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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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Couchoud C, Bertrand X, Bourgeon M, Piton G, Valot B, Hocquet D. Genome-based typing reveals rare events of patient contamination with Pseudomonas aeruginosa from other patients and sink traps in a medical intensive care unit. J Hosp Infect 2023; 134:63-70. [PMID: 36738994 DOI: 10.1016/j.jhin.2023.01.010] [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: 10/18/2022] [Revised: 01/03/2023] [Accepted: 01/18/2023] [Indexed: 02/05/2023]
Abstract
AIM We used genome-based typing data with the aim of identifying the routes of acquisition of Pseudomonas aeruginosa by patients hospitalized in a medical intensive care unit (MICU) over a long period in a non-epidemic context. METHODS This monocentric prospective study took place over 10 months in 2019 in a 15-bed MICU that applies standard precautions of hygiene. Lockable sink traps installed at all water points of use were bleach disinfected twice a week. We sampled all sink traps weekly to collect 404 P. aeruginosa environmental isolates and collected all P. aeruginosa isolates (N = 115) colonizing or infecting patients (N = 65). All isolates had their phenotypic resistance profile determined and their genome sequenced, from which we identified resistance determinants and assessed the population structure of the collection at the nucleotide level to identify events of P. aeruginosa transmission. FINDINGS All sink traps were positive for P. aeruginosa, each sink trap being colonized for several months by one or more clones. The combination of genomic and spatiotemporal data identified one potential event of P. aeruginosa transmission from a sink trap to a patient (1/65, 1.5%) and six events of patient cross-transmission, leading to the contamination of five patients (5/65, 7.7%). All transmitted isolates were fully susceptible to β-lactams and aminoglycosides. CONCLUSIONS Genome-based typing revealed the contamination of patients by P. aeruginosa originating from sink traps to be infrequent (1.5%) in an MICU with sink trap-bleaching measures, and that only 7.7% of the patients acquired P. aeruginosa originating from another patient.
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Affiliation(s)
- C Couchoud
- Hygiène Hospitalière, Centre Hospitalier Universitaire, Besançon, France; Chrono-environnement UMR6249, CNRS Université de Franche-Comté, F-25000, Besançon, France
| | - X Bertrand
- Hygiène Hospitalière, Centre Hospitalier Universitaire, Besançon, France; Chrono-environnement UMR6249, CNRS Université de Franche-Comté, F-25000, Besançon, France
| | - M Bourgeon
- Hygiène Hospitalière, Centre Hospitalier Universitaire, Besançon, France; Centre de Ressources Biologiques - Filière Microbiologique de Besançon, Centre Hospitalier Universitaire, Besançon, France
| | - G Piton
- Service de Médecine Intensive Réanimation, Centre Hospitalier Universitaire, Besançon, France; EA3920, Université de Franche-Comté, Besançon, France
| | - B Valot
- Chrono-environnement UMR6249, CNRS Université de Franche-Comté, F-25000, Besançon, France; Bioinformatique et Big Data Au Service de La Santé, UFR Santé, Université de Bourgogne Franche-Comté, Besançon, France
| | - D Hocquet
- Hygiène Hospitalière, Centre Hospitalier Universitaire, Besançon, France; Chrono-environnement UMR6249, CNRS Université de Franche-Comté, F-25000, Besançon, France; Centre de Ressources Biologiques - Filière Microbiologique de Besançon, Centre Hospitalier Universitaire, Besançon, France; Bioinformatique et Big Data Au Service de La Santé, UFR Santé, Université de Bourgogne Franche-Comté, Besançon, France.
