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Phan F, Halbron M, Jacqueminet S, Popelier M, Soliman H, Coffin B, Hartemann A, Amouyal C. Improved dyspeptic symptoms of type 1 diabetes adults with gastroparesis on hybrid closed loop system: A case series. Diabetes Metab 2023; 49:101471. [PMID: 37657737 DOI: 10.1016/j.diabet.2023.101471] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Revised: 07/15/2023] [Accepted: 08/19/2023] [Indexed: 09/03/2023]
Affiliation(s)
- Franck Phan
- Sorbonne Université, Paris, France; Assistance Publique-Hôpitaux de Paris (APHP), Diabetology Department, La Pitié Salpêtrière-Charles Foix University Hospital, Paris, France; Centre de Recherche des Cordeliers, INSERM, UMR_S 1138, Paris, France; Institute of Cardiometabolism and Nutrition ICAN, Paris, France
| | - Marine Halbron
- Sorbonne Université, Paris, France; Assistance Publique-Hôpitaux de Paris (APHP), Diabetology Department, La Pitié Salpêtrière-Charles Foix University Hospital, Paris, France; Institute of Cardiometabolism and Nutrition ICAN, Paris, France
| | - Sophie Jacqueminet
- Sorbonne Université, Paris, France; Assistance Publique-Hôpitaux de Paris (APHP), Diabetology Department, La Pitié Salpêtrière-Charles Foix University Hospital, Paris, France; Institute of Cardiometabolism and Nutrition ICAN, Paris, France
| | - Marc Popelier
- Sorbonne Université, Paris, France; Assistance Publique-Hôpitaux de Paris (APHP), Diabetology Department, La Pitié Salpêtrière-Charles Foix University Hospital, Paris, France; Institute of Cardiometabolism and Nutrition ICAN, Paris, France
| | - Heithem Soliman
- INSERM, UMR 1149, Université de Paris-Cité, équipe PIMS, Paris, France; Assistance Publique-Hôpitaux de Paris (APHP), DMU Esprit, Gastroenterology Unit, Louis Mourier Hospital, Colombes, France; Université Paris Cité, Paris, France
| | - Benoit Coffin
- INSERM, UMR 1149, Université de Paris-Cité, équipe PIMS, Paris, France; Assistance Publique-Hôpitaux de Paris (APHP), DMU Esprit, Gastroenterology Unit, Louis Mourier Hospital, Colombes, France; Université Paris Cité, Paris, France
| | - Agnès Hartemann
- Sorbonne Université, Paris, France; Assistance Publique-Hôpitaux de Paris (APHP), Diabetology Department, La Pitié Salpêtrière-Charles Foix University Hospital, Paris, France; Centre de Recherche des Cordeliers, INSERM, UMR_S 1138, Paris, France; Institute of Cardiometabolism and Nutrition ICAN, Paris, France
| | - Chloé Amouyal
- Sorbonne Université, Paris, France; Assistance Publique-Hôpitaux de Paris (APHP), Diabetology Department, La Pitié Salpêtrière-Charles Foix University Hospital, Paris, France; Institute of Cardiometabolism and Nutrition ICAN, Paris, France; Nutrition and Obesities: Systemic Approaches (NutriOmics) Research Unit, INSERM, UMRS U1269, Paris, France.
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Le Roux E, Menesguen F, Tejedor I, Popelier M, Halbron M, Faucher P, Malivoir S, Pinto G, Léger J, Hatem S, Polak M, Poitou C, Touraine P. Transition of young adults with endocrine and metabolic diseases: the 'TRANSEND' cohort. Endocr Connect 2021; 10:21-28. [PMID: 33263561 PMCID: PMC7923139 DOI: 10.1530/ec-20-0520] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Accepted: 11/25/2020] [Indexed: 12/16/2022]
Abstract
OBJECTIVE The transition from paediatric to adult medicine involves risks of poor patient outcomes and of significant losses of patients to follow up. The research aimed to analyse the implementation in an initial cohort of patients of a new programme of transition to adult care based on a case management approach. DESIGN A longitudinal study of the case management approach to transition, initiated in a university hospital in France in September 2016. METHODS Patients with the endocrine or metabolic disease diagnosed during childhood and transferred to adult care were included. The transition programme includes three steps based on case management: liaising with paediatric services, personalising care pathways, and liaising with structures outside the hospital (general practitioners, agencies in the educational and social sector). RESULTS The cohort included 500 patients, with malignant brain tumour (n = 56 (11%)), obesity (n = 55 (11%)), type 1 diabetes (n = 54 (11%)), or other disease (n = 335 (67%)). Their median age at transfer was 19, and the sex ratio was 0.5. At median 21 months of follow-up, 439 (88%) had a regular follow-up in or outside the hospital, 47 (9%) had irregular follow-up (absence at the last appointment or no appointment scheduled within the time recommended), 4 had stopped care on doctor's advice, 4 had died, 3 had moved, and 3 had refused care. The programme involved 9615 case management actions; 7% of patients required more than 50 actions. Patients requiring most support were usually those affected by a rare genetic form of obesity. CONCLUSIONS Case managers successfully addressed the complex needs of patients. Over time, the cohort will provide unprecedented long-term outcome results for patients with various conditions who experienced this form of transition.
