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Huret P, Lopes P, Dardari R, Penfornis A, Thomas C, Dardari D. Rapid correction of hyperglycemia: A necessity but at what price? A brief report of a patient living with type 1 diabetes. World J Diabetes 2023; 14:1710-1716. [DOI: 10.4239/wjd.v14.i11.1710] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2023] [Revised: 08/31/2023] [Accepted: 10/16/2023] [Indexed: 11/14/2023] Open
Abstract
BACKGROUND The correction and control of chronic hyperglycemia are the management goals of patients living with diabetes. Chronic hyperglycemia is the main factor inducing diabetes-related complications. However, in certain situations, the rapid and intense correction of chronic hyperglycemia can paradoxically favor the onset of microvascular complications.
CASE SUMMARY In this case report, we describe the case of a 25-year-old woman living with type 1 diabetes since the age of 9 years. Her diabetes was chronic and unstable but without complications. During an unplanned pregnancy, her diabetes was intensely managed with the rapid correction of her hyperglycemia. However, over the following 2 years, she developed numerous degenerative microvascular complications: Charcot neuroarthropathy with multiple joint involvement, severe proliferative diabetic retinopathy, gastroparesis, bladder voiding disorders, and end-stage renal failure requiring hemodialysis.
CONCLUSION In the literature to date, the occurrence of multiple microvascular complications following the rapid correction of chronic hyperglycemia has been rarely described in the same individual.
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Affiliation(s)
- Priscille Huret
- LBEPS, University Evry, IRBA, Université Paris Saclay, Evry 91000, France
| | - Philippe Lopes
- LBEPS, University Evry, IRBA, Université Paris Saclay, Evry 91000, France
| | | | - Alfred Penfornis
- Diabetology, Centre Hospitalier Sud Francilien, Corbeil Essonne 91100, France
| | - Claire Thomas
- LBEPS, University Evry, IRBA, Université Paris Saclay, Evry 91000, France
| | - Dured Dardari
- LBEPS, University Evry, IRBA, Université Paris Saclay, Evry 91000, France
- Diabetology, Centre Hospitalier Sud Francilien, Corbeil Essonne 91100, France
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2
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Dardari D, Franc S, Charpentier G, Orlando L, Bobony E, Bouly M, Xhaard I, Amrous Z, Sall KL, Detournay B, Penfornis A. Hospital stays and costs of telemedical monitoring versus standard follow-up for diabetic foot ulcer: an open-label randomised controlled study. Lancet Reg Health Eur 2023; 32:100686. [PMID: 37520145 PMCID: PMC10384180 DOI: 10.1016/j.lanepe.2023.100686] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Revised: 06/23/2023] [Accepted: 06/29/2023] [Indexed: 08/01/2023]
Abstract
Background Two randomised controlled trials (RCTs) have previously shown that telemedical monitoring of diabetic foot ulcer (DFU) reduces the number of visits to the outpatient clinic, without losing treatment efficacy or increasing costs. Here we present the results of an open-label, randomised controlled trial designed to investigate whether telemonitoring, provided by an expert nurse (with extensive experience in DFU and trained in remote monitoring), reduces the hospital stay and the associated costs for a patient with DFU (TELEPIED trial). Methods Eligible patients (n = 180) were randomly allocated to: (i) a control group, in which they received standard care, and (ii) an intervention group, in which they received asynchronous telemedicine follow-up by the expert nurse. The primary outcome was the cumulative hospital days over 12 months. The main secondary outcomes were (i) direct healthcare costs (estimated in a collective perspective), (ii) wound healing and (iii) amputation rates. ITT (intention-to-treat) population was analysed. Findings In the ITT population, cumulative hospital days were significantly higher in the control group (13.4 days [95% CI 9.0-17.8]) than in the intervention group (7.1 days [2.8-11.5]) (p = 0.0458, ANCOVA model). Cumulative direct costs over 12 months were 7185 € (95% CI 5144-9226) in the control group and 3471 € (95% CI 1430-5512) in the intervention group (p = 0.0120). The percentage of wounds healed and amputation rate were not significantly different between groups. Similar results were found with the PP population. Interpretation The implementation of a telemedical intervention with an expert nurse could lead to a length of hospitalization and direct costs that were two times lower compared to conventional follow-up. This lower medical and economic burden was obtained without losing effectiveness on the rate of healing, nor increasing the amputation rate. Additional studies are required to confirm these findings. Funding This study was designed, funded and conducted by CERITD (Study and Research Centre for Intensification of Diabetes Treatment, Evry, France), Genopole GIP, 20 rue Henri Desbruères, 91030 EVRY Cedex and Laboratoires URGO, 15 Avenue d'Iéna, 75116 Paris Cedex, France. The findings and conclusions in this study are those of the authors and do not necessarily represent the views of the sponsor. The corresponding author (DD) certify that authors were not precluded from accessing data in the study, and they accept responsibility to submit for publication.
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Affiliation(s)
- Dured Dardari
- Department of Diabetes and Endocrinology, South Francilien Hospital Centre, Corbeil-Essonnes, France
- LBEPS, Université d’Evry, IRBA, Université de Paris-Saclay, Evry, France
| | - Sylvia Franc
- Department of Diabetes and Endocrinology, South Francilien Hospital Centre, Corbeil-Essonnes, France
- CERITD (Centre d’Etude et de Recherche pour l'Intensification du Traitement du Diabète), Evry, France
| | - Guillaume Charpentier
- CERITD (Centre d’Etude et de Recherche pour l'Intensification du Traitement du Diabète), Evry, France
| | - Laurent Orlando
- CERITD (Centre d’Etude et de Recherche pour l'Intensification du Traitement du Diabète), Evry, France
| | - Elise Bobony
- CERITD (Centre d’Etude et de Recherche pour l'Intensification du Traitement du Diabète), Evry, France
| | - Marie Bouly
- Department of Diabetes and Endocrinology, South Francilien Hospital Centre, Corbeil-Essonnes, France
| | - Ilham Xhaard
- CERITD (Centre d’Etude et de Recherche pour l'Intensification du Traitement du Diabète), Evry, France
| | - Zohra Amrous
- CERITD (Centre d’Etude et de Recherche pour l'Intensification du Traitement du Diabète), Evry, France
| | - Khadijatou Ly Sall
- Department of Diabetes and Endocrinology, South Francilien Hospital Centre, Corbeil-Essonnes, France
- CERITD (Centre d’Etude et de Recherche pour l'Intensification du Traitement du Diabète), Evry, France
| | - Bruno Detournay
- CEMKA, 43, Boulevard du Maréchal Joffre, Bourg-La-Reine 92340, France
| | - Alfred Penfornis
- Department of Diabetes and Endocrinology, South Francilien Hospital Centre, Corbeil-Essonnes, France
- Paris-Sud Medical School, Paris-Saclay University, Saint-Aubin, France
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Julien CA, Ha Van G, M'Bemba J, Bourgeon M, Dardari D, Lepeut M, Dumont I, Zemmache MZ, Serrand C, Bouillet B, Sultan A, Schuldiner S. Real-world treatment patterns and diagnosis of charcot foot in franco-belgian diabetic foot expert centers (The EPiChar Study). Acta Diabetol 2023; 60:1209-1218. [PMID: 37184671 DOI: 10.1007/s00592-023-02101-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Accepted: 04/09/2023] [Indexed: 05/16/2023]
Abstract
AIM To evaluate the real-life diagnosis and therapeutic means of Charcot Neuroosteoarthropathy (CN) in French-Belgian diabetic foot expert centers. METHODS We collected clinical characteristics, results of exams and therapeutic pathways of consecutive adult patients with diabetic osteoarthropathy seen in consultation or hospitalization from January 1 to December 31, 2019 in 31 diabetic foot expert centers. The primary outcome was to describe the diagnostic and management methods for CN according to patient clinical characteristics, the clinical-radiological characteristics of acute and chronic CN and discharge means. RESULTS 467 patients were included: 364 with chronic CN and 103 in the acute phase. 101 patients had bilateral chronic CN. Most patients were male (73.4%), treated with insulin (73.3%), and with multicomplicated diabetes. In the acute phase, edema and increased foot temperature were present in 75% and 58.3% of cases, respectively. Diagnosis confirmation was usually by MRI and the mode of discharge was variable. In the chronic phase, orthopedic shoes were prescribed in 81.5% of cases. CONCLUSIONS This observational study highlights the diagnostic and therapeutic practices in 31 diabetic foot centers. Our results highlight that the use of MRI and the modalities of offloading, an essential treatment in the acute phase, need to be better standardized. Centers were highly encouraging about creating a patient registry.
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Affiliation(s)
- Carole-Anne Julien
- Service des Maladies métaboliques et Endocriniennes, CHU Nîmes, Univ Montpellier, Nîmes, France
| | - Georges Ha Van
- Service de Diabétologie, AP-HP La Pitié Salpétrière, Paris, France
| | | | - Muriel Bourgeon
- Service Endocrinologie, AP-HP Kremlin Bicêtre, Kremlin Bicêtre, France
| | - Dured Dardari
- Service de Diabétologie, CH Sud Francilien, Corbeil-Essonnes, France
| | - Marc Lepeut
- Service de Diabétologie, CH Roubaix, Roubaix, France
| | | | - Mohammed Zakarya Zemmache
- Department of Biostatistics, Epidemiology, Public Health and Innovation in Methodology (BESPIM), CHU Nîmes, Univ Montpellier, Nîmes, France
| | - Chris Serrand
- Department of Biostatistics, Epidemiology, Public Health and Innovation in Methodology (BESPIM), CHU Nîmes, Univ Montpellier, Nîmes, France
| | - Benjamin Bouillet
- Service d'Endocrinologie, Diabétologie, Maladies Métaboliques, CHU Dijon, Dijon, France
| | - Ariane Sultan
- 10PhyMedExp, INSERM U1046, UMR 9214, Univ Montpellier, Service Des Maladies Métaboliques, CHU Montpellier, Montpellier, France
| | - Sophie Schuldiner
- VBIC, INSERM U1047, Univ Montpellier, Service Des Maladies Métaboliques Et Endocriniennes, CHU Nîmes, Clinique du Pied Gard Occitanie, Route de Carnon, 30240, Le Grau du Roi, France.
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Poonoosamy J, Lopes P, Huret P, Dardari R, Penfornis A, Thomas C, Dardari D. Impact of Intensive Glycemic Treatment on Diabetes Complications-A Systematic Review. Pharmaceutics 2023; 15:1791. [PMID: 37513978 PMCID: PMC10383300 DOI: 10.3390/pharmaceutics15071791] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2023] [Revised: 04/28/2023] [Accepted: 06/12/2023] [Indexed: 07/30/2023] Open
Abstract
Diabetes complications can be related to the long duration of the disease or chronic hyperglycemia. The follow-up of diabetic patients is based on the control of chronic hyperglycemia, although this correction, if obtained rapidly in people living with severe chronic hyperglycemia, can paradoxically interfere with the disease or even induce complications. We reviewed the literature describing the impact of the rapid and intense treatment of hyperglycemia on diabetic complications. The literature review showed that worsening complications occurred significantly in diabetic microangiopathy with the onset of specific neuropathy induced by the correction of diabetes. The results for macroangiopathy were somewhat mixed with the intensive and rapid correction of chronic hyperglycemia having a neutral impact on stroke and myocardial infarction but a significant increase in cardiovascular mortality. The management of diabetes has now entered a new era with new therapeutic molecules, such as gliflozin for patients living with type 2 diabetes, or hybrid insulin delivery systems for patients with insulin-treated diabetes. Our manuscript provides evidence in support of these personalized and progressive algorithms for the control of chronic hyperglycemia.