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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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Cariou B, Wargny M, Boureau AS, Smati S, Tramunt B, Desailloud R, Lebeault M, Amadou C, Ancelle D, Balkau B, Bordier L, Borot S, Bourgeon M, Bourron O, Cosson E, Eisinger M, Gonfroy-Leymarie C, Julla JB, Marchand L, Meyer L, Seret-Bégué D, Simon D, Sultan A, Thivolet C, Vambergue A, Vatier C, Winiszewski P, Saulnier PJ, Bauduceau B, Gourdy P, Hadjadj S. Impact of diabetes on COVID-19 prognosis beyond comorbidity burden: the CORONADO initiative. Diabetologia 2022; 65:1436-1449. [PMID: 35701673 PMCID: PMC9197674 DOI: 10.1007/s00125-022-05734-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Accepted: 04/06/2022] [Indexed: 12/11/2022]
Abstract
AIMS/HYPOTHESIS Diabetes has been recognised as a pejorative prognostic factor in coronavirus disease 2019 (COVID-19). Since diabetes is typically a disease of advanced age, it remains unclear whether diabetes remains a COVID-19 risk factor beyond advanced age and associated comorbidities. We designed a cohort study that considered age and comorbidities to address this question. METHODS The Coronavirus SARS-CoV-2 and Diabetes Outcomes (CORONADO) initiative is a French, multicentric, cohort study of individuals with (exposed) and without diabetes (non-exposed) admitted to hospital with COVID-19, with a 1:1 matching on sex, age (±5 years), centre and admission date (10 March 2020 to 10 April 2020). Comorbidity burden was assessed by calculating the updated Charlson comorbidity index (uCCi). A predefined composite primary endpoint combining death and/or invasive mechanical ventilation (IMV), as well as these two components separately, was assessed within 7 and 28 days following hospital admission. We performed multivariable analyses to compare clinical outcomes between patients with and without diabetes. RESULTS A total of 2210 pairs of participants (diabetes/no-diabetes) were matched on age (mean±SD 69.4±13.2/69.5±13.2 years) and sex (36.3% women). The uCCi was higher in individuals with diabetes. In unadjusted analysis, the primary composite endpoint occurred more frequently in the diabetes group by day 7 (29.0% vs 21.6% in the no-diabetes group; HR 1.43 [95% CI 1.19, 1.72], p<0.001). After multiple adjustments for age, BMI, uCCi, clinical (time between onset of COVID-19 symptoms and dyspnoea) and biological variables (eGFR, aspartate aminotransferase, white cell count, platelet count, C-reactive protein) on admission to hospital, diabetes remained associated with a higher risk of primary composite endpoint within 7 days (adjusted HR 1.42 [95% CI 1.17, 1.72], p<0.001) and 28 days (adjusted HR 1.30 [95% CI 1.09, 1.55], p=0.003), compared with individuals without diabetes. Using the same adjustment model, diabetes was associated with the risk of IMV, but not with risk of death, within 28 days of admission to hospital. CONCLUSIONS/INTERPRETATION Our results demonstrate that diabetes status was associated with a deleterious COVID-19 prognosis irrespective of age and comorbidity status. TRIAL REGISTRATION ClinicalTrials.gov NCT04324736.
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Grants
- the Fondation Francophone de Recherche sur le Diabète (FFRD), supported by Novo Nordisk, Merck Sharpe Dome (MSD), Abbott, AstraZeneca, Lilly and FFD (Fédération Française des Diabétiques) – CORONADO initiative emergency grant
- The CORONADO control leg of the study was supported by a grant from the French Ministry of Health
- Société Francophone du Diabète (SFD) – CORONADO initiative emergency grant
- Fonds de dotation du CHU de Nantes (CORONADO project: Sanofi, Air Liquid Healthcare, Novo Nordisk, NHC, Allergan, Lifescan)
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Affiliation(s)
- Bertrand Cariou
- CHU Nantes, CNRS, Inserm, l'institut du thorax, Nantes Université, Nantes, France.