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Affiliation(s)
- Enora Le Roux
- Université de Paris, ECEVE UMR 1123, Inserm, Paris, France
- AP-HP.Nord-Université de Paris, Hôpital Universitaire Robert Debré, Unité d’Épidémiologie Clinique, Inserm, Paris, France
| | - Florence Menesguen
- AP-HP. Sorbonne Université, Hôpital Universitaire Pitié Salpêtrière-Charles Foix, Service d’Endocrinologie et Médecine de la Reproduction, Centre de Maladies Endocriniennes Rares de la Croissance et du Développement, Centre de Pathologies Gynécologiques Rares, Paris, France
| | - Isabelle Tejedor
- AP-HP. Sorbonne Université, Hôpital Universitaire Pitié Salpêtrière-Charles Foix, Service d’Endocrinologie et Médecine de la Reproduction, Centre de Maladies Endocriniennes Rares de la Croissance et du Développement, Centre de Pathologies Gynécologiques Rares, Paris, France
| | - Marc Popelier
- AP-HP. Sorbonne Université, Hôpital Universitaire Pitié Salpêtrière-Charles Foix, Service de Diabétologie, Paris, France
| | - Marine Halbron
- AP-HP. Sorbonne Université, Hôpital Universitaire Pitié Salpêtrière-Charles Foix, Service de Diabétologie, Paris, France
| | - Pauline Faucher
- AP-HP. Sorbonne Université, Hôpital Universitaire Pitié Salpêtrière-Charles Foix, Service de Nutrition, Centre du Syndrome de Prader-Willi et Autres Obésités Rares, Paris, France
| | - Sabine Malivoir
- AP-HP. Sorbonne Université, Hôpital Universitaire Pitié Salpêtrière-Charles Foix, Service d’Endocrinologie et Médecine de la Reproduction, Centre de Maladies Endocriniennes Rares de la Croissance et du Développement, Centre de Pathologies Gynécologiques Rares, Paris, France
| | - Graziella Pinto
- AP-HP.Université de Paris Centre, Hôpital Universitaire Necker Enfants Malades, Département d’Endocrinologie, Diabétologie et Gynécologie Pédiatrique, Paris, France; Centre de Maladies Endocriniennes Rares de la Croissance et du Développement, Centre de Pathologies Gynécologiques Rares, Paris, France
| | - Juliane Léger
- AP-HP.Nord-Université de Paris, Hôpital Universitaire Robert Debré, Service d’Endocrinologie Diabétologie Pédiatrique, Centre de Référence des Maladies Endocriniennes de la Croissance et du Développement, Paris, France
| | | | - Michel Polak
- AP-HP.Université de Paris Centre, Hôpital Universitaire Necker Enfants Malades, Département d’Endocrinologie, Diabétologie et Gynécologie Pédiatrique, Paris, France; Centre de Maladies Endocriniennes Rares de la Croissance et du Développement, Centre de Pathologies Gynécologiques Rares, Paris, France
| | - Christine Poitou
- AP-HP. Sorbonne Université, Hôpital Universitaire Pitié Salpêtrière-Charles Foix, Service de Nutrition, Centre du Syndrome de Prader-Willi et Autres Obésités Rares, Paris, France
| | - Philippe Touraine
- AP-HP. Sorbonne Université, Hôpital Universitaire Pitié Salpêtrière-Charles Foix, Service d’Endocrinologie et Médecine de la Reproduction, Centre de Maladies Endocriniennes Rares de la Croissance et du Développement, Centre de Pathologies Gynécologiques Rares, Paris, France
- Correspondence should be addressed to P Touraine:
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Amouyal C, Klatzmann D, Tibi E, Salem JE, Halbron M, Popelier M, Jacqueminet S, Ciangura C, Bourron O, Andreelli F, Hartemann A, Rosenzwajg M. Pregnant type 1 diabetes women with rises in C-peptide display higher levels of regulatory T cells: A pilot study. Diabetes Metab 2020; 47:101188. [PMID: 32891755 DOI: 10.1016/j.diabet.2020.04.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Revised: 04/21/2020] [Accepted: 04/22/2020] [Indexed: 10/23/2022]
Abstract
AIM During pregnancy of type 1 diabetes (T1D) women, a C peptide rise has been described, which mechanism is unclear. In T1D, a defect of regulatory T cells (Tregs) and its major controlling cytokine, interleukin-2 (IL2), is observed. METHODS Evolution of clinical, immunological (Treg (CD4+CD25hiCD127-/loFoxp3+ measured by flow cytometry and IL2 measured by luminex xMAP technology) and diabetes parameters (insulin dose per day, HbA1C, glycaemia, C peptide) was evaluated in 13 T1D women during the three trimesters of pregnancy and post-partum (PP, within 6 months) in a monocentric pilot study. Immunological parameters were compared with those of a healthy pregnant cohort (QuTe). RESULTS An improvement of beta cell function (C peptide rise and/or a decrease of insulin dose-adjusted A1c index that estimate individual exogenous insulin need) was observed in seven women (group 1) whereas the six others (group 2) did not display any positive response to pregnancy. A higher level of Tregs and IL2 was observed in group 1 compared to group 2 during pregnancy and at PP for Tregs level. However, compared to the healthy cohort, T1D women displayed a Treg deficiency CONCLUSION: This pilot study highlights that higher level of Tregs and IL2 seem to allow improvement of endogenous insulin secretion of T1D women during pregnancy.
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Affiliation(s)
- C Amouyal
- AP-HP, Pitié-Salpêtrière Hospital, Diabetology Department, F-75013 Paris, France; Sorbonne Université, Nutrition and Obesities: Systemic Approaches (NutriOmics) Research Unit, UMRS U1269, Paris, France.
| | - D Klatzmann
- AP-HP, Pitié-Salpêtrière Hospital, Biotherapy (CIC-BTi) and Inflammation-Immunopathology-Biotherapy Department (I2B), Sorbonne Université, Paris, France; Sorbonne Université, INSERM, UMR_S 959, Immunology-Immunopathology-Immunotherapy (i3), Paris, France
| | - E Tibi
- AP-HP, Pitié-Salpêtrière Hospital, Biotherapy (CIC-BTi) and Inflammation-Immunopathology-Biotherapy Department (I2B), Sorbonne Université, Paris, France
| | - J-E Salem
- Clinical Investigation Centre Paris-Est, CIC-1421, UNICO-GRECO Cardio-oncology Program, INSERM, Department of Pharmacology, Sorbonne Université, Paris, France; Department of Medicine and Pharmacology, Cardio-oncology Program, Vanderbilt University Medical Center, Nashville, TN, USA
| | - M Halbron
- AP-HP, Pitié-Salpêtrière Hospital, Diabetology Department, F-75013 Paris, France
| | - M Popelier
- AP-HP, Pitié-Salpêtrière Hospital, Diabetology Department, F-75013 Paris, France
| | - S Jacqueminet
- AP-HP, Pitié-Salpêtrière Hospital, Diabetology Department, F-75013 Paris, France
| | - C Ciangura
- AP-HP, Pitié-Salpêtrière Hospital, Diabetology Department, F-75013 Paris, France
| | - O Bourron
- AP-HP, Pitié-Salpêtrière Hospital, Diabetology Department, F-75013 Paris, France; Sorbonne Université, INSERM, UMR_S 1138, Centre de Recherche des Cordeliers, Institute of Cardiometabolism and Nutrition, Paris, France
| | - F Andreelli
- AP-HP, Pitié-Salpêtrière Hospital, Diabetology Department, F-75013 Paris, France; Sorbonne Université, Nutrition and Obesities: Systemic Approaches (NutriOmics) Research Unit, UMRS U1269, Paris, France
| | - A Hartemann
- AP-HP, Pitié-Salpêtrière Hospital, Diabetology Department, F-75013 Paris, France; Sorbonne Université, INSERM, UMR_S 1138, Centre de Recherche des Cordeliers, Institute of Cardiometabolism and Nutrition, Paris, France
| | - M Rosenzwajg
- AP-HP, Pitié-Salpêtrière Hospital, Biotherapy (CIC-BTi) and Inflammation-Immunopathology-Biotherapy Department (I2B), Sorbonne Université, Paris, France; Sorbonne Université, INSERM, UMR_S 959, Immunology-Immunopathology-Immunotherapy (i3), Paris, France
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Roux EL, Menesguen F, Tejedor I, Popelier M, Halbron M, Faucher P, Malivoir S, Polak M, Poitou C, Touraine P. MON-LB308 Studying the Care and Social Pathway of Young Adults With Endocrine and Metabolic Diseases During Transition: The “Transend” Cohort. J Endocr Soc 2020. [PMCID: PMC7208793 DOI: 10.1210/jendso/bvaa046.2138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Context. The transition period between pediatric and adult medicine is associated with poor patient outcomes and an important number of patients lost to follow up. Intervention exist but the few published randomized trials do not allow to study long-term patient outcomes nor intervention sustainability in time. Objective. Describe the cohort of patients in adult care who benefit from a new transition program based on case management approach, its activity and follow-up outcomes. Methods. A longitudinal study was led since September 2016 in adult services of endocrinology, nutrition and diabetology of a French University Hospital. Patients with any endocrine disease diagnosed during childhood and transferred to adult care were included. The care pathway for these patients was built in three steps. Step 1 is dedicated in liaising with pediatric services and patient to facilitate its first visit in adult care. Step 2 defines the care pathway in adult service based on the needs assessment realized by the coordinator upon the patient’s arrival in adult service. Step 3 focuses in liaising with structures outside hospital (GP, educational and social sector). Thorough the follow-up, the coordinator is identified as the key contact by the patients. Attendance to medical appointments, clinical, and social data are collected throughout patient follow-up. Results. Since 3 years, 500 patients benefited from the case management mainly for their obesity (n=91, 18%), type 1 diabetes (n=54, 11%), malignant brain tumor (n=68, 14%) or congenital hypopituitarism (n=42, 8%). They were aged 19 in median at transfer in adult care, sex ratio: 0,5, A large majority live in the parental home (409, 82%), 169 (34%) are university students, 130 (26%) are in high school, 90 (18%) are in medico-social institution. Patients who required most of support from the coordinator usually combine one (or more) somatic disease and either a neuro-cognitive disorder or a psychiatric disorder, they all have social difficulties. In patients with more than 3 months of follow-up (median: 18 months), 22/418 (5%) are out of follow-up. Concerning the patients for whom the follow-up is 36 months or more, the percentage of out of lollow-up is the same: 5% Conclusions. The case manager addresses the complex needs of diverse patients. With time, the cohort will provide unprecedented long-term results of patients with various conditions who went through transition.