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Affiliation(s)
| | - Philippe Lopes
- LBEPS, IRBA, Université Paris Saclay, 91025 Evry, France
| | | | - Randa Dardari
- Al Fourkan Diabetes Center, Al Fourkan, Aleppo, Syria
| | - Alfred Penfornis
- Diabetology Department, Centre Hopitalier Sud Francilien, 91100 Corbeil-Essonnes, France
- Paris-Sud Medical School, Paris-Saclay University, 91100 Corbeil-Essonnes, France
| | - Claire Thomas
- LBEPS, IRBA, Université Paris Saclay, 91025 Evry, France
| | - Dured Dardari
- LBEPS, IRBA, Université Paris Saclay, 91025 Evry, France
- Diabetology Department, Centre Hopitalier Sud Francilien, 91100 Corbeil-Essonnes, France
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Dardari D. Trends in the pathophysiology of Charcot neuroarthropathy. Trends Endocrinol Metab 2023; 34:61-62. [PMID: 36528439 DOI: 10.1016/j.tem.2022.12.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Accepted: 12/06/2022] [Indexed: 12/23/2022]
Abstract
The pathophysiology of Charcot neuroarthropathy (CN) includes a number of gray areas, particularly regarding the onset of inflammation which induces the disruption of the bone remodeling factor responsible for the onset of bone lysis. This clinical insight highlights a potential link between this inflammation and the rapid correction of chronic hyperglycemia (Dardari et al., 2022), which is known to be responsible for a particular type of neuropathy known as treatment-induced neuropathy of diabetes (TIND). Our description makes an additional contribution to shed light on the mysterious physiopathology of CN.
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Affiliation(s)
- Dured Dardari
- Diabetology Department, Centre, Hopitalier Sud Francilien, Corbeil-Essonnes, France; LBEPS, Université d'Evry, IRBA, Université Paris Saclay, 91025 Evry, France.
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Dardari D, Potier L, Sultan A, Francois M, M’Bemba J, Bouillet B, Chaillous L, Kessler L, Carlier A, Jalek A, Sbaa A, Orlando L, Bobony E, Detournay B, Kjartansson H, Bjorg Arsaelsdottir R, Baldursson BT, Charpentier G. Intact Fish Skin Graft vs. Standard of Care in Patients with Neuroischaemic Diabetic Foot Ulcers (KereFish Study): An International, Multicentre, Double-Blind, Randomised, Controlled Trial Study Design and Rationale. Medicina (B Aires) 2022; 58:medicina58121775. [PMID: 36556977 PMCID: PMC9786154 DOI: 10.3390/medicina58121775] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2022] [Revised: 11/06/2022] [Accepted: 11/24/2022] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Cell and/or tissue-based wound care products have slowly advanced in the treatment of non-healing ulcers, however, few studies have evaluated the effectiveness of these devices in the management of severe diabetic foot ulcers. METHOD This study (KereFish) is part of a multi-national, multi-centre, randomised, controlled clinical investigation (Odin) with patients suffering from deep diabetic wounds, allowing peripheral artery disease as evaluated by an ankle brachial index equal or higher than 0.6. The study has parallel treatment groups: Group 1 treatment with Kerecis® Omega3 Wound™ versus Group 2 treatment with standard of care. The primary objective is to test the hypothesis that a larger number of severe diabetic ulcers and amputation wounds, including those with moderate arterial disease, will heal in 16 weeks when treated with Kerecis® Omega3 Wound™ than with standard of care. CONCLUSION This study has received the ethics committee approval of each participating country. Inclusion of participants began in March 2020 and ended in July 2022. The first results will be presented in March 2023. The study is registered in ClinicalTrials.gov as Identifier: NCT04537520.
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Affiliation(s)
- Dured Dardari
- Diabetic Foot Unit, Centre Hospitalier sud Francilien Corbeil Essonnes, 91100 Corbeil-Essonnes, France
- LBEPS, IRBA, Université Evry Paris Saclay, 91025 Evry, France
- Correspondence: ; Tel.: +33-6-61-54-28-09
| | - Louis Potier
- Diabetology Department, CHU Bichat—Claude Bernard, 75018 Paris, France
- Institut Necker-Enfants Malades, Université Paris Cité, INSERM UMR-S1151, CNRS UMR-S8253, 75006 Paris, France
| | - Ariane Sultan
- Diabetology Nutrition Department, CHU Montpelier, Université de Montpellier, 34090 Montpellier, France
- Inserm, CNRS, Phymedexp, CHU de Montpellier, 34090 Montpellier, France
| | | | | | - Benjamin Bouillet
- Department of Endocrinology-Diabetology, Dijon University Hospital, 21000 Dijon, France
- INSERM Unit, LNC-UMR 1231, University of Burgundy, 21078 Dijon, France
| | - Lucy Chaillous
- Department of Endocrinology, Metabolic Diseases and Nutrition, University Hospital of Nante, 44000 Nantes, France
| | - Laurence Kessler
- Department of Diabetology, CHU Strasbourg, 67000 Strasbourg, France
| | - Aurelie Carlier
- Diabetology Department, CHU Bichat—Claude Bernard, 75018 Paris, France
| | - Abdulkader Jalek
- Diabetology Nutrition Department, CHU Montpelier, Université de Montpellier, 34090 Montpellier, France
| | - Ayoub Sbaa
- Department of Diabetology, CHU Strasbourg, 67000 Strasbourg, France
| | - Laurent Orlando
- CERITD (Center for Study and Research for Improvement of the Treatment of Diabetes), Bioparc-Genopole Evry-Corbeil, 91042 Evry, France
| | - Elise Bobony
- CERITD (Center for Study and Research for Improvement of the Treatment of Diabetes), Bioparc-Genopole Evry-Corbeil, 91042 Evry, France
| | - Bruno Detournay
- CEMKA, 43 boulevard du Maréchal Joffre, 92340 Bourg-la-Reine, France
| | | | | | | | - Guillaume Charpentier
- CERITD (Center for Study and Research for Improvement of the Treatment of Diabetes), Bioparc-Genopole Evry-Corbeil, 91042 Evry, France
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Benard T, Lequint C, Jugnet AC, Bouly M, Winther T, Penfornis A, Dardari D. Delayed Diagnosis of Bilateral Neuroarthropathy: Serious Impact on the Development of Charcot's Foot, a Case Report. Medicina (Kaunas) 2022; 58:medicina58121763. [PMID: 36556964 PMCID: PMC9783763 DOI: 10.3390/medicina58121763] [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] [Figures] [Subscribe] [Scholar Register] [Received: 10/02/2022] [Revised: 11/08/2022] [Accepted: 11/22/2022] [Indexed: 12/03/2022]
Abstract
Charcot neuroarthropathy (CN) is a destructive complication of the joints in patients with diabetes and should be managed from the onset of the first symptoms to avoid joint deformity and the risk of amputating the affected joint. Here, we describe the case of a young 24-year-old patient living with type I diabetes who developed active bilateral CN in both tarsal joints. This case of neuroarthropathy was uncommon due to the bilateral presentation at the same level of the joint. Despite the patient consulting from the beginning of the symptoms, none of the physicians suspected or diagnosed CN, leading to a delay in management and the aggravation of bone destruction by CN. This highlights the importance of early management of CN with the need to refer people with suspected CN to specialised diabetic foot care centres.
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Affiliation(s)
- Tatiana Benard
- Centre Hopitalier Sud Francilien, Diabetology Department, 91100 Corbeil-Essonnes, France
| | - Corinne Lequint
- Centre Hopitalier Sud Francilien, Diabetology Department, 91100 Corbeil-Essonnes, France
| | - Anne Christine Jugnet
- Centre Hopitalier Sud Francilien, Diabetology Department, 91100 Corbeil-Essonnes, France
| | - Marie Bouly
- Centre Hopitalier Sud Francilien, Diabetology Department, 91100 Corbeil-Essonnes, France
| | - Thomas Winther
- Centre Hopitalier Sud Francilien, Diabetology Department, 91100 Corbeil-Essonnes, France
| | - Alfred Penfornis
- Centre Hopitalier Sud Francilien, Diabetology Department, 91100 Corbeil-Essonnes, France
- Paris-Sud Medical School, Paris-Saclay University, 91100 Corbeil-Essonnes, France
| | - Dured Dardari
- Centre Hopitalier Sud Francilien, Diabetology Department, 91100 Corbeil-Essonnes, France
- LBEPS, IRBA, Université d’Evry, Université Paris Saclay, 91025 Evry, France
- Correspondence: ; Tel.: +33-6-61-54-28-09
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Dardari D, Schuldiner S, Julien CA, Ha Van G, M'Bemba J, Bourgeon M, Sultan A, Lepeut M, Grandperret-Vauthier S, Baudoux F, François M, Clavel S, Martini J, Vouillarmet J, Michon P, Moret M, Monnier A, Chingan-Martino V, Rigalleau V, Dumont I, Kessler L, Stifii I, Bouillet B, Bonnin P, Lemoine A, Da Costa Correia E, Faraill MMB, Muller M, Cazaubiel M, Zemmache MZ, Hartemann A. Trends in the relation between hyperglycemia correction and active Charcot neuroarthropathy: results from the EPICHAR study. BMJ Open Diabetes Res Care 2022; 10:10/5/e002380. [PMID: 36215101 PMCID: PMC9462091 DOI: 10.1136/bmjdrc-2021-002380] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Accepted: 08/02/2022] [Indexed: 11/23/2022] Open
Abstract
INTRODUCTION The pathophysiology of Charcot neuroarthropathy (CN) remains unclear. There are a number of hypotheses but these are not exclusive. In its clinical presentation, this complication intersects with the semiology of diabetic-induced neuropathy, such as peripheral hypervascularization and the appearance of arteriovenous shunt. The EPICHAR study is as yet an unpublished cohort of people living with diabetes complicated by CN (in active or chronic phase). Based on the findings of the EPICHAR study, this study aimed to investigate whether a reduction in the rate of hyperglycemia accompanies the onset of an active phase of CN. RESEARCH DESIGN AND METHODS Hemoglobin A1c (HbA1c) levels were assessed 3 months (M3) and 6 months (M6) before the diagnosis of active CN (M0). RESULTS 103 patients living with diabetes and presenting active CN were included between January and December 2019 from the 31 centers participating in this study (30 in France and 1 in Belgium). The mean age of the participants was 60.2±12.2 years; the vast majority were men (71.8%) living with type 2 diabetes (75.5%). Mean HbA1c levels significantly declined between M6 (median 7.70; Q1, Q3: 7.00, 8.55) and M3 (median 7.65; Q1, Q3: 6.90, 8.50) (p=0.012), as well as between M6 and M0 (median 7.40; Q1, Q3: 6.50, 8.50) (p=0.014). No significant difference was found between M3 and M0 (p=0.072). CONCLUSIONS A significant reduction in HbA1c levels seems to accompany the onset of the active phase of CN. TRIAL REGISTRATION NUMBER NCM03744039.