| | - Matthieu Wargny
- CHU Nantes, CNRS, Inserm, l'institut du thorax, Nantes Université, Nantes, France
- CHU Nantes, Inserm CIC 1413, Pôle Hospitalo-Universitaire 11 : Santé Publique, Clinique des données, Nantes, France
| | - Anne-Sophie Boureau
- CHU Nantes, CNRS, Inserm, l'institut du thorax, Nantes Université, Nantes, France
- CHU Nantes, Pôle de Gérontologie Clinique, Nantes, France
| | - Sarra Smati
- CHU Nantes, CNRS, Inserm, l'institut du thorax, Nantes Université, Nantes, France
| | - Blandine Tramunt
- Service de Diabétologie, Maladies Métaboliques & Nutrition, CHU Toulouse, Institut des Maladies Métaboliques & Cardiovasculaires, UMR1297 Inserm/UT3, Université de Toulouse, Toulouse, France
| | - Rachel Desailloud
- Department of Endocrinology, Diabetes Mellitus and Nutrition, Amiens University Hospital, Amiens, France; PériTox UMR_I 01, University of Picardie Jules Verne, Amiens, France
| | - Maylis Lebeault
- Département de Diabétologie, Centre Hospitalier Universitaire, Angers, France
| | - Coralie Amadou
- Département de Diabétologie, Centre Hospitalier Sud Francilien, Corbeil Essonne, France
- Université Paris-Saclay, Le Kremlin-Bicêtre, Paris, France
| | - Deborah Ancelle
- Service endocrinologie-diabétologie-nutrition, CH Le Havre, Montivilliers, France
| | - Beverley Balkau
- Épidémiologie Clinique, Centre de Recherche en Épidémiologie et Santé des Populations, Inserm U1018, Université Paris-Saclay, USVQ, Université Paris-Sud, Villejuif, France
| | - Lyse Bordier
- Service d'endocrinologie et maladies métaboliques, H.I.A Bégin, Saint-Mandé, France
| | - Sophie Borot
- Department of Endocrinology, Diabetology and Nutrition, Besançon University Hospital, Besançon, France
| | - Muriel Bourgeon
- Department of Endocrinology, Diabetology and Nutrition, Assistance Publique Hôpitaux de Paris, Paris-Saclay University, Antoine Béclère Hospital, Clamart, Bicêtre Hospital, Le Kremlin-Bicêtre, France
| | - Olivier Bourron
- Assistance Publique Hôpitaux de Paris, Département de Diabétologie, CHU La Pitié-Salpêtrière - Charles-Foix; Inserm, UMR_S 1138, Centre de Recherche des Cordeliers, Paris 06; Institute of Cardiometabolism and Nutrition ICAN, Sorbonne Université, Paris, France
| | - Emmanuel Cosson
- Assistance Publique Hôpitaux de Paris, Avicenne Hospital, Paris 13 University, Sorbonne Paris Cité, Department of Endocrinology, Diabetology and Nutrition, CRNH-IdF, CINFO, Bobigny, France
- Paris 13 University, Sorbonne Paris Cité, UMR U557 Inserm / U11125 INRAE / CNAM / Paris13 University, Nutritional Epidemiological Research Unit, Bobigny, France
| | - Martin Eisinger
- Hôpital de la Conception, Service d'Endocrinologie, Maladies Métaboliques et Nutrition, Marseille, France
- Inserm, INRAE, C2VN, Aix Marseille Univ, Marseille, France
| | | | - Jean-Baptiste Julla
- Département Diabète et Endocrinologie, Hôpital Lariboisière, Assistance Publique Hôpitaux de Paris, Paris, France
- Inserm UMRS 1138, Université Paris Diderot-Paris VII, Sorbonne Paris Cité, Paris, France
| | | | - Laurent Meyer
- Département d'Endocrinologie, Diabétologie et Nutrition, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - Dominique Seret-Bégué
- Unité de Diabétologie, Endocrinologie et Nutrition, Centre Hospitalier de Gonesse, Gonesse, France
| | | | - Ariane Sultan
- Department of Endocrinology-Diabetology-Nutrition, CHU Montpellier, University of Montpellier, Montpellier, France
- PhyMedExp, CHU Montpellier, Inserm, CNRS, University of Montpellier, Montpellier, France
| | - Charles Thivolet
- Centre du Diabète DIAB-eCARE, Hospices Civils de Lyon et Laboratoire CarMeN, Inserm, INRA, INSA, Université Claude Bernard Lyon 1, Lyon, France
- Société Francophone du Diabète (SFD), Paris, France
| | - Anne Vambergue