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Affiliation(s)
- Enora Le Roux
- Université de Paris, ECEVE UMR 1123, Inserm, Paris, France
| | - Florence Menesguen
- AP-HP. Sorbonne Université, Hôpital Universitaire Pitié Salpêtrière- Charles Foix, Service d’Endocrinologie et médecine de la reproduction; Centre de maladies endocriniennes rares de la croissance; Centre de pathologies gynécologiques rares, Paris, France
| | - Isabelle Tejedor
- AP-HP. Sorbonne Université, Hôpital Universitaire Pitié Salpêtrière- Charles Foix, Service d’Endocrinologie et médecine de la reproduction; Centre de maladies endocriniennes rares de la croissance; Centre de pathologies gynécologiques rares, Paris, France
| | - Marc Popelier
- AP-HP. Sorbonne Université, Hôpital Universitaire Pitié Salpêtrière- Charles Foix, Service de diabétologie, Paris, France
| | - Marine Halbron
- AP-HP. Sorbonne Université, Hôpital Universitaire Pitié Salpêtrière- Charles Foix, Service de diabétologie, Paris, France
| | - Pauline Faucher
- AP-HP. Sorbonne Université, Hôpital Universitaire Pitié Salpêtrière- Charles Foix, Service de nutrition, Paris, France
| | - Sabine Malivoir
- AP-HP. Sorbonne Université, Hôpital Universitaire Pitié Salpêtrière- Charles Foix, Service d’Endocrinologie et médecine de la reproduction; Centre de maladies endocriniennes rares de la croissance; Centre de pathologies gynécologiques rares, Paris, France
| | - Michel Polak
- AP-HP.Centre-Université de Paris, Hôpital Universitaire Necker enfants malades, Paris, France
| | - Christine Poitou
- AP-HP. Sorbonne Université, Hôpital Universitaire Pitié Salpêtrière- Charles Foix, Service de nutrition, Paris, France
| | - Philippe Touraine
- AP-HP. Sorbonne Université, Hôpital Universitaire Pitié Salpêtrière- Charles Foix, Service d’Endocrinologie et médecine de la reproduction; Centre de maladies endocriniennes rares de la croissance; Centre de pathologies gynécologiques rares, Paris, France
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Jeannin AC, Salem JE, Massy Z, Aubert CE, Vemeer C, Amouyal C, Phan F, Halbron M, Funck-Brentano C, Hartemann A, Bourron O. Inactive matrix gla protein plasma levels are associated with peripheral neuropathy in Type 2 diabetes. PLoS One 2020; 15:e0229145. [PMID: 32092076 PMCID: PMC7039520 DOI: 10.1371/journal.pone.0229145] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2019] [Accepted: 01/30/2020] [Indexed: 02/06/2023] Open
Abstract
AIMS/HYPOTHESIS Diabetic peripheral neuropathy is a frequent and severe complication of diabetes. As Matrix-gla-protein (MGP) is expressed in several components of the nervous system and is involved in some neurological disease, MGP could play a role in peripheral nervous system homeostasis. The aim of this study was to evaluate factors associated with sensitive diabetic neuropathy in Type 2 Diabetes, and, in particular, dephospho-uncarboxylated MGP (dp-ucMGP), the inactive form of MGP. METHODS 198 patients with Type 2 Diabetes were included. Presence of sensitive diabetic neuropathy was defined by a neuropathy disability score (NDS) ≥6. Plasma levels of dp-ucMGP were measured by ELISA. RESULTS In this cohort, the mean age was 64+/-8.4 years old, and 80% of patients were men. Peripheral neuropathy was present in 15.7% of the patients and was significantly associated (r = 0.51, p<0.0001) with dp-ucMGP levels (β = -0.26, p = 0.045) after integrating effects of height (β = -0.38, p = 0.01), insulin treatment (β = 0.42, p = 0.002), retinopathy treated by laser (β = 0.26, p = 0.02), and total cholesterol levels (β = 0.3, p = 0.03) by multivariable analysis. CONCLUSIONS The association between diabetic neuropathy and the inactive form of MGP suggests the existence of new pathophysiological pathways to explore. Further studies are needed to determine if dp-ucMGP may be used as a biomarker of sensitive neuropathy. Since dp-ucMGP is a marker of poor vitamin K status, clinical studies are warranted to explore the potential protective effect of high vitamin K intake on diabetic peripheral neuropathy.