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Affiliation(s)
- Dured Dardari
- Diabetology, Centre Hospitalier Sud Francilien, Corbeil Essonne, France
- LBEPS, Université d'Evry, Evry, France
| | - Sophie Schuldiner
- Department of Endocrinology, Diabetology and Nutrition, University Hospital Nîmes, Nimes, France
| | | | - Georges Ha Van
- Diabetology, Hopital Universitaire Pitie Salpetriere, Paris, France
| | | | - Muriel Bourgeon
- Department of Endocrinology-Diabetology University Hospital Kremlin-Bicêtre France + Department of Medecine University Hospital Antoine Béclère Clamart France, Kremlin-Bicêtre, France
| | - Ariane Sultan
- Phymedexp, Université de Montpellier, Inserm, CNRS, CHRU de Montpellier, Montpellier, France
- Endocrinology Diabetes Department, CHU Montpellier, Montpellier, France
| | - Marc Lepeut
- Department of Endocrinology and Diabetology, Roubaix Hospital, Roubaix, France
| | | | - Florence Baudoux
- Department of Endocrinology and Diabetology, Claude Huriez Regional University Hospital, Lille, France
| | - Maud François
- Department of Endocrinology and Diabetology, Nutrition Robert Debré Hospital, Reims, France
| | - Sylvaine Clavel
- Department of Endocrinology and Diabetology, Hôtel Dieu Hospital, Le Creusot, France
| | - Jacques Martini
- Department of Endocrinology and Diabetology, University Hospital Rangueil, Toulouse, France
| | - Julien Vouillarmet
- Department of Endocrinology and Diabetology, Lyon South Hospital, Lyon, France
| | - Paul Michon
- Department of Endocrinology and Diabetology, Lyon South Hospital, Lyon, France
| | - Myriam Moret
- Department of Endocrinology and Diabetology, Cardiology Hospital Louis Pradel, Bron, France
| | | | - Vaneva Chingan-Martino
- Department of Endocrinology and Diabetology, University Hospital, Pointe-à-Pitre, France
| | - Vincent Rigalleau
- Department of Endocrinology and Diabetology, Haut-Lévêque University Hospital, Pessac, France
- Bordeaux Medical School, Bordeaux, France
| | | | - Laurence Kessler
- Internal Medicine Rheumatology Nutrition Endocrinology Diabetes Pole, Strasbourg University Hospitals, Strasbourg, France
- Medicine School Strasbourg, Strasbourg, France
| | - Ionela Stifii
- Internal Medicine Rheumatology Nutrition Endocrinology Diabetes Pole, Strasbourg University Hospitals, Strasbourg, France
| | - Benjamin Bouillet
- Department of Endocrinology, Diabetology and Nutrition, Dijon University Hospital, Dijon, France
- INSERM Unit, LNC-UMR 1231, University of Burgundy, DIJON, France
| | - Pierre Bonnin
- Department of Infectiology, Annecy Genevois Hospital, Metz-Tessy, France
| | - Amal Lemoine
- Vienne Hospital Centre Indoor Use Pharmacy, Vienne, France
| | | | | | - Marie Muller
- Department of Endocrinology and Diabetology, CHU MICHALLON, Grenoble, France
| | - Marie Cazaubiel
- Anesthesia Department, Tourcoing Hospital Center, Tourcoing, France
| | | | - Agnes Hartemann
- Department of Diabetes, Pitié Salpêtrière Hospital, Paris, France
- Sorbonne University Médicine, PARIS, FRANCE
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Bouly M, Laborne FX, Tourte C, Henry E, Penfornis A, Dardari D. Post-healing follow-up study of patients in remission for diabetic foot ulcers Pied-REM study. PLoS One 2022; 17:e0268242. [PMID: 35587931 PMCID: PMC9119502 DOI: 10.1371/journal.pone.0268242] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Accepted: 04/25/2022] [Indexed: 11/19/2022] Open
Abstract
The rate of recurrence for diabetic foot ulcer (DFU) is 50% at 2 years Armstrong DG, 2017. International recommendations call for regular monitoring to prevent DFU recurrence. We aim to investigate the relation between post-healing follow-up and recurrence rates. The study will begin in November 2021 and end in April 2022; final study results are scheduled for December 2022. The purpose of the study is to evaluate the benefit of the multidisciplinary follow-up of healed DFU patients at the rate of two annual consultations and its impact on foot wound recurrence.
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Affiliation(s)
- Marie Bouly
- Diabetology Department, Centre Hopitalier Sud Francilien, Corbeil-Essonnes, France
| | | | - Caroline Tourte
- Unité de Recherche Clinique Centre Hospitalier Sud Francilien, Corbeil-Essonnes, France
| | - Elodie Henry
- Unité de Recherche Clinique Centre Hospitalier Sud Francilien, Corbeil-Essonnes, France
| | - Alfred Penfornis
- Diabetology Department, Centre Hopitalier Sud Francilien, Corbeil-Essonnes, France
- Paris-Sud Medical School, Paris-Saclay University, Gif-Sur-Yvette, France
| | - Dured Dardari
- Diabetology Department, Centre Hopitalier Sud Francilien, Corbeil-Essonnes, France
- LBEPS, Univ Evry, IRBA, Université Paris Saclay, Evry, France
- * E-mail:
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Dardari D, Lequint C, Jugnet AC, Bénard T, Bouly M, Penfornis A. Curing Necrotic Angiodermatitis with an Intact Fish Skin Graft in a Patient Living with Diabetes. Medicina (B Aires) 2022; 58:medicina58020292. [PMID: 35208615 PMCID: PMC8876191 DOI: 10.3390/medicina58020292] [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] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Revised: 01/30/2022] [Accepted: 02/01/2022] [Indexed: 11/20/2022] Open
Abstract
Background and Objectives: We describe a case of necrotic angiodermatitis. Materials and Methods: We used an intact fish skin graft to treat a patient living with diabetes, which was complicated by end-stage renal failure and arterial hypertension. The entire therapeutic procedure was carried out in ambulatory care without requiring the hospitalization of the patient. Results: The patient experienced a marked reduction in pain and complete epithelization of the lesion after 10 weeks of treatment. Conclusion: Our experience presents a new therapeutic approach to necrotic angiodermatitis.
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Affiliation(s)
- Dured Dardari
- Centre Hopitalier Sud Francilien, Diabetology Department, 91100 Corbeil-Essonnes, France; (C.L.); (A.C.J.); (T.B.); (M.B.); (A.P.)
- LBEPS, IRBA, Université Paris Saclay, 91025 Evry, France
- Correspondence: ; Tel.: +33-6-61-54-28-09
| | - Corinne Lequint
- Centre Hopitalier Sud Francilien, Diabetology Department, 91100 Corbeil-Essonnes, France; (C.L.); (A.C.J.); (T.B.); (M.B.); (A.P.)
| | - Anne Christine Jugnet
- Centre Hopitalier Sud Francilien, Diabetology Department, 91100 Corbeil-Essonnes, France; (C.L.); (A.C.J.); (T.B.); (M.B.); (A.P.)
| | - Tatiana Bénard
- Centre Hopitalier Sud Francilien, Diabetology Department, 91100 Corbeil-Essonnes, France; (C.L.); (A.C.J.); (T.B.); (M.B.); (A.P.)
| | - Marie Bouly
- Centre Hopitalier Sud Francilien, Diabetology Department, 91100 Corbeil-Essonnes, France; (C.L.); (A.C.J.); (T.B.); (M.B.); (A.P.)
| | - Alfred Penfornis
- Centre Hopitalier Sud Francilien, Diabetology Department, 91100 Corbeil-Essonnes, France; (C.L.); (A.C.J.); (T.B.); (M.B.); (A.P.)
- Paris-Sud Medical School, Paris-Saclay University, 91100 Corbeil-Essonnes, France
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Dardari D, Dardari R. Why the Risk of Developing Neuroarthropathy Is Higher After Simultaneous Kidney and Pancreatic Transplantation Compared to Kidney Transplantation Only: The Role of Euglycemia. Ann Transplant 2021; 26:e928449. [PMID: 33526764 PMCID: PMC7866488 DOI: 10.12659/aot.928449] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
Charcot’s neuroarthropathy is a destructive complication of the joint, which is often found in patients living with diabetes. Despite the fact that its description was published almost 100 years ago, its pathophysiology, diagnosis, and treatment remain areas that need to be updated. Its prevalence is low in patients living with diabetes, but this increases in particular situations such as peripheral neuropathy, as well as after simultaneous kidney-pancreas transplantation (SPKT) in patients living with type 1 diabetes. We suggest that the development of neuroarthropathy after SPK in not only due to glucocorticoid therapy, as described, but also to the rapid passage into euglycemia. The reduced prevalence of neuroarthropathy after only kidney transplantation compared to SPK seems to validate our hypothesis.
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Affiliation(s)
- Dured Dardari
- Department of Diabetes, Sud Francilien Hospital Center 40 Avenue Serge Dassault, Corbeil-Essonnes, France.,LEBPS, Univ Evry, IRBA, Université de Paris-Saclay, Evry, France
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Abstract
Charcot's neuroarthropathy is a destructive complication of the joints, which is often found in people with diabetes with peripheral neuropathy. Despite the fact that its description was published almost 130 years ago, its pathophysiology, diagnosis, and treatment remain areas that need to be described. Thanks to the use of bone remodelling, new therapeutic classes have emerged, we hope that this review will shed light on the pathology from its discovery through to the current state of knowledge on its classification, diagnosis and treatment methods.
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Affiliation(s)
- Dured Dardari
- Diabetology Department, Centre Hopitalier Sud Francilien, Corbeil Essonnes, France
- LBEPS, Univ Evry, IRBA, Université Paris Saclay, 91025 Evry, France
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Dardari D, Penfornis A, Hartemann A. The onset of acute Charcot neuroarthropathy during pregnancy in patients with type 1 diabetes. Endocrinol Diabetes Metab Case Rep 2020; 2020:EDM200002. [PMID: 32669476 PMCID: PMC7424321 DOI: 10.1530/edm-20-0002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2020] [Accepted: 05/26/2020] [Indexed: 11/08/2022] Open
Abstract
SUMMARY We report the onset of acute Charcot neuroarthropathy during pregnancy in two patients with type 1 diabetes using retrospective review of case notes. We describe for the first time the onset of acute Charcot neuroarthropathy during pregnancy in two patients with type 1 diabetes. Pregnancy may promote the onset and worsening of a number of diabetic complications. A link between pregnancy and the onset of acute Charcot neuroarthropathy is demonstrated for the first time in this report. LEARNING POINTS Patients with already diagnosed sensitive neuropathy can develop an active phase of Charcot neuroarthropathy during pregnancy. The rapid correction of hyperglycaemia may induce an active phase of Charcot neuroarthropathy during pregnancy.
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Affiliation(s)
- Dured Dardari
- Diabetology Department, Centre Hopitalier Sud Francilien, Corbeil-Essonnes, France
- Sorbonne Université, Paris, France
| | - Alfred Penfornis
- Diabetology Department, Centre Hopitalier Sud Francilien, Corbeil-Essonnes, France
- Paris-Sud Medical School, Paris-Saclay University, Orsay, France
| | - Agnes Hartemann
- Diabetology Department, AP-HP, Hôpital Pitié-Salpêtrière, Paris, France
- Sorbonne Université, Paris, France
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Dardari D, Bouly M, Deschamps E, Uddin M, Hoque I, Zohra FT, Nabeed N, Dardari R. Description of a specific lesion of the foot related to the practice of Friday prayers in Muslim patients living with diabetes. Journal of Clinical and Translational Endocrinology: Case Reports 2020. [DOI: 10.1016/j.jecr.2020.100059] [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: 10/24/2022] Open
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Dardari D, Franc S, Charpentier G, Bobony E, Demangeon L, Bouly M, Xhaard I, Orlando L, Alhajj M, Sall KL, Randazzo C, Penfornis A. Télépied Study: A Single-Centre Trial in Diabetic Subjects Comparing Total Duration of Hospitalization Over a 1-Year Period Required for Complete Healing of a Foot Ulcer Using Telemedicine Management and a Referral Nurse Versus the Standard Care Pathway. Diabetes Ther 2020; 11:1419-1427. [PMID: 32383100 PMCID: PMC7261308 DOI: 10.1007/s13300-020-00821-1] [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] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Indexed: 11/15/2022] Open
Abstract
PURPOSE The aim of this study is to demonstrate that the total number of days in hospital required for healing of a de novo diabetes-related foot ulcer (DFU) is lower in patients followed up using a telemedicine platform (Télépied Follow-Up group [Group 2]) than in patients followed up using standard care (Standard Follow-Up control group [Group 1]). Patients are assigned to either Group 1 or Group 2 depending on whether their first inclusion visit is during an even or odd week. Patients included in Group 1 are to be followed at spaced intervals during day hospital visits by the investigator assisted by a specialized referral nurse as part of the regular follow-up procedure (dressing changes + ulcer monitoring). Between visits, an independent nurse (IN) provides local care on a daily basis. Patients included in Group 2 have their DFU treated by a referral nurse trained at the diabetic foot unit of the investigating centre, and they are also followed up by an IN under the supervision of a referral nurse. In Group 2, monitoring of lesions is performed weekly by the referral nurse using photos of the DFU with planimetry taken by the IN and sent to the referral nurse via telemedicine software. The referral nurse can, in turn, provide guidance to the IN on the care to be provided and/or decide that a further hospital visit is needed. Both treatment groups are to be followed for 12 months or until complete healing of the ulcer. RESULTS Recruitment for the study began in March 2017 and ended in May 2019, with the final study visit scheduled for May 2020. CONCLUSION The aim of the Télépied study is to assess the impact of ambulatory foot ulcer management in diabetics over a 1-year period by a non-specialized IN working under the supervision of a referral nurse via telemedicine follow-up versus standard follow-up by an IN alone. The primary endpoint is the total duration of hospitalization required until full healing of the ulcer.