- Department of Diabetology, Endocrinology, Metabolism and Nutrition Lille University Hospital, Lille, France
- European Genomic Institute of Diabetes, University School of Medicine, Lille, France
| | - Camille Vatier
- Assistance Publique Hôpitaux de Paris, Saint-Antoine Hospital, Reference Center of Rare Diseases of Insulin Secretion and Insulin Sensitivity (PRISIS), Department of Endocrinology, Paris, France
- Inserm UMRS 938, Saint-Antoine Research Center, Sorbonne University, Paris, France
| | - Patrice Winiszewski
- Service d'Endocrinologie, Diabétologie et Nutrition, Hôpital Nord Franche-Comté, Trévenans, France
| | - Pierre-Jean Saulnier
- Clinical Investigation Centre CIC1402, University of Poitiers, Inserm, CHU Poitiers, Poitiers, France
| | - Bernard Bauduceau
- Service d'endocrinologie et maladies métaboliques, H.I.A Bégin, Saint-Mandé, France
- Fondation Francophone pour la Recherche sur le Diabète (FFRD), Paris, France
| | - Pierre Gourdy
- Service de Diabétologie, Maladies Métaboliques & Nutrition, CHU Toulouse, Institut des Maladies Métaboliques & Cardiovasculaires, UMR1297 Inserm/UT3, Université de Toulouse, Toulouse, France
| | - Samy Hadjadj
- CHU Nantes, CNRS, Inserm, l'institut du thorax, Nantes Université, Nantes, France
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5
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Diedisheim M, Dancoisne E, Gautier JF, Larger E, Cosson E, Fève B, Chanson P, Czernichow S, Tatulashvili S, Raffin-Sanson ML, Sallah K, Bourgeon M, Ajzenberg C, Hartemann A, Daniel C, Moreau T, Roussel R, Potier L. Response to Letter to the Editor From Woolcott and Castilla-Bancayán: "Diabetes Increases Severe COVID-19 Outcomes Primarily in Younger Adults". J Clin Endocrinol Metab 2021; 106:e5277-e5278. [PMID: 34370033 PMCID: PMC8385935 DOI: 10.1210/clinem/dgab583] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Indexed: 11/19/2022]
Affiliation(s)
- Marc Diedisheim
- Cordeliers Research Centre, ImMeDiab team,
INSERM, Université de Paris, 75006 Paris, France
- Hôpital Cochin, APHP, Diabetology
Department, 75014 Paris, France
| | - Etienne Dancoisne
- Assistance Publique-Hôpitaux de Paris, DSI WIND, Web
Innovation Données, 75012 Paris, France
- Hôpital Bichat - Claude-Bernard, APHP, URC
PNVS, CIC-EC 1425, INSERM, 75018 Paris, France
| | - Jean-François Gautier
- Cordeliers Research Centre, ImMeDiab team,
INSERM, Université de Paris, 75006 Paris, France
- GH Lariboisiere Fernand-Widal, APHP, Department of
Diabetes and Endocrinology, 75010 Paris, France
| | - Etienne Larger
- Hôpital Cochin, APHP, Diabetology
Department, 75014 Paris, France
| | - Emmanuel Cosson
- Hospital Avicenne, APHP, Department of
Endocrinology-Diabetology-Nutrition, CRNH-IdF, CINFO, 93000
Bobigny, France
- Université Sorbonne Paris Cité, UMR U557 INSERM/U11125
INRAE, Unité de Recherche Epidémiologique Nutritionnelle, 93000
Bobigny, France
| | - Bruno Fève
- Hôpital Saint-Antoine, APHP, Department of
Endocrinology-Diabetology, 75012 Paris, France
- Institut Hospitalo-Universitaire ICAN, 75013
Paris, France
- Sorbonne Université, INSERM, UMR_S938, CRMR
PRISIS, 75012 Paris, France
| | - Philippe Chanson
- 11Hôpital Bicêtre, APHP, Service d’Endocrinologie et des
Maladies de la Reproduction 94270 Le Kremlin-Bicetre, France
- 12Université Paris-Saclay, INSERM, Physiologie et
Physiopathologie Endocriniennes, 94270 Le Kremlin-Bicetre,
France
| | - Sébastien Czernichow
- Hôpital Européen Georges Pompidou, APHP, Service de
Nutrition, Centre Spécialisé Obésité, 75015 Paris, France
- Université de Paris, INSERM, UMR1153,
Epidemiology and Biostatistics Sorbonne Paris Cité Centre (CRESS), 75015 Paris,
France
| | - Sopio Tatulashvili
- Hospital Avicenne, APHP, Department of
Endocrinology-Diabetology-Nutrition, CRNH-IdF, CINFO, 93000
Bobigny, France
- Université Sorbonne Paris Cité, UMR U557 INSERM/U11125