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Affiliation(s)
- Anne-Caroline Jeannin
- Sorbonne Université, Paris, France
- Assistance Publique-Hôpitaux de Paris (APHP), Diabetology Department, Pitié-Salpêtrière Hospital, Paris, France
| | - Joe-Elie Salem
- Sorbonne Université, Paris, France
- Department of Pharmacology and CIC-1421, AP-HP, Pitié-Salpêtrière Hospital, Paris, France
- INSERM, CIC-1421, Paris, France
- Institute of Cardiometabolism and Nutrition ICAN, Paris, France
| | - Ziad Massy
- Division of Nephrology, Ambroise Paré Hospital, AP-HP, Pitié-Salpêtrière Hospital, Université Paris-Saclay, Paris, France
| | - Carole Elodie Aubert
- Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland
| | - Cees Vemeer
- Cardiovascular Research Institute CARIM, Maastricht University, Maastricht, The Netherlands
| | - Chloé Amouyal
- Sorbonne Université, Paris, France
- Assistance Publique-Hôpitaux de Paris (APHP), Diabetology Department, Pitié-Salpêtrière Hospital, Paris, France
- Institute of Cardiometabolism and Nutrition ICAN, Paris, France
| | - Franck Phan
- Sorbonne Université, Paris, France
- Assistance Publique-Hôpitaux de Paris (APHP), Diabetology Department, Pitié-Salpêtrière Hospital, Paris, France
- Institute of Cardiometabolism and Nutrition ICAN, Paris, France
- INSERM, UMR_S 1138, Centre de Recherche des Cordeliers, Paris, France
| | - Marine Halbron
- Sorbonne Université, Paris, France
- Assistance Publique-Hôpitaux de Paris (APHP), Diabetology Department, Pitié-Salpêtrière Hospital, Paris, France
- Institute of Cardiometabolism and Nutrition ICAN, Paris, France
| | - Christian Funck-Brentano
- Sorbonne Université, Paris, France
- Department of Pharmacology and CIC-1421, AP-HP, Pitié-Salpêtrière Hospital, Paris, France
- INSERM, CIC-1421, Paris, France
- Institute of Cardiometabolism and Nutrition ICAN, Paris, France
| | - Agnès Hartemann
- Sorbonne Université, Paris, France
- Assistance Publique-Hôpitaux de Paris (APHP), Diabetology Department, Pitié-Salpêtrière Hospital, Paris, France
- Institute of Cardiometabolism and Nutrition ICAN, Paris, France
- INSERM, UMR_S 1138, Centre de Recherche des Cordeliers, Paris, France
| | - Olivier Bourron
- Sorbonne Université, Paris, France
- Assistance Publique-Hôpitaux de Paris (APHP), Diabetology Department, Pitié-Salpêtrière Hospital, Paris, France
- Institute of Cardiometabolism and Nutrition ICAN, Paris, France
- INSERM, UMR_S 1138, Centre de Recherche des Cordeliers, Paris, France
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Halbron M, Bourron O, Andreelli F, Ciangura C, Jacqueminet S, Popelier M, Bosquet F, Rouanet S, Amouyal C, Hartemann A. Insulin Pump Combined with Flash Glucose Monitoring: A Therapeutic Option to Improve Glycemic Control in Severely Nonadherent Patients with Type 1 Diabetes. Diabetes Technol Ther 2019; 21:409-412. [PMID: 31265349 DOI: 10.1089/dia.2019.0041] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Some patients with type 1 diabetes (T1D) are severely noncompliant; they rarely perform self-blood glucose measures and miss insulin injections. Their HbA1c is far above the target rate. Current guidelines do not recommend starting treatment with an insulin pump (continuous subcutaneous insulin infusion [CSII]) for these persons. The aim of this study was to determine whether a CSII associated with a flash glucose monitoring (FGM) device could reduce HbA1c without increasing the risk of acute events, diabetic ketoacidosis (DKA) and severe hypoglycemia (SH), in these patients. We conducted a 6-month nonrandomized, pilot prospective study. Patients with T1D on multiple daily injections who performed less than two self-blood glucose tests/day and had an HbA1c >9% were equipped with CSII and an FGM device. The primary composite endpoint was defined by a change in HbA1c ≥1% without any episode of DKA or SH during 6 months. Change in mean HbA1c, weight, treatment satisfaction, frequency of minor hypoglycemia, and ketoacidosis were secondary endpoints. Nineteen adults were included. Median (Q1-Q3) HbA1c at baseline was 10.8 (10.3-13.0), 14 participants did not perform any self-monitoring and 5 performed maximum two tests daily. Twelve participants (63%) (95% confidence interval 41%-81%) met the primary composite endpoint. Seventeen patients completed the study. HbA1c decreased by 2% (1.0-3.3) (P < 0.001), and satisfaction with treatment significantly improved. Three participants experienced SH and one a DKA, versus, respectively, five and eight in the year preceding the study. Participants scanned the sensor 4 (3-6) times per day and injected 3 (2.7-4.1) boluses per day. Weight increased significantly. An association of an insulin pump with an FGM device can be an effective and safe therapeutic option in severely nonadherent and noncompliant patients with high HbA1c.
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Affiliation(s)
- Marine Halbron
- 1 Assistance Publique-Hôpitaux de Paris (AP-HP), Diabetes Department, Hôpital Pitié-Salpêtrière, Paris, France
- 2 Assistance Publique-Hôpitaux de Paris (AP-HP), CIC 1421, Department of Pharmacology, INSERM, Paris, France
| | - Olivier Bourron
- 1 Assistance Publique-Hôpitaux de Paris (AP-HP), Diabetes Department, Hôpital Pitié-Salpêtrière, Paris, France
- 3 Assistance Publique-Hôpitaux de Paris (AP-HP), Diabetes Department, Hôpital Pitié-Salpêtrière, Sorbonne Université, Paris, France
| | - Fabrizio Andreelli
- 1 Assistance Publique-Hôpitaux de Paris (AP-HP), Diabetes Department, Hôpital Pitié-Salpêtrière, Paris, France
- 3 Assistance Publique-Hôpitaux de Paris (AP-HP), Diabetes Department, Hôpital Pitié-Salpêtrière, Sorbonne Université, Paris, France
| | - Cecile Ciangura
- 1 Assistance Publique-Hôpitaux de Paris (AP-HP), Diabetes Department, Hôpital Pitié-Salpêtrière, Paris, France
| | - Sophie Jacqueminet
- 1 Assistance Publique-Hôpitaux de Paris (AP-HP), Diabetes Department, Hôpital Pitié-Salpêtrière, Paris, France
| | - Marc Popelier
- 1 Assistance Publique-Hôpitaux de Paris (AP-HP), Diabetes Department, Hôpital Pitié-Salpêtrière, Paris, France
| | - Frederic Bosquet
- 1 Assistance Publique-Hôpitaux de Paris (AP-HP), Diabetes Department, Hôpital Pitié-Salpêtrière, Paris, France
| | | | - Chloe Amouyal
- 1 Assistance Publique-Hôpitaux de Paris (AP-HP), Diabetes Department, Hôpital Pitié-Salpêtrière, Paris, France
| | - Agnes Hartemann
- 1 Assistance Publique-Hôpitaux de Paris (AP-HP), Diabetes Department, Hôpital Pitié-Salpêtrière, Paris, France
- 3 Assistance Publique-Hôpitaux de Paris (AP-HP), Diabetes Department, Hôpital Pitié-Salpêtrière, Sorbonne Université, Paris, France
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Aubert CE, Liabeuf S, Amouyal C, Kemel S, Lajat-Kiss F, Lacorte JM, Halbron M, Carlier A, Salem JE, Funck-Brentano C, Perisic Matic L, Witasp A, Stenvinkel P, Phan F, Massy ZA, Hartemann A, Bourron O. Serum concentration and vascular expression of adiponectin are differentially associated with the diabetic calcifying peripheral arteriopathy. Diabetol Metab Syndr 2019; 11:32. [PMID: 31168327 PMCID: PMC6489190 DOI: 10.1186/s13098-019-0429-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2019] [Accepted: 04/17/2019] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Medial calcification in diabetes contributes to the arterial occlusive process occurring below the knee level. Adiponectin is an adipokine with atheroprotective properties and possible protective role against arterial calcification. The aim of the study was to investigate, in type 2 diabetes, the link between vascular expression and serum concentration of adiponectin and (1) peripheral arterial calcification and (2) lower limb occlusive arterial disease. METHODS Scoring of peripheral vascular calcification and peripheral arterial occlusive disease, using CT-scan and color-duplex ultrasonography respectively, were conducted and explored in relation to serum adiponectin level in a cross sectional study of 197 patients with type 2 diabetes. Vascular adiponectin expression in the arterial wall of diabetic patients with and without medial calcification was evaluated by immunohistochemistry. RESULTS Peripheral arterial calcification score was higher in patients with the highest adiponectin concentration. In a multivariate logistic regression analysis, an increase of 1 µg/mL of adiponectin was associated with a 22% increase of arterial calcification (adjusted OR = 1.22; 95% CI 1.03-1.44; p = 0.02). Arterial occlusive score was also higher in patients with adiponectin concentration > median (2.8 ± 4.8 vs 4.2 ± 5.7, p = 0.034). Immunohistochemical analyses showed a strong and specific staining of adiponectin in smooth muscle cells in calcified arteries, with a more pronounced expression of adiponectin in early stages of medial calcification. CONCLUSIONS Peripheral arterial calcification is positively associated with circulating adiponectin levels in patients with type 2 diabetes, but vascular adiponectin expression is already observed at early stages of calcification. Adiponectin secretion could be a compensatory mechanism against the calcification process.Trial registration DIACART NCT number: NCT02431234. Registered 30 April 2015.