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Affiliation(s)
- Dured Dardari
- Diabetology Department, Centre Hospitalier Sud Francilien, 40 Avenue Serge Dassault, 91106, Corbeil-Essonnes, France.
- Cordeliers Research Centre INSERM U1138 "Diabetes, Metabolic Diseases and Comorbidities" Team, 15 rue de l'Ecole de Médecine, 75270, Paris cedex 06, France.
| | - Sylvia Franc
- Diabetology Department, Centre Hospitalier Sud Francilien, 40 Avenue Serge Dassault, 91106, Corbeil-Essonnes, France
- Centre for Studies and Research for Intensification of Diabetes Therapy (CERITD), Bioparc Génopôle Evry-Corbeil, Campus 3, Bâtiment 5, 1 rue Pierre Fontaine, 91058, Evry-Cedex, France
| | - Guillaume Charpentier
- Centre for Studies and Research for Intensification of Diabetes Therapy (CERITD), Bioparc Génopôle Evry-Corbeil, Campus 3, Bâtiment 5, 1 rue Pierre Fontaine, 91058, Evry-Cedex, France
| | - Elise Bobony
- Diabetology Department, Centre Hospitalier Sud Francilien, 40 Avenue Serge Dassault, 91106, Corbeil-Essonnes, France
- Centre for Studies and Research for Intensification of Diabetes Therapy (CERITD), Bioparc Génopôle Evry-Corbeil, Campus 3, Bâtiment 5, 1 rue Pierre Fontaine, 91058, Evry-Cedex, France
| | - Laetitia Demangeon
- Diabetology Department, Centre Hospitalier Sud Francilien, 40 Avenue Serge Dassault, 91106, Corbeil-Essonnes, France
- Centre for Studies and Research for Intensification of Diabetes Therapy (CERITD), Bioparc Génopôle Evry-Corbeil, Campus 3, Bâtiment 5, 1 rue Pierre Fontaine, 91058, Evry-Cedex, France
| | - Marie Bouly
- Diabetology Department, Centre Hospitalier Sud Francilien, 40 Avenue Serge Dassault, 91106, Corbeil-Essonnes, France
| | - Ilham Xhaard
- Centre for Studies and Research for Intensification of Diabetes Therapy (CERITD), Bioparc Génopôle Evry-Corbeil, Campus 3, Bâtiment 5, 1 rue Pierre Fontaine, 91058, Evry-Cedex, France
| | - Laurent Orlando
- Centre for Studies and Research for Intensification of Diabetes Therapy (CERITD), Bioparc Génopôle Evry-Corbeil, Campus 3, Bâtiment 5, 1 rue Pierre Fontaine, 91058, Evry-Cedex, France
| | - Maria Alhajj
- Centre for Studies and Research for Intensification of Diabetes Therapy (CERITD), Bioparc Génopôle Evry-Corbeil, Campus 3, Bâtiment 5, 1 rue Pierre Fontaine, 91058, Evry-Cedex, France
| | - Kadijatou Ly Sall
- Diabetology Department, Centre Hospitalier Sud Francilien, 40 Avenue Serge Dassault, 91106, Corbeil-Essonnes, France
- Centre for Studies and Research for Intensification of Diabetes Therapy (CERITD), Bioparc Génopôle Evry-Corbeil, Campus 3, Bâtiment 5, 1 rue Pierre Fontaine, 91058, Evry-Cedex, France
| | - Caroline Randazzo
- Centre for Studies and Research for Intensification of Diabetes Therapy (CERITD), Bioparc Génopôle Evry-Corbeil, Campus 3, Bâtiment 5, 1 rue Pierre Fontaine, 91058, Evry-Cedex, France
| | - Alfred Penfornis
- Diabetology Department, Centre Hospitalier Sud Francilien, 40 Avenue Serge Dassault, 91106, Corbeil-Essonnes, France
- Paris-Sud Medical School, Paris-Saclay University, Saint-Aubin, France
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Dardari D, Van GH, M’Bemba J, Laborne FX, Bourron O, Davaine JM, Phan F, Foufelle F, Jaisser F, Penfornis A, Hartemann A. Rapid glycemic regulation in poorly controlled patients living with diabetes, a new associated factor in the pathophysiology of Charcot's acute neuroarthropathy. PLoS One 2020; 15:e0233168. [PMID: 32437409 PMCID: PMC7241699 DOI: 10.1371/journal.pone.0233168] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Accepted: 04/29/2020] [Indexed: 02/06/2023] Open
Abstract
Objective Aggressive antidiabetic therapy and rapid glycemic control are associated with diabetic neuropathy. Here we investigated if this is also the case for Charcot neuroarthropathy. Research design and methods HbA1c levels and other relevant data were extracted from medical databases of 44 cases of acute Charcot neuroarthropathy. Results HbA1c levels significantly declined from 8.25% (67mmol/mol) [7.1%–9.4%](54-79mmol/mol), at -6 months (M-6), to 7.40%(54mmol/mol) [6.70%–8.03%] (50–64 mmol/mol) during the six months preceding the diagnosis of Charcot neuroarthropathy (P <0.001). Conclusions HbA1c levels significantly declined during the six months preceding the onset of Charcot neuroarthropathy. This decline seems to be a associated factor with the appearance of an active phase of Charcot neuroarthropathy in poorly controlled patients with diabetic sensitive neuropathy.
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Affiliation(s)
- Dured Dardari
- Department of Diabetes, Sud Francilien Hospital Center, Corbeil-Essonnes, France
- INSERM UMRS 1138, Cordeliers Research Center, Paris, France
- Sorbonne University, Paris, France
- * E-mail:
| | - Georges Ha Van
- Department of Diabetes, Pitié-Salpêtrière Hospital, Paris, France
| | | | | | - Olivier Bourron
- INSERM UMRS 1138, Cordeliers Research Center, Paris, France
- Sorbonne University, Paris, France
- Department of Diabetes, Pitié-Salpêtrière Hospital, Paris, France
| | - Jean Michel Davaine
- INSERM UMRS 1138, Cordeliers Research Center, Paris, France
- Department of Vascular Surgery Pitié-Salpêtrière Hospital, Paris, France
| | - Franck Phan
- INSERM UMRS 1138, Cordeliers Research Center, Paris, France
- Sorbonne University, Paris, France
- Department of Diabetes, Pitié-Salpêtrière Hospital, Paris, France
| | | | | | - Alfred Penfornis
- Department of Diabetes, Sud Francilien Hospital Center, Corbeil-Essonnes, France
- Paris-Sud Medical School, Paris-Saclay University, Corbeil-Essonnes, France
| | - Agnes Hartemann
- INSERM UMRS 1138, Cordeliers Research Center, Paris, France
- Sorbonne University, Paris, France
- Department of Diabetes, Pitié-Salpêtrière Hospital, Paris, France
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Potier L, François M, Dardari D, Feron M, Belhatem N, Nobecourt-Dupuy E, Dolz M, Bordier L, Ducloux R, Chibani A, Eveno DF, Crea Avila T, Sultan A, Baillet-Blanco L, Rigalleau V, Gand E, Saulnier PJ, Velho G, Roussel R, Pellenc Q, Dupré JC, Malgrange D, Marre M, Mohammedi K. Comparison of a new versus standard removable offloading device in patients with neuropathic diabetic foot ulcers: a French national, multicentre, open-label randomized, controlled trial. BMJ Open Diabetes Res Care 2020; 8:8/1/e000954. [PMID: 32393479 PMCID: PMC7223015 DOI: 10.1136/bmjdrc-2019-000954] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 10/10/2019] [Revised: 04/14/2020] [Accepted: 04/18/2020] [Indexed: 12/30/2022] Open
Abstract
INTRODUCTION The offloading is crucial to heal neuropathic diabetic foot ulcer (DFU). Removable offloading are the most used devices. Orthèse diabète is a new customized removable knee-high offloading device immobilizing foot and ankle joints, with some specific and innovative features that may improve offloading. We aimed to evaluate the efficiency of this device in DFU healing. RESEARCH, DESIGN AND METHODS The evaluation of Offloading using a new removable ORTHOsis in DIABetic foot study is a French multicenter (13 centers) randomized controlled trial with blinded end points evaluation. Adults with neuropathic DFU were randomly assigned to either Orthèse Diabète (experimental device), or any type of conventional (usually used in France) removable offloading devices (control group). The primary outcome was the 3-month proportion of patients with fully healed DFU. RESULTS Among 112 randomized patients (men 78%, age 62±10 years), the primary outcome occurred in 19 (33%) participants using conventional device vs 19 (35%) Orthèse Diabète users (p=0.79). Study groups were also comparable in terms of prespecified secondary end points including occurrence of new DFU (25% vs 27% in conventional and experimental groups), ipsilateral lower-limb amputation (4% vs 10%) or infectious complications (14% vs 13%) (p>0.05 for all). Adverse events were comparable between groups, including 4 deaths unrelated to study allocation (1 sudden death, 2 ventricular arrhythmias and 1 pancreatic cancer). Adverse events believed to be related to the device were higher in the Orthèse Diabète group than in the control group (15% vs 4%). Orthèse Diabète was less frequently worn than conventional devices (46% vs 66%, p=0.04). CONCLUSIONS Orthèse Diabète, a new removable offloading orthosis immobilizing foot and ankle joints did not show superiority compared with conventional removable devices in neuropathic DFU healing and cannot be recommended to heal DFU. TRIAL REGISTRATION NUMBER NCT01956162.
