France
| | - Thomas Østerbye
- Laboratory of Experimental Immunology, Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Etienne Larger
- Faculté de Médecine, Paris Descartes University, Sorbonne Paris Cité, Paris, France
- Department of Diabetology, Cochin-Hôtel Dieu Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Sandrine Luce
- INSERM, U986, DeAR Lab Avenir, Cochin-Saint Vincent de Paul Hospital, Paris, France
- Faculté de Médecine, Paris Descartes University, Sorbonne Paris Cité, Paris, France
| | - Cécile Raverdy
- Department of Pediatric Endocrinology and Diabetes, Robert Debré Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
- Paris 7 Denis Diderot University, Paris, France
| | - Giulia Novelli
- Departement of Internal Medicine, University of Turin, Turin, Italy
| | - Graziella Bruno
- Departement of Internal Medicine, University of Turin, Turin, Italy
| | - Céline Gonfroy-Leymarie
- Department of Diabetology, Cochin-Hôtel Dieu Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Odile Launay
- INSERM, CIC BT505, Centre d’Investigation Clinique de Vaccinologie Cochin Pasteur, Cochin-Hôtel Dieu Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - François A. Lemonnier
- INSERM, U986, DeAR Lab Avenir, Cochin-Saint Vincent de Paul Hospital, Paris, France
- Faculté de Médecine, Paris Descartes University, Sorbonne Paris Cité, Paris, France
| | - Søren Buus
- Laboratory of Experimental Immunology, Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Jean-Claude Carel
- Department of Pediatric Endocrinology and Diabetes, Robert Debré Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
- Paris 7 Denis Diderot University, Paris, France
| | - Christian Boitard
- INSERM, U986, DeAR Lab Avenir, Cochin-Saint Vincent de Paul Hospital, Paris, France
- Faculté de Médecine, Paris Descartes University, Sorbonne Paris Cité, Paris, France
- Department of Diabetology, Cochin-Hôtel Dieu Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Roberto Mallone
- INSERM, U986, DeAR Lab Avenir, Cochin-Saint Vincent de Paul Hospital, Paris, France
- Faculté de Médecine, Paris Descartes University, Sorbonne Paris Cité, Paris, France
- Department of Diabetology, Cochin-Hôtel Dieu Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
- Corresponding author: Roberto Mallone,
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