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Affiliation(s)
- Carole E. Aubert
- Assistance Publique-Hôpitaux de Paris (APHP), Diabetology Department, Pitié Salpêtrière Hospital, 47-83 Boulevard de l’Hôpital, Paris, France
| | - Sophie Liabeuf
- INSERM U1088, UFR de Médecine et Pharmacie, Jules Verne University of Picardy, Amiens, France
- Clinical Research Centre, Division of Clinical Pharmacology, Amiens University Hospital and the Jules Verne University of Picardy, Amiens, France
| | - Chloé Amouyal
- Sorbonne Université, UPMC Univ, Paris 06, France
- Assistance Publique-Hôpitaux de Paris (APHP), Diabetology Department, Pitié Salpêtrière Hospital, 47-83 Boulevard de l’Hôpital, Paris, France
- Institute of Cardiometabolism and Nutrition ICAN, Paris, France
| | - Salim Kemel
- Cardiovascular and Interventional Radiology Department, AP-HP, Pitié-Salpêtrière Hospital, Paris, France
| | | | - Jean-Marc Lacorte
- Sorbonne Université, UPMC Univ, Paris 06, France
- Department of Endocrine and Oncologic Biochemistry, AP-HP, Pitié-Salpêtrière Hospital, Paris, France
- Institute of Cardiometabolism and Nutrition ICAN, Paris, France
- INSERM U1166, Paris, France
| | - Marine Halbron
- Assistance Publique-Hôpitaux de Paris (APHP), Diabetology Department, Pitié Salpêtrière Hospital, 47-83 Boulevard de l’Hôpital, Paris, France
- Institute of Cardiometabolism and Nutrition ICAN, Paris, France
| | - Aurélie Carlier
- Sorbonne Université, UPMC Univ, Paris 06, France
- Assistance Publique-Hôpitaux de Paris (APHP), Diabetology Department, Pitié Salpêtrière Hospital, 47-83 Boulevard de l’Hôpital, Paris, France
- Institute of Cardiometabolism and Nutrition ICAN, Paris, France
| | - Joe-Elie Salem
- Sorbonne Université, UPMC Univ, Paris 06, France
- Institute of Cardiometabolism and Nutrition ICAN, Paris, France
- Department of Pharmacology and CIC-1421, AP-HP, AP-HP, Pitié-Salpêtrière Hospital, Paris, France
- INSERM, CIC-1421, Paris, France
| | - Christian Funck-Brentano
- Sorbonne Université, UPMC Univ, Paris 06, France
- Institute of Cardiometabolism and Nutrition ICAN, Paris, France
- Department of Pharmacology and CIC-1421, AP-HP, AP-HP, Pitié-Salpêtrière Hospital, Paris, France
- INSERM, CIC-1421, Paris, France
| | - Ljubica Perisic Matic
- Division of Vascular Surgery, Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
- Center for Molecular Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Anna Witasp
- Center for Molecular Medicine, Karolinska Institutet, Stockholm, Sweden
- Division of Renal Medicine, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
| | - Peter Stenvinkel
- Division of Renal Medicine, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
| | - Franck Phan
- Sorbonne Université, UPMC Univ, Paris 06, France
- Assistance Publique-Hôpitaux de Paris (APHP), Diabetology Department, Pitié Salpêtrière Hospital, 47-83 Boulevard de l’Hôpital, Paris, France
- Institute of Cardiometabolism and Nutrition ICAN, Paris, France
| | - Ziad A. Massy
- Division of Nephrology, Ambroise Paré Hospital, AP-HP, Boulogne-Billancourt, France
- INSERM U1018, Research Centre in Epidemiology and Population Health (CESP) Team 5, University of Paris Saclay-Versailles-St-Quentin-en-Yvelines (UVSQ), Villejuif, France
| | - Agnès Hartemann
- Sorbonne Université, UPMC Univ, Paris 06, France
- Assistance Publique-Hôpitaux de Paris (APHP), Diabetology Department, Pitié Salpêtrière Hospital, 47-83 Boulevard de l’Hôpital, Paris, France
- INSERM, UMR_S 1138, Centre de Recherche des Cordeliers, Paris 06, France
- Institute of Cardiometabolism and Nutrition ICAN, Paris, France
| | - Olivier Bourron
- Sorbonne Université, UPMC Univ, Paris 06, France
- Assistance Publique-Hôpitaux de Paris (APHP), Diabetology Department, Pitié Salpêtrière Hospital, 47-83 Boulevard de l’Hôpital, Paris, France
- INSERM, UMR_S 1138, Centre de Recherche des Cordeliers, Paris 06, France
- Institute of Cardiometabolism and Nutrition ICAN, Paris, France
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Gallo A, Halbron M, Bruckert E. Early coronary heart disease after PCSK9-inhibitors withdrawal in very high-risk subjects. Atherosclerosis 2018. [DOI: 10.1016/j.atherosclerosis.2018.06.728] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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9
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Barnard KD, Bromba M, de Lange M, Halbron M, Levy BL, Lévy M, Lippmann-Grob B, Walshe K, Ziegler R. High reported treatment satisfaction in people with type 1 diabetes switching to latest generation insulin pump regardless of previous therapy. J Diabetes Sci Technol 2015; 9:231-6. [PMID: 25591855 PMCID: PMC4604575 DOI: 10.1177/1932296814567893] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
The effects of transition by individuals with type 1 diabetes (T1D) to more recently available continuous glucose monitoring (CGM)-enabled insulin pumps from either multiple daily insulin injections (MDI) or older insulin pumps on treatment satisfaction have not been well studied. We conducted a survey to assess treatment satisfaction among users of the Animas(®) Vibe™ insulin pump, a latest generation insulin pump (LGIP) system (CGM-enabled), after switching from MDI or earlier generation insulin pumps. Individuals with T1D from 141 centers in 5 countries and 4 language areas participated in the survey. Treatment satisfaction was assessed by the Insulin Treatment Satisfaction Questionnaire (ITSQ), which was included in a 50-item online questionnaire that also assessed preference for using the LGIP compared with previous treatment and satisfaction with key LGIP features. A total of 356 individuals, ages 12-79 years, responded to the survey: mean (SD) age 38.4 (16.1) years; diabetes duration 19.1 (13.3) years; female 59%; previously treated with MDI 58%. Overall mean (SD) ITSQ scores were high among all respondents regardless of prior treatment: 95.1 (23.2) (scale: 0-132). No differences between previous-treatment groups were seen. Most (83%) of respondents rated the LGIP to be better than their previous insulin delivery system: "much better" (65%), "a bit better" (18%) regardless of age, and 95% would recommend using the LGIP to others. Use of the Animas Vibe was associated with high treatment satisfaction and perceived as a better method of insulin delivery regardless of previous insulin therapy or age.