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Affiliation(s)
- Louis Potier
- Diabetology, Endocrinology and Nutrition, Bichat Hospital, Assistance Publique-Hôpitaux de Paris, Paris, Île-de-France, France
- Université de Paris, Paris, Île-de-France, France
| | - Maud François
- Endocrinology, Diabetology and Nutrition, Centre Hospitalier Universitaire de Reims, Reims, France
| | - Dured Dardari
- Diabetology, Centre Hospitalier Sud Francilien, Corbeil-Essonnes, Paris, France
| | - Marilyne Feron
- Diabetology, Endocrinology and Nutrition, Bichat Hospital, Assistance Publique-Hôpitaux de Paris, Paris, Île-de-France, France
| | - Narimene Belhatem
- Diabetology, Endocrinology and Nutrition, Bichat Hospital, Assistance Publique-Hôpitaux de Paris, Paris, Île-de-France, France
| | - Estelle Nobecourt-Dupuy
- Department of Diabetology, Endocrinology and Nutrition, Centre Hospitalier Universitaire de la Réunion, Saint Denis de la Réunion, France
| | - Manuel Dolz
- Endocrinology Department, Hôpital Bégin, Saint-Mandé, France
| | - Lyse Bordier
- Endocrinology Department, Hôpital Bégin, Saint-Mandé, France
| | - Roxane Ducloux
- APHP, Hôpital Corentin-Celton, Centre de Cicatrisation du Pied du Diabétique, Issy les Moulineaux, France
| | - Abdelkader Chibani
- Department of Diabetology, Endocrinology and Nutrition, Centre Hospitalier Gonesse, Gonesse, France
| | - Dominique-François Eveno
- Department of Functional Rehabilitation, Centre Hospitalier La Tourmaline, La Tourmaline, France
| | - Teresa Crea Avila
- Department of Diabetology, Endocrinology and Nutrition, Centre Hospitalier Régional de Metz-Thionville, Thionville, France
| | - Ariane Sultan
- Department of Endocrinology, Diabetology and Nutrition, CHRU Montpellier, Montpellier, France
- INSERM U1046, University of Montpellier 1, Montpellier, France
| | - Laurence Baillet-Blanco
- Department of Endocrinology, Diabetology and Nutrition, CHU Bordeaux, Haut Lévèque Hospital, Pessac, France
| | - Vincent Rigalleau
- Department of Endocrinology, Diabetology and Nutrition, CHU Bordeaux, Haut Lévèque Hospital, Pessac, France
- Department of Life and Health Sciences, University of Bordeaux, Bordeaux, Aquitaine, France
| | - Elise Gand
- INSERM CIC 1402, University of Poitiers, CHU Poitiers, Poitiers, France
| | | | - Gilberto Velho
- INSERM, UMR_S 1138, Centre de Recherche des Cordeliers, Paris, France
| | - Ronan Roussel
- Diabetology, Endocrinology and Nutrition, Bichat Hospital, Assistance Publique-Hôpitaux de Paris, Paris, Île-de-France, France
- INSERM, UMR_S 1138, Centre de Recherche des Cordeliers, Paris, France
| | - Quentin Pellenc
- Vascular Surgery Department, Bichat Hospital, Assistance Publique-Hôpitaux de Paris, Paris, Île-de-France, France
| | - Jean-Claude Dupré
- Diabetology, Endocrinology and Nutrition, Bichat Hospital, Assistance Publique-Hôpitaux de Paris, Paris, Île-de-France, France
| | - Dominique Malgrange
- Endocrinology, Diabetology and Nutrition, Centre Hospitalier Universitaire de Reims, Reims, France
| | - Michel Marre
- Diabetology, Endocrinology and Nutrition, Bichat Hospital, Assistance Publique-Hôpitaux de Paris, Paris, Île-de-France, France
| | - Kamel Mohammedi
- Department of Endocrinology, Diabetology and Nutrition, CHU Bordeaux, Haut Lévèque Hospital, Pessac, France
- Department of Life and Health Sciences, University of Bordeaux, Bordeaux, Aquitaine, France
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Dardari D, Penfornis A, Amadou C, Phan F, Bourron O, Davaine JM, Foufelle F, Jaisser F, Laborne FX, Hartemann A. Multifocal (tarsus and knee) activation of neuroarthropathy following rapid glycaemic correction. J Diabetes Complications 2019; 33:107438. [PMID: 31668589 DOI: 10.1016/j.jdiacomp.2019.107438] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [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: 04/14/2019] [Revised: 08/21/2019] [Accepted: 08/25/2019] [Indexed: 11/24/2022]
Abstract
OBJECTIVE To report a case of neuroarthropathy in the tarsus and knee following rapid glycaemic normalisation in a female patient with type I diabetes. METHODS A retrospective review of case notes. RESULTS We describe the case of a female patient with type I diabetes who had developed a multifocal neuroarthropathy in only six months, probably due to a rapid glycaemic normalisation. The onset of this neuroarthropathy was not only fast but mostly multifocal affecting two levels of joints. CONCLUSION The link between the onset of multifocal neuroarthropathy and the rapid correction of chronic hyperglycaemia is probably proven in our case. Patients with chronic hyperglycaemia with sensitive neuropathy should benefit from a gradual correction of their glycaemic imbalance in order to avoid the apparition of neuroarthropathy.
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Affiliation(s)
- Dured Dardari
- Diabetology Department, Centre Hopitalier Sud Francilien, Corbeil Essonnes, France; Centre de recherche des Cordeliers INSERM U1138 Team "Diabetes, metabolic diseases and comorbidities", 15 rue de l'Ecole de Médecine, 75270 Paris cedex 06, France; Sorbonne Université, 15 rue de l'Ecole de Médecine, 75006 Paris, France.
| | - Alfred Penfornis
- Diabetology Department, Centre Hopitalier Sud Francilien, Corbeil Essonnes, France
| | - Coralie Amadou
- Diabetology Department, Centre Hopitalier Sud Francilien, Corbeil Essonnes, France
| | - Franck Phan
- Diabetology Department, AP-HP, Hôpital Pitié-Salpêtrière, F-75013 Paris, France; Centre de recherche des Cordeliers INSERM U1138 Team "Diabetes, metabolic diseases and comorbidities", 15 rue de l'Ecole de Médecine, 75270 Paris cedex 06, France; Sorbonne Université, 15 rue de l'Ecole de Médecine, 75006 Paris, France
| | - Olivier Bourron
- Diabetology Department, AP-HP, Hôpital Pitié-Salpêtrière, F-75013 Paris, France; Centre de recherche des Cordeliers INSERM U1138 Team "Diabetes, metabolic diseases and comorbidities", 15 rue de l'Ecole de Médecine, 75270 Paris cedex 06, France; Sorbonne Université, 15 rue de l'Ecole de Médecine, 75006 Paris, France
| | - Jean Michel Davaine
- Centre de recherche des Cordeliers INSERM U1138 Team "Diabetes, metabolic diseases and comorbidities", 15 rue de l'Ecole de Médecine, 75270 Paris cedex 06, France; Vascular Surgery Department AP-HP, Hôpital Pitié-Salpêtrière, F-75013 Paris, France; Sorbonne Université, 15 rue de l'Ecole de Médecine, 75006 Paris, France
| | - Fabienne Foufelle
- Centre de recherche des Cordeliers INSERM U1138 Team "Diabetes, metabolic diseases and comorbidities", 15 rue de l'Ecole de Médecine, 75270 Paris cedex 06, France
| | - Frédéric Jaisser
- Centre de recherche des Cordeliers INSERM U1138 Team "Diabetes, metabolic diseases and comorbidities", 15 rue de l'Ecole de Médecine, 75270 Paris cedex 06, France
| | - Francois-Xavier Laborne
- Clinical Research Unit centre hospitalier sud Francilien, 40 Avenue Serge Dassault, 91100 Corbeil-Essonnes, France
| | - Agnes Hartemann
- Diabetology Department, AP-HP, Hôpital Pitié-Salpêtrière, F-75013 Paris, France; Centre de recherche des Cordeliers INSERM U1138 Team "Diabetes, metabolic diseases and comorbidities", 15 rue de l'Ecole de Médecine, 75270 Paris cedex 06, France; Sorbonne Université, 15 rue de l'Ecole de Médecine, 75006 Paris, France
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Franc S, Joubert M, Daoudi A, Fagour C, Benhamou P, Rodier M, Boucherie B, Benamo E, Schaepelynck P, Guerci B, Dardari D, Borot S, Penfornis A, D'Orsay G, Mari K, Reznik Y, Randazzo C, Charpentier G. Efficacy of two telemonitoring systems to improve glycaemic control during basal insulin initiation in patients with type 2 diabetes: The TeleDiab-2 randomized controlled trial. Diabetes Obes Metab 2019; 21:2327-2332. [PMID: 31173451 PMCID: PMC6771866 DOI: 10.1111/dom.13806] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Revised: 05/24/2019] [Accepted: 06/05/2019] [Indexed: 11/27/2022]
Abstract
TeleDiab-2 was a 13-month randomized controlled trial evaluating the efficacy and safety of two telemonitoring systems to optimize basal insulin (BI) initiation in subjects with inadequately controlled type 2 diabetes (HbA1c, 7.5%-10%). A total of 191 participants (mean age 58.7 years, mean HbA1c 8.9%) were randomized into three groups: group 1(G1, standard care, n = 63), group 2 (G2, interactive voice response system, n = 64) and group 3 (G3, Diabeo-BI app software, n = 64). The two telemonitoring systems proposed daily adjustments of BI doses, in order to facilitate the achievement of fasting blood glucose (FBG) values targeted at ~100 mg/dL. At 4 months follow-up, HbA1c reduction was significantly higher in the telemonitoring groups (G2: -1.44% and G3: -1.48% vs. G1: -0.92%; P < 0.002). Moreover, target FBG was reached by twice as many patients in the telemonitoring groups as in the control group, and insulin doses were also titrated to higher levels. No severe hypoglycaemia was observed in the telemonitoring groups and mild hypoglycaemia frequency was similar in all groups. In conclusion, both telemonitoring systems improved glycaemic control to a similar extent, without increasing hypoglycaemic episodes.