INRAE, Unité de Recherche Epidémiologique Nutritionnelle, 93000
Bobigny, France
| | - Marie-Laure Raffin-Sanson
- Hospital Ambroise Paré, APHP, Service d'Endocrinologie
Diabétologie et Nutrition, 92100 Boulogne-Billancourt,
France
- Université de Versailles
Saint-Quentin-en-Yvelines, 78000 Versailles, France
| | - Kankoé Sallah
- Hôpital Bichat - Claude-Bernard, APHP, URC
PNVS, CIC-EC 1425, INSERM, 75018 Paris, France
| | - Muriel Bourgeon
- Hôpital Antoine-Béclère, APHP, Service de Médecine
Interne, 92140 Clamart, France
| | | | - Agnès Hartemann
- Hôpital Pitié Salpêtrière, APHP, Diabetology
Department, 75013Paris, France
| | - Christel Daniel
- Assistance Publique-Hôpitaux de Paris, DSI WIND, Web
Innovation Données, 75012 Paris, France
- Sorbonne Université, University Paris 13, Sorbonne Paris
Cité, INSERM UMR_S 1142, 75006 Paris, France
| | - Thomas Moreau
- Université Paris-Saclay, INRIA, CEA, 91120
Palaiseau, France
| | - Ronan Roussel
- Cordeliers Research Centre, ImMeDiab team,
INSERM, Université de Paris, 75006 Paris, France
- Hôpital Bichat - Claude-Bernard, APHP, Department of
Diabetology, 75018 Paris, France
| | - Louis Potier
- Cordeliers Research Centre, ImMeDiab team,
INSERM, Université de Paris, 75006 Paris, France
- Hôpital Bichat - Claude-Bernard, APHP, Department of
Diabetology, 75018 Paris, France
- Corresponding author: Dr Louis Potier, Diabetology, Endocrinology
and Nutrition Department, Bichat Hospital, APHP, 46 rue Henri Huchard 75018
Paris, tel: + 33 (0) 1 40 25 73 01,
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Diedisheim M, Dancoisne E, Gautier JF, Larger E, Cosson E, Fève B, Chanson P, Czernichow S, Tatulashvili S, Raffin-Sanson ML, Bourgeon M, Ajzenberg C, Hartemann A, Daniel C, Moreau T, Roussel R, Potier L. Diabetes Increases Severe COVID-19 Outcomes Primarily in Younger Adults. J Clin Endocrinol Metab 2021; 106:e3364-e3368. [PMID: 34406396 PMCID: PMC8195170 DOI: 10.1210/clinem/dgab393] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Indexed: 01/24/2023]
Abstract
CONTEXT Diabetes is reported as a risk factor for severe coronavirus disease 2019 (COVID-19), but whether this risk is similar in all categories of age remains unclear. OBJECTIVE To investigate the risk of severe COVID-19 outcomes in hospitalized patients with and without diabetes according to age categories. DESIGN SETTING AND PARTICIPANTS We conducted a retrospective observational cohort study of 6314 consecutive patients hospitalized for COVID-19 between February and 30 June 2020 in the Paris metropolitan area, France; follow-up was recorded until 30 September 2020. MAIN OUTCOME MEASURE(S) The main outcome was a composite outcome of mortality and orotracheal intubation in subjects with diabetes compared with subjects without diabetes, after adjustment for confounding variables and according to age categories. RESULTS Diabetes was recorded in 39% of subjects. Main outcome was higher in patients with diabetes, independently of confounding variables (hazard ratio [HR] 1.13 [1.03-1.24]) and increased with age in individuals without diabetes, from 23% for those <50 to 35% for those >80 years but reached a plateau after 70 years in those with diabetes. In direct comparison between patients with and without diabetes, diabetes-associated risk was inversely proportional to age, highest in <50 years and similar after 70 years. Similarly, mortality was higher in patients with diabetes (26%) than in those without diabetes (22%, P < 0.001), but adjusted HR for diabetes was significant only in patients younger than age 50 years (HR 1.81 [1.14-2.87]). CONCLUSIONS Diabetes should be considered as an independent risk factor for the severity of COVID-19 in young adults more so than in older adults, especially for individuals younger than 70 years.