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Affiliation(s)
| | | | | | - Marine Halbron
- Diabetology Department, AP-HP, Hôpital Pitié-Salpétrière, Paris, France
| | | | - Marc Lévy
- Hôpital de Nanterre, Nanterre, France
| | | | | | - Ralph Ziegler
- Diabetes Clinic for Children and Adolescents, Muenster, Germany
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10
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Bourron O, Caron-Debarle M, Hie M, Amoura Z, Andreelli F, Halbron M, Fonfrede M, Leroux G, Vigouroux C, Hartemann A. Type B Insulin-resistance syndrome: a cause of reversible autoimmune hypoglycaemia. Lancet 2014; 384:1548. [PMID: 25390580 DOI: 10.1016/s0140-6736(14)61833-x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Olivier Bourron
- Assistance Publique-Hôpitaux de Paris, Department of Endocrinology, Nutrition, and Diabetes, Paris, France; Sorbonne Universités, Paris, France; INSERM UMR_S 1138 Centre de recherche des Cordeliers, Paris, France; Institute of Cardiometabolism and Nutrition, Paris, France.
| | - Martine Caron-Debarle
- Sorbonne Universités, Paris, France; INSERM UMR_S 938 Saint-Antoine Research Centre, Paris, France; Institute of Cardiometabolism and Nutrition, Paris, France
| | - Miguel Hie
- Department of Internal Medicine, Pitié-Salpêtrière Hospital, Paris, France; Sorbonne Universités, Paris, France
| | - Zahir Amoura
- Department of Internal Medicine, Pitié-Salpêtrière Hospital, Paris, France; Sorbonne Universités, Paris, France
| | - Fabrizio Andreelli
- Assistance Publique-Hôpitaux de Paris, Department of Endocrinology, Nutrition, and Diabetes, Paris, France; Sorbonne Universités, Paris, France; Institute of Cardiometabolism and Nutrition, Paris, France
| | - Marine Halbron
- Assistance Publique-Hôpitaux de Paris, Department of Endocrinology, Nutrition, and Diabetes, Paris, France; Institute of Cardiometabolism and Nutrition, Paris, France
| | - Michelle Fonfrede
- Department of Biochemistry, Pitié-Salpêtrière Hospital, Paris, France
| | - Gaëlle Leroux
- Department of Internal Medicine, Pitié-Salpêtrière Hospital, Paris, France
| | - Corinne Vigouroux
- Department of Molecular Biology, Saint-Antoine Hospital, Paris, France; Sorbonne Universités, Paris, France; INSERM UMR_S 938 Saint-Antoine Research Centre, Paris, France; Institute of Cardiometabolism and Nutrition, Paris, France
| | - Agnès Hartemann
- Assistance Publique-Hôpitaux de Paris, Department of Endocrinology, Nutrition, and Diabetes, Paris, France; Sorbonne Universités, Paris, France; INSERM UMR_S 1138 Centre de recherche des Cordeliers, Paris, France; Institute of Cardiometabolism and Nutrition, Paris, France
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11
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Halbron M, Sachon C, Simon D, Obadia T, Grimaldi A, Hartemann A. Evaluation of a 5-day education programme in type 1 diabetes: achieving individual targets with a patient-centred approach. Diabet Med 2014; 31:500-3. [PMID: 24299225 DOI: 10.1111/dme.12372] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2013] [Revised: 10/28/2013] [Accepted: 11/17/2013] [Indexed: 11/28/2022]
Abstract
AIMS To evaluate if a single inpatient education training programme can achieve individualized therapeutic targets. METHODS Patients with Type 1 diabetes participating in a flexible intensive therapy programme were consecutively included in a prospective monocentric study. They all participated in the same education programme which had a patient-centred approach. Before the intervention, patients were divided into three groups according to their main therapeutic target: Group 1, to decrease HbA1c concentration in patients with baseline HbA1c ≥ 58 mmol/mol (7.5%); Group 2, to improve quality of life and satisfaction with treatment in patients with baseline HbA1c < 58 mmol/mol (7.5%); and Group 3, to decrease the frequency of hypoglycaemic episodes in patients with severe or frequent hypoglycaemic episodes. Therapeutic targets were evaluated at 12 months. Quality of life and treatment satisfaction were evaluated with validated questionnaires completed at baseline and 6 months. RESULTS In Group 1 (n = 74), the mean ± sd HbA1c concentration decreased from 75 ± 15 mmol/mol (9.0 ±1.4%) to 68 ±15 mmol/mol (8.4 ± 1.4%; P < 0.001), with 53% of patients experiencing a decrease in HbA1c concentration of at least 6 mmol/mol (0.5%), without weight gain or more frequent hypoglycaemia. In Group 2 (n = 12), patient satisfaction with treatment improved significantly (P < 0.0001). In Group 3 (n = 35), minor hypoglycaemia significantly decreased from a mean ± sd of 6.6 ± 4.7 to 3.2 ± 3.0 hypoglycaemic episodes/week (P < 0.001) and the incidence of severe hypoglycaemia dropped significantly from a mean ± sd of 2.31 ± 3.07 to 0.86 ± 2.46 episodes/patient/year (P < 0.001). CONCLUSIONS Many patients with different needs, who attended the same flexible intensive therapy education programme, which had a patient-centred approach, were able to achieve their individual therapeutic targets.