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Affiliation(s)
- Sylvia Franc
- CERITD (Centre for Studies and Research for the Intensification of Diabetes Treatment)Bioparc Genopole CampusEvryFrance
- Department of DiabetesSud‐Francilien HospitalCorbeil‐EssonnesFrance
| | | | - Ahmed Daoudi
- CERITD (Centre for Studies and Research for the Intensification of Diabetes Treatment)Bioparc Genopole CampusEvryFrance
| | - Cédric Fagour
- Department of Diabetology and EndocrinologyFort‐de‐France University HospitalFort de FranceFrance
| | - Pierre‐Yves Benhamou
- Department of Diabetology, Endocrinology and Nutrition DiseasesGrenoble University HospitalGrenobleFrance
| | - Michel Rodier
- Department of Metabolic Diseases and EndocrinologyNimes University HospitalNimesFrance
| | - Beatrix Boucherie
- CERITD (Centre for Studies and Research for the Intensification of Diabetes Treatment)Bioparc Genopole CampusEvryFrance
| | - Eric Benamo
- Department of Endocrinology and Metabolic DiseasesAvignon University HospitalAvignonFrance
| | - Pauline Schaepelynck
- Department of Endocrinology, Diabetes and Metabolic DiseasesMarseille University HospitalMarseilleFrance
| | - Bruno Guerci
- Department of Endocrinology, Diabetes and NutritionNancy University HospitalNancyFrance
| | - Dured Dardari
- CERITD (Centre for Studies and Research for the Intensification of Diabetes Treatment)Bioparc Genopole CampusEvryFrance
- Department of DiabetesSud‐Francilien HospitalCorbeil‐EssonnesFrance
| | - Sophie Borot
- Department of Diabetology and EndocrinologyBesançon University HospitalBesançonFrance
| | - Alfred Penfornis
- Department of DiabetesSud‐Francilien HospitalCorbeil‐EssonnesFrance
| | | | - Karine Mari
- Randomised Clinical Trials (RCTs') Department of StatisticsLyonFrance
| | - Yves Reznik
- Diabetes Care UnitCaen University HospitalCaenFrance
| | - Caroline Randazzo
- CERITD (Centre for Studies and Research for the Intensification of Diabetes Treatment)Bioparc Genopole CampusEvryFrance
| | - Guillaume Charpentier
- CERITD (Centre for Studies and Research for the Intensification of Diabetes Treatment)Bioparc Genopole CampusEvryFrance
- Department of DiabetesSud‐Francilien HospitalCorbeil‐EssonnesFrance
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20
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Mohammedi K, Potier L, François M, Dardari D, Feron M, Nobecourt-Dupuy E, Dolz M, Ducloux R, Chibani A, Eveno DF, Crea Avila T, Sultan A, Baillet-Blanco L, Rigalleau V, Velho G, Tubach F, Roussel R, Dupré JC, Malgrange D, Marre M. The evaluation of off-loading using a new removable oRTHOsis in DIABetic foot (ORTHODIAB) randomized controlled trial: study design and rational. J Foot Ankle Res 2016; 9:34. [PMID: 27555884 PMCID: PMC4994157 DOI: 10.1186/s13047-016-0163-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2016] [Accepted: 08/09/2016] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Off-loading is essential for diabetic foot management, but remains understudied. The evaluation of Off-loading using a new removable oRTHOsis in DIABetic foot (ORTHODIAB) trial aims to evaluate the efficacy of a new removable device "Orthèse Diabète" in the healing of diabetic foot. METHODS/DESIGN ORTHODIAB is a French multi-centre randomized, open label trial, with a blinded end points evaluation by an adjudication committee according to the Prospective Randomized Open Blinded End-point. Main endpoints are adjudicated based on the analysis of diabetic foot photographs. Orthèse Diabète is a new removable off-loading orthosis (PROTEOR, France) allowing innovative functions including real-time evaluation of off-loading and estimation of patients' adherence. Diabetic patients with neuropathic plantar ulcer or amputation wounds (toes or transmetatarsal) are assigned to one of 2 parallel-groups: Orthèse Diabète or control group (any removable device) according to a central computer-based randomization. Study visits are scheduled for 6 months (days D7 and D14, and months M1, M2, M3, and M6). The primary endpoint is the proportion of patients whose principal ulcer is healed at M3. Secondary endpoints are: the proportion of patients whose principal ulcer is healed at M1, M2 and M6; the proportion of patients whose initial ulcers are all healed at M1, M2, M3, and M6; principal ulcer area reduction; time-related ulcer-free survival; development of new ulcers; new lower-extremity amputation; infectious complications; off-loading adherence; and patient satisfaction. The study protocol was approved by the French National Agency for Medicines and Health Products Safety, and by the ethics committee of Saint-Louis Hospital (Paris). Comprehensive study information including a Patient Information Sheet has been provided to each patient who must give written informed consent before enrolment. Monitoring, data management, and statistical analyses are providing by UMANIS Life Science (Paris), independently to the sponsor. Since 27/10/2013, 13 centres have agreed to participate in this study, 117 participants were included, and 70 have achieved the study schedules. The study completion is expected for the end of 2016, and the main results will be published in 2017. CONCLUSION ORTHODIAB trial evaluates an innovating removable off-loading device, seeking to improve diabetic foot healing (ClinicalTrials.gov identifier: NCT01956162).
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Affiliation(s)
- Kamel Mohammedi
- Department of Endocrinology, Diabetes, and Nutrition, DHU FIRE, Bichat-Claude Bernard Hospital, Assistance Publique Hôpitaux de Paris, Paris, France ; INSERM, UMR_S 1138, Centre de Recherche des Cordeliers, Paris, France
| | - Louis Potier
- Department of Endocrinology, Diabetes, and Nutrition, DHU FIRE, Bichat-Claude Bernard Hospital, Assistance Publique Hôpitaux de Paris, Paris, France ; INSERM, UMR_S 1138, Centre de Recherche des Cordeliers, Paris, France ; Université Paris Diderot, Sorbonne Paris Cité, UFR de Médecine, Paris, France
| | - Maud François
- Centre Hospitalier Universitaire de Reims, Service d'Endocrinologie, Diabète, Nutrition, Reims, France
| | - Dured Dardari
- Department of Diabetology, Endocrinology and Nutrition, Centre hospitalier Sud Francilien, Corbeil-Essonnes, France
| | - Marilyne Feron
- Department of Endocrinology, Diabetes, and Nutrition, DHU FIRE, Bichat-Claude Bernard Hospital, Assistance Publique Hôpitaux de Paris, Paris, France
| | - Estelle Nobecourt-Dupuy
- Department of Diabetology, Endocrinology and Nutrition, Centre Hospitalier Universitaire de Nantes, Nantes, France
| | - Manuel Dolz
- Endocrinology Department, Hôpital Bégin, Saint-Mandé, France
| | - Roxane Ducloux
- APHP, Hôpital Corentin-Celton, Centre de Cicatrisation du Pied du Diabétique, Issy-les-Moulineaux, France
| | - Abdelkader Chibani
- Department of Diabetology, Endocrinology and Nutrition, Centre Hospitalier de Gonesse, Gonesse, France
| | - Dominique-François Eveno
- Department of functional rehabilitation, Centre Hospitalier La Tourmaline, Saint Herblain, France
| | - Teresa Crea Avila
- Department of Diabetology, Centre Hospitalier Régional de Metz - Thionville, Endocrinology and Nutrition, Thionville, France
| | - Ariane Sultan
- Endocrinology-Diabetology-Nutrition Department, CHRU Montpellier, Montpellier, France ; INSERM U1046, University of Montpellier 1, Montpellier, France
| | | | - Vincent Rigalleau
- Nutrition and Diabetology Unit, CHU de Bordeaux, Haut Lévèque Hospital, Pessac, France ; University of Bordeaux, Bordeaux, France
| | - Gilberto Velho
- INSERM, UMR_S 1138, Centre de Recherche des Cordeliers, Paris, France
| | - Florence Tubach
- Département d'Epidémiologie et Recherche Clinique, APHP, CIC-EC 1425, Centre de Pharmacoépidémiologie (Cephepi), Paris, France ; Université Paris Diderot, Sorbonne Paris Cité, UFR de Médecine, Paris, France
| | - Ronan Roussel
- Department of Endocrinology, Diabetes, and Nutrition, DHU FIRE, Bichat-Claude Bernard Hospital, Assistance Publique Hôpitaux de Paris, Paris, France ; INSERM, UMR_S 1138, Centre de Recherche des Cordeliers, Paris, France ; Université Paris Diderot, Sorbonne Paris Cité, UFR de Médecine, Paris, France
| | - Jean-Claude Dupré
- Department of Endocrinology, Diabetes, and Nutrition, DHU FIRE, Bichat-Claude Bernard Hospital, Assistance Publique Hôpitaux de Paris, Paris, France
| | - Dominique Malgrange
- Centre Hospitalier Universitaire de Reims, Service d'Endocrinologie, Diabète, Nutrition, Reims, France
| | - Michel Marre
- Department of Endocrinology, Diabetes, and Nutrition, DHU FIRE, Bichat-Claude Bernard Hospital, Assistance Publique Hôpitaux de Paris, Paris, France ; INSERM, UMR_S 1138, Centre de Recherche des Cordeliers, Paris, France ; Université Paris Diderot, Sorbonne Paris Cité, UFR de Médecine, Paris, France
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Leveziel N, Ragot S, Gand E, Lichtwitz O, Halimi JM, Gozlan J, Gourdy P, Robert MF, Dardari D, Boissonnot M, Roussel R, Piguel X, Dupuy O, Torremocha F, Saulnier PJ, Maréchaud R, Hadjadj S. Association Between Diabetic Macular Edema and Cardiovascular Events in Type 2 Diabetes Patients: A Multicenter Observational Study. Medicine (Baltimore) 2015; 94:e1220. [PMID: 26287408 PMCID: PMC4616429 DOI: 10.1097/md.0000000000001220] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
Diabetic macular edema (DME) is the main cause of visual loss associated with diabetes but any association between DME and cardiovascular events is unclear.This study aims to describe the possible association between DME and cardiovascular events in a multicenter cross-sectional study of patients with type 2 diabetes.Two thousand eight hundred seven patients with type 2 diabetes were recruited from diabetes and nephrology clinical institutional centers participating in the DIAB 2 NEPHROGENE study focusing on diabetic complications. DME (presence/absence) and diabetic retinopathy (DR) classification were based on ophthalmological report and/or on 30° color retinal photographs. DR was defined as absent, nonproliferative (background, moderate, or severe) or proliferative. Cardiovascular events were stroke, myocardial infarction, and lower limb amputation.Details regarding associations between DME and cardiovascular events were evaluated.The study included 2807 patients with type 2 diabetes, of whom 355 (12.6%) had DME. DME was significantly and independently associated with patient age, known duration of diabetes, HbA1c, systolic blood pressure, and DR stage. Only the prior history of lower limb amputation was strongly associated with DME in univariate and multivariate analyses, whereas no association was found with regard to myocardial infarction or stroke. Moreover, both major (n = 32) and minor lower limb (n = 96) amputations were similarly associated with DME, with respective odds ratio of 3.7 (95% confidence interval [CI], 1.77-7.74; P = 0.0012) and of 4.29 (95% CI, 2.79-6.61; P < 0.001).DME is strongly and independently associated with lower limb amputation in type 2 diabetic patients.
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Affiliation(s)
- Nicolas Leveziel
- From the Department of ophthalmology, University Hospital of Poitiers, France (NL, OL, JG, M-FR, MB); University of Poitiers, UFR Médecine et Pharmacie, France (NL, RM); U1084, Inserm, Poitiers, France (NL); Centre d'investigation clinique, University of Poitiers, Poitiers, France (SR, P-JS, SH); CIC1402, Inserm, France (SR, P-JS, SH); Centre d'investigation clinique, University Hospital of Poitiers, Poitiers, France (SR, P-JS, SH); Endocrinology and Diabetology Department, pole DUNE, University Hospital of Poitiers, Poitiers, France (EG, XP, RM, SH); Department of Nephrology-immunology, University Hospital of Tours, François Rabelais University, Tours, France (JMH); Diabetology Department, Rangueuil Hospital, University Hospital of Toulouse, France (PG); Endocrinology Department Hospital of Sud Francilien, Corbeil Essonnes, France (DD); UMRS1138, Inserm, Paris, France (RR); University Paris 7 Denis Diderot, UMRS1138, Paris, France (RR); Diabetology, endocrinology and Nutrition Department, Groupe Hospitalier Bichat Claude Bernard, Assistance Public-Hopitaux de Paris (AP-HP), Paris, France (RR); Diabetology Department Bégin Armed Forces Hospital, Saint Mandé, France (OD); U1082, Inserm, Poitiers, France (SH)
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Dardari D, Bouly M, Guillot M, Charpentier G, Fernandes S, Penformis A. OP2 La fourniture de la chaussure de décharge pendant la consultation de pied diabétique réduit le risque d’aggravation des lésions du pied diabétique. Diabetes & Metabolism 2015. [DOI: 10.1016/s1262-3636(15)30474-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Canipel L, Dardari D, Franc S, Laroye H, Mounier S, Boscus O, Brandicourt A, Agnard V, De Moura C, Ribeiro A, Not D, Mistretta F, Charpentier G. Étude ARCHIPEL : suivi d’une cohorte de patients diabétiques insulino traités par pompe à insuline externe et bénéficiant d’un protocole de coopération plan d’éducation personnalisé électronique (ePEP). Rev Epidemiol Sante Publique 2014. [DOI: 10.1016/j.respe.2013.11.005] [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: 10/25/2022] Open
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Franc S, Borot S, Ronsin O, Quesada JL, Dardari D, Fagour C, Renard E, Leguerrier AM, Vigeral C, Moreau F, Winiszewski P, Vambergue A, Mosnier-Pudar H, Kessler L, Reffet S, Guerci B, Millot L, Halimi S, Thivolet C, Benhamou PY, Penfornis A, Charpentier G, Hanaire H. Telemedicine and type 1 diabetes: is technology per se sufficient to improve glycaemic control? Diabetes Metab 2013; 40:61-66. [PMID: 24139705 DOI: 10.1016/j.diabet.2013.09.001] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/26/2013] [Revised: 08/15/2013] [Accepted: 09/02/2013] [Indexed: 11/26/2022]
Abstract
AIM In the TELEDIAB-1 study, the Diabeo system (a smartphone coupled to a website) improved HbA1c by 0.9% vs controls in patients with chronic, poorly controlled type 1 diabetes. The system provided two main functions: automated advice on the insulin doses required; and remote monitoring by teleconsultation. The question is: how much did each function contribute to the improvement in HbA1c? METHODS Each patient received a smartphone with an insulin dose advisor (IDA) and with (G3 group) or without (G2 group) the telemonitoring/teleconsultation function. Patients were classified as "high users" if the proportion of "informed" meals using the IDA exceeded 67% (median) and as "low users" if not. Also analyzed was the respective impact of the IDA function and teleconsultations on the final HbA1c levels. RESULTS Among the high users, the proportion of informed meals remained stable from baseline to the end of the study 6months later (from 78.1±21.5% to 73.8±25.1%; P=0.107), but decreased in the low users (from 36.6±29.4% to 26.7±28.4%; P=0.005). As expected, HbA1c improved in high users from 8.7% [range: 8.3-9.2%] to 8.2% [range: 7.8-8.7%] in patients with (n=26) vs without (n=30) the benefit of telemonitoring/teleconsultation (-0.49±0.60% vs -0.52±0.73%, respectively; P=0.879). However, although HbA1c also improved in low users from 9.0% [8.5-10.1] to 8.5% [7.9-9.6], those receiving support via teleconsultation tended to show greater improvement than the others (-0.93±0.97 vs -0.46±1.05, respectively; P=0.084). CONCLUSION The Diabeo system improved glycaemic control in both high and low users who avidly used the IDA function, while the greatest improvement was seen in the low users who had the motivational support of teleconsultations.