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Affiliation(s)
- Marc Diedisheim
- Cordeliers Research Centre, ImMeDiab team, INSERM, Université de Paris, Paris, France
- Hospital Cochin, APHP, Diabetology Department, Paris, France. Université de Paris, Paris, France
| | - Etienne Dancoisne
- Assistance Publique-Hôpitaux de Paris, DSI WIND, Web Innovation Données, Paris, France
- Hôpital Bichat - Claude-Bernard, Clinical Research Unit, France
| | - Jean-François Gautier
- Cordeliers Research Centre, ImMeDiab team, INSERM, Université de Paris, Paris, France
- GH Lariboisiere Fernand-Widal, AP-HP, Department of Diabetes and Endocrinology, Paris, France. Cordeliers Research Centre, INSERM, ImMeDiab team, Paris, France
| | - Etienne Larger
- Hospital Cochin, APHP, Diabetology Department, Paris, France. Université de Paris, Paris, France
| | - Emmanuel Cosson
- Hospital Avicenne, APHP, Department of Endocrinology-Diabetology-Nutrition, CRNH-IdF, CINFO, Bobigny, France
- Université Sorbonne Paris Cité, UMR U557 INSERM/U11125 INRAE, Unité de Recherche Epidémiologique Nutritionnelle, Bobigny, France
| | - Bruno Fève
- Hôpital Saint-Antoine, Department of Endocrinology-Diabetology, APHP, Institut Hospitalo-Universitaire ICAN, Paris, France. Sorbonne Université, INSERM, UMR_S938, CRMR PRISIS, Paris, France
| | - Philippe Chanson
- Hôpital Bicêtre, APHP, Service d’Endocrinologie et des Maladies de la Reproduction Le Kremlin-Bicetre, France. Université Paris-Saclay, Inserm, Physiologie et Physiopathologie Endocriniennes, Le Kremlin-Bicetre, France
| | - Sébastien Czernichow
- Hôpital Européen Georges Pompidou Cancérologie, Service de Nutrition, Centre Spécialisé Obésité, Paris, France. Université de Paris, INSERM, UMR1153, Epidemiology and Biostatistics Sorbonne Paris Cité Centre (CRESS), Paris, France
| | - Sopio Tatulashvili
- Hospital Avicenne, AP-HP, Department of Endocrinology-Diabetology-Nutrition Bobigny, France. Université Sorbonne Paris Cité, Epidemiology and Biostatistics Research Center, Nutritional Epidemiology Research Team (EREN), Inserm U1153, INRA U1125 Bobigny, France
| | - Marie-Laure Raffin-Sanson
- Hospital Ambroise Paré, APHP, Service d'Endocrinologie Diabétologie et Nutrition, Boulogne-Billancourt, France. Université de Versailles Saint-Quentin-en-Yvelines Versailles, France
| | - Muriel Bourgeon
- Hôpital Antoine-Béclère, APHP, Service de Médecine Interne, Clamart, France
| | | | - Agnès Hartemann
- Sorbonne Université, Institute of Cardiometabolism and Nutrition ICAN, Paris, France. University Hospital Pitié Salpêtrière, APHP, Diabetes Department, Paris, France
| | - Christel Daniel
- Assistance Publique-Hôpitaux de Paris, DSI WIND, Web Innovation Données, Paris, France
- Sorbonne Université, University Paris 13, Sorbonne Paris Cité, INSERM UMR_S 1142, Paris, France
| | - Thomas Moreau
- Université Paris-Saclay, Inria, CEA, Palaiseau, France
| | - Ronan Roussel
- Cordeliers Research Centre, ImMeDiab team, INSERM, Université de Paris, Paris, France
- Hôpital Bichat - Claude-Bernard, APHP, Department of Diabetology, Paris, France
| | - Louis Potier
- Cordeliers Research Centre, ImMeDiab team, INSERM, Université de Paris, Paris, France
- Hôpital Bichat - Claude-Bernard, APHP, Department of Diabetology, Paris, France
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7