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Affiliation(s)
- M Halbron
- Diabetology Department, AP-HP, Hopital Pitie-Salpetriere, Paris, France
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12
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Bourron O, Chebbi F, Halbron M, Saint-Martin C, Bellanné-Chantelot C, Abed A, Charbit B, Magnan C, Lacorte J, Hartemann A. Incretin effect of glucagon-like peptide 1 receptor agonist is preserved in presence of ABCC8/SUR1 mutation in β-cell. Diabetes Care 2012; 35:e76. [PMID: 23093687 PMCID: PMC3476900 DOI: 10.2337/dc12-0535] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Affiliation(s)
- Olivier Bourron
- From the Department of Endocrinology, Nutrition and Diabetes, Assistance Publique-Hôpitaux de Paris (AP-HP), Pitié-Salpêtrière-Charles Foix Hospital, Paris, France; the
- Medicine Faculty, Université Pierre et Marie Curie - Paris 6, Paris, France; the
| | - Fatma Chebbi
- Department of Endocrine and Oncological Biochemistry, Assistance Publique-Hôpitaux de Paris, Pitié-Salpêtrière-Charles Foix Hospital, Paris, France; the
| | - Marine Halbron
- From the Department of Endocrinology, Nutrition and Diabetes, Assistance Publique-Hôpitaux de Paris (AP-HP), Pitié-Salpêtrière-Charles Foix Hospital, Paris, France; the
| | - Cécile Saint-Martin
- Department of Genetics, Assistance Publique-Hôpitaux de Paris (AP-HP), Pitié-Salpêtrière-Charles Foix Hospital Hospital, Paris, France
| | - Christine Bellanné-Chantelot
- Medicine Faculty, Université Pierre et Marie Curie - Paris 6, Paris, France; the
- Department of Genetics, Assistance Publique-Hôpitaux de Paris (AP-HP), Pitié-Salpêtrière-Charles Foix Hospital Hospital, Paris, France
| | - Ahmed Abed
- Department of Endocrine and Oncological Biochemistry, Assistance Publique-Hôpitaux de Paris, Pitié-Salpêtrière-Charles Foix Hospital, Paris, France; the
- Université Pierre et Marie Curie - Paris 6, UMR S 872, Les Cordeliers, Paris, France
- INSERM, U872, Paris, France
| | - Beny Charbit
- INSERM, Clinical Investigation Center Paris-EST (CIC 9304), Paris, France; and
| | - Christophe Magnan
- Biologie Fonctionnelle et Adaptative, Centre National de la Recherche Scientifique, Université Paris Diderot - Paris 5, Paris, France
| | - J.M. Lacorte
- Department of Endocrine and Oncological Biochemistry, Assistance Publique-Hôpitaux de Paris, Pitié-Salpêtrière-Charles Foix Hospital, Paris, France; the
- Université Pierre et Marie Curie - Paris 6, UMR S 872, Les Cordeliers, Paris, France
- INSERM, U872, Paris, France
| | - Agnès Hartemann
- From the Department of Endocrinology, Nutrition and Diabetes, Assistance Publique-Hôpitaux de Paris (AP-HP), Pitié-Salpêtrière-Charles Foix Hospital, Paris, France; the
- Medicine Faculty, Université Pierre et Marie Curie - Paris 6, Paris, France; the
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Bourron O, Vigouroux C, Halbron M, Touati EB, Capel E, Caron-Debarle M, Hartemann A. Association of type B insulin resistance and type 1 diabetes resulting in ketoacidosis. Diabetes Care 2012; 35:e4. [PMID: 22275456 PMCID: PMC3263889 DOI: 10.2337/dc11-1967] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Affiliation(s)
- Olivier Bourron
- Department of Endocrinology, Nutrition and Diabetes, Pitié-Salpêtrière Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France
- Pierre et Marie Curie University Paris 06, Paris, France
| | - Corinne Vigouroux
- Pierre et Marie Curie University Paris 06, Paris, France
- INSERM, UMR_S 938, Saint-Antoine Research Center, Paris, France
- Department of Biochemistry and Hormonology, Tenon Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France
| | - Marine Halbron
- Department of Endocrinology, Nutrition and Diabetes, Pitié-Salpêtrière Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France
| | - Elia Belle Touati
- Department of Endocrinology, Nutrition and Diabetes, Pitié-Salpêtrière Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France
| | - Emilie Capel
- Pierre et Marie Curie University Paris 06, Paris, France
- INSERM, UMR_S 938, Saint-Antoine Research Center, Paris, France
| | - Martine Caron-Debarle
- Pierre et Marie Curie University Paris 06, Paris, France
- INSERM, UMR_S 938, Saint-Antoine Research Center, Paris, France
| | - Agnès Hartemann
- Department of Endocrinology, Nutrition and Diabetes, Pitié-Salpêtrière Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France
- Pierre et Marie Curie University Paris 06, Paris, France
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14
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Jacqueminet S, Barthelemy O, Rouzet F, Isnard R, Halbron M, Bouzamondo A, Le Guludec D, Grimaldi A, Metzger JP, Le Feuvre C. A randomized study comparing isotope and echocardiography stress testing in the screening of silent myocardial ischaemia in type 2 diabetic patients. Diabetes Metab 2010; 36:463-9. [PMID: 20832344 DOI: 10.1016/j.diabet.2010.06.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Received: 02/18/2010] [Revised: 06/09/2010] [Accepted: 06/14/2010] [Indexed: 11/18/2022]
Abstract
AIMS This study aimed to compare the positive predictive value (PPV) of stress myocardial scintigraphy (SPECT) and of dobutamine echocardiography (DE) in the diagnosis of significant coronary artery stenosis (CAD) in asymptomatic type 2 diabetic patients, and to assess long-term clinical outcomes according to silent myocardial ischaemia (SMI) screening. METHODS A total of 204 asymptomatic type 2 diabetic patients at high cardiovascular (CV) risk were prospectively randomized to undergo either SPECT (n=104) or DE (n=100). Coronary angiography was proposed in cases of SMI, with revascularization of suitable lesions. Intensive treatment of CV risk factors was prescribed for all patients. Death and myocardial infarction (MI) were recorded during the 3-year follow-up. RESULTS Clinical characteristics were similar in the two testing groups. The prevalence of SMI and significant CAD were 13% and 4%, respectively, in the SPECT group vs 11% and 5%, respectively, in the DE group (not significant [NS]). The PPV for the detection of significant CAD was 29% for SPECT and 45% for DE (NS). Seven patients (3%) underwent initial revascularization. The 3-year rate of CV death and MI was 2.5%, and similar in both groups. CONCLUSION Rates of SMI and significant CAD in asymptomatic high-risk type 2 diabetic patients receiving intensive care of risk factors are low, and SPECT and DE are similar in the detection of SMI and CAD. Coronary revascularization and intensive CV risk-factor therapy are associated with a low rate of adverse CV events at 3 years, whichever stress test was used.
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Affiliation(s)
- S Jacqueminet
- Service de diabétologie, groupe hospitalier Pitié-Salpêtrière, AP-HP, Paris, France
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Ratziu V, Charlotte F, Bernhardt C, Giral P, Halbron M, Lenaour G, Hartmann-Heurtier A, Bruckert E, Poynard T. Long-term efficacy of rosiglitazone in nonalcoholic steatohepatitis: results of the fatty liver improvement by rosiglitazone therapy (FLIRT 2) extension trial. Hepatology 2010; 51:445-53. [PMID: 19877169 DOI: 10.1002/hep.23270] [Citation(s) in RCA: 279] [Impact Index Per Article: 19.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
UNLABELLED Short-term trials of glitazones in nonalcoholic steatohepatitis (NASH) yielded controversial histological results. Longer treatment might result in additional improvement. After a 1-year randomized trial, 53 patients underwent a control liver biopsy and were enrolled in an open-label extension trial of rosiglitazone (RSG), 8 mg/day for 2 additional years. In all, 44 completed the extension phase including 40 with a third liver biopsy. Of these, 22 received placebo (PLB) in the randomized phase (PLB-RSG), and 18 RSG (RSG-RSG). During the 2-year extension phase serum insulin decreased by 26%, homeostasis model assessment (HOMA) by 30%, and alanine aminotransferase (ALT) by 24%. However, there was no significant change in the mean NASH activity score (NAS) (3.8 +/- 2.11 versus 3.68 +/- 1.8), ballooning score, fibrosis stage (1.76 +/- 1.18 versus 1.85 +/- 1.19), or area of fibrosis by micromorphometry (4.43% +/- 0.68 to 5.54% +/- 0.68). In the PLB-RSG group steatosis significantly decreased after 2 years of RSG (median decrease of 15%); in the RSG-RSG group, after an initial decline in the first year of 20%, 2 additional years of RSG did not result in further improvement. Likewise, there was no improvement in the NAS score, ballooning, intralobular inflammation, fibrosis stage, or area of fibrosis with 2 additional years of RSG in the RSG-RSG group. CONCLUSION Rosiglitazone has a substantial antisteatogenic effect in the first year of treatment without additional benefit with longer therapy despite a maintained effect on insulin sensitivity and transaminase levels. This suggests that improving insulin sensitivity might not be sufficient in NASH and that additional targets of therapy for liver injury should be explored.