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Affiliation(s)
- S Franc
- Department of Diabetes, Sud-Francilien Hospital, Corbeil-Essonnes, France; Centre d'Études et de Recherches pour l'Intensification du Traitement du Diabète (CERITD), Corbeil-Essonnes, France.
| | - S Borot
- Department of Endocrinology-Metabolism and Diabetology-Nutrition, Jean-Minjoz Hospital, Besançon, France
| | - O Ronsin
- Department of Diabetes, Sainte-Marguerite University Hospital, Marseille, France
| | - J-L Quesada
- Department of Biostatistics, CIC-Inserm, University Hospital, Grenoble, France
| | - D Dardari
- Centre d'Études et de Recherches pour l'Intensification du Traitement du Diabète (CERITD), Corbeil-Essonnes, France
| | - C Fagour
- Department of Endocrinology, University Hospital Pessac, Pessac, France
| | - E Renard
- Department of Endocrinology, University Hospital, Montpellier, France
| | - A-M Leguerrier
- Department of Endocrinology, University Hospital, Rennes, France
| | - C Vigeral
- Department of Diabetes, Hôtel-Dieu University Hospital, Paris, France
| | - F Moreau
- Department of Endocrinology, University Hospital, Strasbourg, France
| | - P Winiszewski
- Department of Endocrinology, Belfort Hospital, Belfort, France
| | - A Vambergue
- Clinique Marc Linquette, Department of Endocrinology and Diabetology, Lille, France
| | | | - L Kessler
- Department of Endocrinology, University Hospital, Strasbourg, France
| | - S Reffet
- Department of Endocrinology, Édouard-Herriot Hospital, Lyon, France
| | - B Guerci
- Diabetology, Nutrition, Metabolic disorders, Brabois Hospital and Center of Clinical Investigation ILCV, University Hospital, Nancy, France
| | - L Millot
- Department of Endocrinology, Bellevue Hospital, Saint-Étienne, France
| | - S Halimi
- Department of Endocrinology, Diabetology, Nutrition University Hospital, Grenoble, France; University J Fourier 1, Grenoble, France
| | - C Thivolet
- Department of Endocrinology, Édouard-Herriot Hospital, Lyon, France
| | - P-Y Benhamou
- Department of Endocrinology, Diabetology, Nutrition University Hospital, Grenoble, France
| | - A Penfornis
- Department of Endocrinology-Metabolism and Diabetology-Nutrition, Jean-Minjoz Hospital, Besançon, France
| | - G Charpentier
- Department of Diabetes, Sud-Francilien Hospital, Corbeil-Essonnes, France; Centre d'Études et de Recherches pour l'Intensification du Traitement du Diabète (CERITD), Corbeil-Essonnes, France
| | - H Hanaire
- Department of Diabetes, Rangueil University Hospital, Toulouse, France
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Montaigne D, Bailloeuil O, Hulin-Delmotte C, Edme JL, Sosner P, Miot A, Ragot S, Saulnier PJ, Dupuy O, Gourdy P, Lecomte P, Guerci B, Dardari D, Roussel R, Neviere R, Lacroix D, Hadjadj S. Renal complications correlate with electrical atrial vulnerability hallmarks in type 2 diabetic patients. Int J Cardiol 2012; 159:63-6. [PMID: 22713678 DOI: 10.1016/j.ijcard.2012.04.035] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2012] [Accepted: 04/08/2012] [Indexed: 11/17/2022]
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Franc S, Daoudi A, Mounier S, Boucherie B, Laroye H, Peschard C, Dardari D, Juy O, Requeda E, Canipel L, Charpentier G. Telemedicine: What more is needed for its integration in everyday life? Diabetes & Metabolism 2011; 37 Suppl 4:S71-7. [DOI: 10.1016/s1262-3636(11)70969-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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Franc S, Daoudi A, Mounier S, Boucherie B, Dardari D, Laroye H, Neraud B, Requeda E, Canipel L, Charpentier G. Telemedicine and diabetes: achievements and prospects. Diabetes Metab 2011; 37:463-76. [PMID: 21889388 DOI: 10.1016/j.diabet.2011.06.006] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/06/2011] [Revised: 06/22/2011] [Accepted: 06/23/2011] [Indexed: 12/28/2022]
Abstract
Health authorities currently have high expectations for telemedicine (TM), as it addresses several major challenges: to improve access to healthcare (especially for patients in underserved or remote areas); to overcome the scarcity of specialists faced with epidemic disease; and to reduce the costs of healthcare while improving quality. The aims of TM in the field of diabetes differ according to the type of diabetes. In type 1 diabetes (T1DM) associated with complex insulin regimens, the goal of TM is to help patients achieve better control of their blood glucose levels through accurate adjustment of insulin doses. In type 2 diabetes (T2DM), while therapeutic adjustments may be necessary, improvement in blood glucose control is based primarily on behavioural changes (reduced calorie and carbohydrate intakes, increased physical activity). Many TM studies focusing on management of blood glucose levels have been published, but most failed to demonstrate any superiority of TM vs traditional care. While previously published meta-analyses have shown a slight advantage at best for TM, these meta-analyses included a mix of studies of varying durations and different populations (both T1DM and T2DM patients, adults and children), and tested systems of inconsistent quality. Studies published to date on TM suggest two currently promising approaches. First, handheld communicating devices, such as smartphones, loaded with software to apply physicians' prescriptions, have been shown to improve glycaemic control. These systems provide immediate assistance to the patient (such as insulin-dose calculation and food choice optimization at meals), and all data stored in the smartphone can be transmitted to authorized caregivers, enabling remote monitoring and even teleconsultation. These systems, initially developed for T1DM, appear to offer many possibilities for T2DM, too. Second, systems combining an interactive Internet system (or a mobile phone coupled to a remote server) with a system of communication between the healthcare provider and the patient by e-mail, texting or phone calls have also shown certain benefits for glycaemic control. These systems, primarily aimed at T2DM patients, generally provide motivational support as well. Although the individual benefits of these systems for glycaemic control are fewer than with smartphones, their widespread use should be of particular value for overcoming the relative shortage of doctors and reducing the health costs associated with a disease of such epidemic proportions.
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Affiliation(s)
- S Franc
- Centre d'études et de recherche pour l'intensification du traitement du diabète, 91100 Corbeil-Essonnes, France.
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Saulnier PJ, Roussel R, Halimi JM, Lebrec J, Dardari D, Maimaitiming S, Guilloteau G, Prugnard X, Marechaud R, Ragot S, Marre M, Hadjadj S. Impact of natriuretic peptide clearance receptor (NPR3) gene variants on blood pressure in type 2 diabetes. Diabetes Care 2011; 34:1199-204. [PMID: 21464461 PMCID: PMC3114497 DOI: 10.2337/dc10-2057] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Hypertension in diabetes is characterized by abnormal sodium homeostasis, suggesting a particular role of natriuretic peptide pathway. Natriuretic peptides can affect blood pressure (BP) through their plasma concentrations, which are dependent on their receptor activities. We thus assessed the association between nine NPR3 gene polymorphisms and BP levels in patients with type 2 diabetes. RESEARCH DESIGN AND METHODS Nine single nucleotide polymorphisms (SNPs) tagging the haplotype structure of the NPR3 gene were genotyped in the 3,126 French Non-insulin-dependent Diabetes, Hypertension, Microalbuminuria or Proteinuria, Cardiovascular Events, and Ramipril (DIABHYCAR) trial participants. We then used a second population (Diabete de type 2, Nephropathie et Genetique [DIAB2NEPHROGENE]/Survie, Diabete de type 2 et Genetique [SURDIAGENE] study) of 2,452 patients for the purpose of replication. Finally, we separately investigated subjects selected according to their rs 2270915SNP genotypes for their BP response to salt restriction. RESULTS In DIABHYCAR patients, three SNPs (rs6889608, rs1173773, and rs2270915) were significantly associated with systolic BP (SBP). The effect of the rs2270915 was replicated in the second step population: AA homozygotes had a lower SBP than G carriers (137.4 ± 19.1 vs. 140.0 ± 20.2 mmHg, P = 0.004). The rs2270915 influenced the response of SBP to salt reduction, with AA homozygous patients showing greater reductions after restriction of salt intake compared with G carriers: -20 mmHg (-43 to -8) vs. -3 (-20 to +7); P = 0.006. CONCLUSIONS We found a consistent and significant association between the rs2270915 polymorphism of the NPR3 gene and SBP in diabetic patients. This genetic variation may affect pressure response to changes in dietary sodium.
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Affiliation(s)
- Pierre-Jean Saulnier
- Centre d’investigation clinique, INSERM CIC0802, Centre Hospitalier Universitaire de Poitiers, Poitiers, France.
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Charpentier G, Benhamou PY, Dardari D, Clergeot A, Franc S, Schaepelynck-Belicar P, Catargi B, Melki V, Chaillous L, Farret A, Bosson JL, Penfornis A. The Diabeo software enabling individualized insulin dose adjustments combined with telemedicine support improves HbA1c in poorly controlled type 1 diabetic patients: a 6-month, randomized, open-label, parallel-group, multicenter trial (TeleDiab 1 Study). Diabetes Care 2011; 34:533-9. [PMID: 21266648 PMCID: PMC3041176 DOI: 10.2337/dc10-1259] [Citation(s) in RCA: 228] [Impact Index Per Article: 17.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To demonstrate that Diabeo software enabling individualized insulin dose adjustments combined with telemedicine support significantly improves HbA(1c) in poorly controlled type 1 diabetic patients. RESEARCH DESIGN AND METHODS In a six-month open-label parallel-group, multicenter study, adult patients (n = 180) with type 1 diabetes (>1 year), on a basal-bolus insulin regimen (>6 months), with HbA(1c) ≥ 8%, were randomized to usual quarterly follow-up (G1), home use of a smartphone recommending insulin doses with quarterly visits (G2), or use of the smartphone with short teleconsultations every 2 weeks but no visit until point end (G3). RESULTS Six-month mean HbA(1c) in G3 (8.41 ± 1.04%) was lower than in G1 (9.10 ± 1.16%; P = 0.0019). G2 displayed intermediate results (8.63 ± 1.07%). The Diabeo system gave a 0.91% (0.60; 1.21) improvement in HbA(1c) over controls and a 0.67% (0.35; 0.99) reduction when used without teleconsultation. There was no difference in the frequency of hypoglycemic episodes or in medical time spent for hospital or telephone consultations. However, patients in G1 and G2 spent nearly 5 h more than G3 patients attending hospital visits. CONCLUSIONS The Diabeo system gives a substantial improvement to metabolic control in chronic, poorly controlled type 1 diabetic patients without requiring more medical time and at a lower overall cost for the patient than usual care.
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Affiliation(s)
- Guillaume Charpentier
- Department of Diabetes, Centre d'Études et de Recherche pour l’Intensification du Traitement du Diabète, Sud-Francilien Hospital, Corbeil-Essonnes, France.
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Franc S, Dardari D, Peschard C, Riveline JP, Biedzinski M, Boucherie B, Petit C, Requeda E, Mistretta F, Varroud-Vial M, Charpentier G. Can postprandial blood glucose excursion be predicted in type 2 diabetes? Diabetes Care 2010; 33:1913-8. [PMID: 20551017 PMCID: PMC2928333 DOI: 10.2337/dc10-0115] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE We investigated the relationship between carbohydrate intake and postprandial blood glucose (BG) levels to determine the most influential meal for type 2 diabetic subjects treated with basal insulin and needing prandial insulin. RESEARCH DESIGN AND METHODS Three-day BG profiles for 37 type 2 diabetic subjects, with A1C levels of 7.7%, treated with sulfonylurea and metformin, and well titrated on insulin glargine, were analyzed using a continuous glucose monitoring system. Food intake from 680 meals was recorded and quantified during continuous glucose monitoring. RESULTS The median BG excursion (DeltaBG) was higher at breakfast than at lunch or dinner (111 [81; 160] vs. 69.5 [41.5; 106] and 82.5 mg/dl [53; 119] mg/dl, P < 0.0001). There was a weak overall correlation between DeltaBG and carbohydrate intake. Correlation improved when mealtime was taken into account. Simple relationships were established: DeltaBG (mg/dl) = 65 x carbohydrate/body weight + 73 for breakfast (R(2) = 0.20, P < 0.0001); the slope was reduced by half at lunch and by one-third at dinner. Twelve relevant variables likely to affect DeltaBG were integrated into a polynomial equation. This model accounted for 49% of DeltaBG variability. Two groups of patients were identified: responders, in whom DeltaBG was well correlated with carbohydrate intake (R(2) >or= 0.30, n = 8), and nonresponders (R(2) < 0.30, n = 29). Responders exhibited a greater insulinopenic profile than nonresponders. CONCLUSIONS The carbohydrate intake in responders clearly drives DeltaBG, whereas, in nonresponders, other factors predominate. This sort of characterization should be used to guide therapeutic choices toward more targeted care with improved type 2 diabetes management.
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Affiliation(s)
- Sylvia Franc
- Department of Diabetes, Sud-Francilien Hospital, Corbeil-Essonnes, France.
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Penfornis A, Clergeot A, Dardari D, Benhamou P, Schaepelynck P, Hanaire H, Catargi B, Chaillous L, Renard E, Halimi S, Bosson J, Charpentier G. O77 Amélioration de l’équilibre glycémique par le système de télémédecine DIABEO chez des patients diabétiques de type 1 : résultats de l’étude Télédiab1. Diabetes & Metabolism 2010. [DOI: 10.1016/s1262-3636(10)70081-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Franc S, Dardari D, Boucherie B, Riveline JP, Biedzinski M, Petit C, Requeda E, Leurent P, Varroud-Vial M, Hochberg G, Charpentier G. Real-life application and validation of flexible intensive insulin-therapy algorithms in type 1 diabetes patients. Diabetes Metab 2010; 35:463-8. [PMID: 19914853 DOI: 10.1016/j.diabet.2009.05.006] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/14/2009] [Revised: 05/17/2009] [Accepted: 05/18/2009] [Indexed: 10/20/2022]
Abstract
AIMS Flexible intensive insulin therapy (FIT) has become the reference standard in type 1 diabetes. Besides carbohydrate counting (CHO), it requires the use of algorithms to adjust prandial insulin doses to the number of CHO portions. As recourse to standard algorithms is usual when initiating FIT, the use of personalized algorithms would also allow more precise adjustments to be made. The aim of the present study was to validate personalized prandial algorithms for FIT as proposed by Howorka et al. in 1990. METHODS We conducted a 4-month observational study of 35 patients with type 1 diabetes, treated with FIT for at least 6 months, who were already using Howorka's prandial algorithms (meal-related and correctional insulin doses for blood glucose increases induced by CHO). These patients were asked to use a personal digital assistant (PDA) phone with an electronic diary (instead of a paper one) to take advantage of the computerized data-collection system to assess the quality of postprandial metabolic control. RESULTS Whatever the number of CHO portions, mean postprandial blood glucose values remained close to the target of 7.8mmol/L, and the compensatory algorithm allowed precise correction of preprandial hyperglycaemia. In fact, the algorithms for meal-related and correctional insulin doses at the end of the study did not differ significantly from those initially calculated, but they generally differed from one patient to another. CONCLUSION In type 1 diabetic patients treated with FIT, the use of individualized parameters permits fast and accurate adjustment of mealtime insulin doses, leading to good control of the postprandial state.
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Affiliation(s)
- S Franc
- Department of Diabetes, Sud-Francilien Hospital, Bd Henri Dunant, Corbeil-Essonnes, France.
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Riveline JP, Teynie J, Belmouaz S, Franc S, Dardari D, Bauwens M, Caudwell V, Ragot S, Bridoux F, Charpentier G, Marechaud R, Hadjadj S. Glycaemic control in type 2 diabetic patients on chronic haemodialysis: use of a continuous glucose monitoring system. Nephrol Dial Transplant 2009; 24:2866-71. [PMID: 19389864 DOI: 10.1093/ndt/gfp181] [Citation(s) in RCA: 86] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND The proportion of diabetic patients undergoing haemodialysis is rapidly increasing. Glucose control among such patients is difficult to assess. We aimed to evaluate the clinical performance of a continuous glucose monitoring system (CGMS) in type 2 diabetic patients on chronic haemodialysis. METHODS We used a 4-day CGMS to monitor glucose levels in 19 haemodialysed type 2 diabetic patients (HD T2) including 2 days with and 2 days without dialysis session, and 39 non-HD T2 in a double-centre study. RESULTS The glucose concentration according to the glucose meter and CGMS were correlated in HD T2 patients (r = 0.90, P < 0.0001) and in non-HD T2 patients (r = 0.81, P < 0.0001). The relative absolute difference (RAD) between glucose determined by a glucose meter and glucose determined by the CGMS did not differ between HD T2 and non-HD T2 patients (9.2 +/- 10.5 vs. 8.2 +/- 7.6%; P = 0.165). Glycated haemoglobin (A1c) and mean glucose concentration were strongly correlated in non-HD T2 patients (r = 0.71; P < 0.0001) but weakly correlated in HD T2 patients (r = 0.47; P = 0.042). Fructosamine was correlated with the mean glucose concentration in non-HD T2 (r = 0.67; P < 0.0001) but not in HD T2 patients (r = 0.04; P = 0.88). CONCLUSION CGM is a validated marker of glycaemic control in HD diabetic patients. This tool showed that A1c and fructosamine, despite being good markers of glycaemic control in non-HD diabetic patients, are of poor value in HD diabetic patients.
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Tubiana-Rufi N, Riveline JP, Dardari D. Real-time continuous glucose monitoring using Guardian®RT: from research to clinical practice. Diabetes & Metabolism 2007; 33:415-20. [DOI: 10.1016/j.diabet.2007.05.003] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/29/2007] [Accepted: 05/17/2007] [Indexed: 11/28/2022]
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Abstract
In an attempt to prevent the complications of type 2 diabetes, particular attention should be paid to controlling postprandial glycemia (PPG): on the one hand, it contributes substantially to the HbAlc level in moderately controlled patients, on the other hand, the postprandial glucose peak induces oxidative stress and endothelial dysfunction, the first step toward accelerated atherogenesis. Metformin, glitazones, and insulin secretagogues have an additive effect on fasting blood glucose (FBG), and a significant impact on PPG. Alpha-glucosidase inhibitors can reduce PPG by a mean 0.50 g/l, no matter what the insulin resistance or insulinopenia status or the other diabetes treatments already in use. After evolving for several years and the failure of oral antidiabetics to normalize fasting blood glucose, long-acting (slow-acting) insulin analogues, well titrated, can reach this goal. They will have no effect on PPG other than a simple level effect. At this stage, rather than overtreating high fasting blood glucose concentrations, systematic PPG exploration should be the rule so as to better define PPG treatment: the advantages of alpha-glucosidase inhibitors and the role of GLP-1 analogs should be defined, the use of a rapid-acting insulin analog before the meal causing the highest postprandial blood glucose excursions, even systematically at all three meals, should be considered, or inhaled insulin. As natural life expectancy is on the rise, these active strategies designed to normalize the daily glycemic profile, necessary in a strict strategy to prevent the complications of diabetes, will need to be discussed for an increasing number of patients with type 2 diabetes.
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Affiliation(s)
- G Charpentier
- Service d'Endocrinologie-Diabétologie, Centre Hospitalier Sud Francilien, Corbeil-Essonnes, France.
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Abstract
Numerous prospective studies support the concept of postprandial glycaemia (PPG) as a risk factor for cardiovascular diseases (CVDs) in individuals with impaired glucose tolerance (IGT). A meta-analysis has demonstrated an exponential relationship between 2-hour postchallenge glucose levels and the incidence of CVD. This relationship is stronger than those observed with fasting glycaemia or glycosylated haemoglobin (HbA(1c)), and persists after adjustment for other vascular risk factors. Although there are fewer data available for the diabetic population, those that are available also support PPG as a risk factor for CVD. Treating PPG with acarbose is associated with a reduction in cardiovascular events in both patients with IGT and diabetes mellitus. Acarbose also reduces the progression of intima-media thickness (IMT), which is a surrogate endpoint for atherosclerosis. It has been suggested that the beneficial effect could be related to an improvement in postprandial hyperglycaemia and associated atherogenic factors - oxidative stress, endothelial dysfunction and pro-coagulation factors - and to an improvement in other cardiovascular risk factors such as systolic blood pressure (by decreasing water and salt absorption), postprandial hypertriglyceridaemia and insulin resistance. Treating PPG with glinides improves IMT as well as interleukin-6 and C-reactive protein levels, while treating PPG with rapid-acting insulin analogues is also associated with improvements in endothelial dysfunction. The Kumamoto study suggests that reduced PPG is strongly associated with reductions in retinopathy and nephropathy. Finally, decreasing PPG in patients with IGT reduces the progression of diabetes. In conclusion, physicians should increase efforts to control PPG in order to further improve HbA(1c), and should also ensure close control of postprandial hyperglycaemic peaks so as to optimise patients' chances of avoiding cardiovascular complications. As for the prevention of CVD, further prospective intervention trials, powered to answer this question, are still required.
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Affiliation(s)
- Guillaume Charpentier
- Fédération d'Endocrino-Diabétologie, Centre Hospitalier Sud Francilien, Corbeil Essonnes, France.
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