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Affiliation(s)
- Vlad Ratziu
- Hôpital Pitié-Salpêtrière, Service d'Hépatogastroentérologie, Université Pierre et Marie Curie Paris VI, Assistance Publique-Hôpitaux de Paris, France
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16
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Hartemann-Heurtier A, Halbron M, Golmard JL, Jacqueminet S, Bastard JP, Rouault C, Ayed A, Pieroni L, Clément K, Grimaldi A. Effects of bed-time insulin versus pioglitazone on abdominal fat accumulation, inflammation and gene expression in adipose tissue in patients with type 2 diabetes. Diabetes Res Clin Pract 2009; 86:37-43. [PMID: 19683825 DOI: 10.1016/j.diabres.2009.06.028] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2009] [Revised: 06/22/2009] [Accepted: 06/29/2009] [Indexed: 01/04/2023]
Abstract
AIMS/HYPOTHESIS Intra-abdominal fat (IAF) and inflammatory markers are correlated with cardio-vascular risk. We compared the impact of bed-time insulin versus pioglitazone treatment on these parameters in type 2 diabetic (T2D) patients. METHODS Twenty-eight T2D patients poorly controlled with metformin and sulfonylurea were randomized to receive add-on therapy with pioglitazone or bed-time NPH insulin. IAF and subcutaneous fat (SCF) content, systemic low-grade inflammation level and expression of inflammation related genes in SCF, were measured before and after 24 weeks of treatment. RESULTS Insulin and pioglitazone resulted in a significant decrease in HbA1c (-1.6% and -1.2%, respectively) and a significant increase in total body fat mass (1+/-2.3 and 3.3+/-2.7 kg, respectively). There was no change in IAF content after both treatments whereas significant increase in SCF content was only seen after pioglitazone treatment (p<0.05 versus insulin). hsCRP level decreased after pioglitazone and ferritin level decreased after insulin treatment. No change in mRNA expression of inflammation related genes was found after either treatment. CONCLUSION/INTERPRETATION This suggests that a 24-week treatment with pioglitazone or bed-time insulin has a similar impact on intra-abdominal fat mass and systemic low-grade inflammation.
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17
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Potier L, Halbron M, Bouilloud F, Dadon M, Le Doeuff J, Ha Van G, Grimaldi A, Hartemann-Heurtier A. Ankle-to-brachial ratio index underestimates the prevalence of peripheral occlusive disease in diabetic patients at high risk for arterial disease. Diabetes Care 2009; 32:e44. [PMID: 19336632 DOI: 10.2337/dc08-2015] [Citation(s) in RCA: 62] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Affiliation(s)
- Louis Potier
- Diabetes and Metabolic Diseases Department, AP-HP Pitié-Salpêtrière Hospital, Université Pierre et Marie Curie, Paris, France
| | - Marine Halbron
- Diabetes and Metabolic Diseases Department, AP-HP Pitié-Salpêtrière Hospital, Université Pierre et Marie Curie, Paris, France
| | - Florence Bouilloud
- Diabetes and Metabolic Diseases Department, AP-HP Pitié-Salpêtrière Hospital, Université Pierre et Marie Curie, Paris, France
| | - Michel Dadon
- Vascular Surgery Department, AP-HP Pitié-Salpêtrière Hospital, Université Pierre et Marie Curie, Paris, France
| | - Josette Le Doeuff
- Vascular Surgery Department, AP-HP Pitié-Salpêtrière Hospital, Université Pierre et Marie Curie, Paris, France
| | - Georges Ha Van
- Diabetes and Metabolic Diseases Department, AP-HP Pitié-Salpêtrière Hospital, Université Pierre et Marie Curie, Paris, France
| | - André Grimaldi
- Diabetes and Metabolic Diseases Department, AP-HP Pitié-Salpêtrière Hospital, Université Pierre et Marie Curie, Paris, France
| | - Agnèes Hartemann-Heurtier
- Diabetes and Metabolic Diseases Department, AP-HP Pitié-Salpêtrière Hospital, Université Pierre et Marie Curie, Paris, France
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Halbron M, Jacqueminet S, Sachon C, Bosquet F, Hartemann-Heurtier A, Grimaldi A. Insulin therapy for type 2 diabetes: premixed or basal-prandial? Diabetes & Metabolism 2007; 33:316-20. [PMID: 17466560 DOI: 10.1016/j.diabet.2007.01.005] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/25/2006] [Accepted: 01/16/2007] [Indexed: 11/27/2022]
Abstract
It is logical to begin type 2 insulin therapy with an injection of an intermediate-acting or a long-acting insulin at bedtime, but one should treat to target, i.e. aim at fasting glycaemias lower than 1.20 g/l to obtain an HbA(1c) close to 7%. Nevertheless, basal insulin therapy does not prevent progression to insulin-secretory deficiency. If necessary, recourse should be made to multiple-injection protocols, taking into account postprandial hyperglycaemia. For every level of HbA(1c), the suppression of postprandial hyperglycaemia, 1 point of HbA(1c) can be gained in theory, whereas reducing the fasting glycaemia to values of less than 1.10 g/l reduces HbA(1c) to close to 7%, whatever the initial level of HbA(1c). However, when a diabetic is clearly not controlled, the preprandial acting use of rapid analogues allows the fasting glycaemia to be improved significantly. Inversely, an early treatment with basal insulin, by correcting glucotoxicity, can also decrease postprandial hyperglycaemia. Many industry-sponsored studies comparing insulin therapy regimens show annoying biased interpretations of results. It does not seem pertinent to compare a single injection with two or even three injections, nor to compare an efficient titration with an inefficient titration or to eliminate oral drugs, in particular sulphonylureas combined with a basal insulin. If premix insulins can give satisfactory results in patients who maintain a sufficient residual insulin-secretion, we think it would be preferable to adopt the basal-prandial regimen and a step-by-step escalating therapy. The first stage consists in combining oral therapy with an injection of NPH insulin or a long-acting analogue at bedtime, aiming at a fasting glycaemia of less than 1.20 g/l. In the next stages, a single injection of rapid-acting insulin analogue is added each time. The main advantage of this regimen is to fix a target adapted to each injection and, as a result, to facilitate forced titration of the doses.
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Affiliation(s)
- M Halbron
- Service de Diabétologie-Métabolisme, Groupe Hospitalier de la Pitié-salpêtrière, 83 Boulevard de l'Hôpital, 75651 Paris cedex 13, France
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