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Tramunt B, Smati S, Coudol S, Wargny M, Pichelin M, Guyomarch B, Al-Salameh A, Amadou C, Barraud S, Bigot E, Bordier L, Borot S, Bourgeon M, Bourron O, Charrière S, Chevalier N, Cosson E, Fève B, Flaus-Furmaniuk A, Fontaine P, Galioot A, Gonfroy-Leymarie C, Guerci B, Lablanche S, Lalau JD, Larger E, Lasbleiz A, Laviolle B, Marre M, Munch M, Potier L, Prevost G, Renard E, Reznik Y, Seret-Bégué D, Sibilia P, Thuillier P, Vergès B, Gautier JF, Hadjadj S, Cariou B, Mauvais-Jarvis F, Gourdy P. Sex disparities in COVID-19 outcomes of inpatients with diabetes: insights from the CORONADO study. Eur J Endocrinol 2021; 185:299-311. [PMID: 34085949 PMCID: PMC9494335 DOI: 10.1530/eje-21-0068] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2021] [Accepted: 06/03/2021] [Indexed: 11/14/2022]
Abstract
OBJECTIVE Male sex is one of the determinants of severe coronavirus diseas-e-2019 (COVID-19). We aimed to characterize sex differences in severe outcomes in adults with diabetes hospitalized for COVID-19. METHODS We performed a sex-stratified analysis of clinical and biological features and outcomes (i.e. invasive mechanical ventilation (IMV), death, intensive care unit (ICU) admission and home discharge at day 7 (D7) or day 28 (D28)) in 2380 patients with diabetes hospitalized for COVID-19 and included in the nationwide CORONADO observational study (NCT04324736). RESULTS The study population was predominantly male (63.5%). After multiple adjustments, female sex was negatively associated with the primary outcome (IMV and/or death, OR: 0.66 (0.49-0.88)), death (OR: 0.49 (0.30-0.79)) and ICU admission (OR: 0.57 (0.43-0.77)) at D7 but only with ICU admission (OR: 0.58 (0.43-0.77)) at D28. Older age and a history of microvascular complications were predictors of death at D28 in both sexes, while chronic obstructive pulmonary disease (COPD) was predictive of death in women only. At admission, C-reactive protein (CRP), aspartate amino transferase (AST) and estimated glomerular filtration rate (eGFR), according to the CKD-EPI formula predicted death in both sexes. Lymphocytopenia was an independent predictor of death in women only, while thrombocytopenia and elevated plasma glucose concentration were predictors of death in men only. CONCLUSIONS In patients with diabetes admitted for COVID-19, female sex was associated with lower incidence of early severe outcomes, but did not influence the overall in-hospital mortality, suggesting that diabetes mitigates the female protection from COVID-19 severity. Sex-associated biological determinants may be useful to optimize COVID-19 prevention and management in women and men.
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Affiliation(s)
- Blandine Tramunt
- Department of Diabetology, Metabolic Diseases and Nutrition, Toulouse University Hospital, Institute of Metabolic and Cardiovascular Diseases, UMR1297 INSERM/UPS, Toulouse University, Toulouse, France
| | - Sarra Smati
- Nantes University, Nantes University Hospital, CNRS, INSERM, L’Institut du Thorax, Nantes, France
| | | | - Matthieu Wargny
- Nantes University, Nantes University Hospital, CNRS, INSERM, L’Institut du Thorax, Nantes, France
- CIC-EC 1413, Data Clinic, France
| | - Matthieu Pichelin
- Nantes University, Nantes University Hospital, CNRS, INSERM, L’Institut du Thorax, Nantes, France
| | - Béatrice Guyomarch
- Research Department, Methodology and Biostatistics Platform, Nantes University Hospital, Nantes, France
| | - Abdallah Al-Salameh
- Department of Endocrinology, Diabetes Mellitus and Nutrition, Amiens University Hospital, Amiens, France
- PériTox=UMR_I 01, University of Picardie Jules Verne, Amiens, France
| | - Coralie Amadou
- Department of Diabetology, Sud Francilien Hospital Center, Corbeil Essonne, France
| | - Sara Barraud
- CRESTIC EA 3804, University of Reims Champagne Ardenne, UFR Sciences Exactes et Naturelles, Moulin de la Housse, Reims, France
- Department of Endocrinology-Diabetes-Nutrition, Reims University Hospital, Avenue du Général Koenig, Reims, France
| | - Edith Bigot
- Department of Biochemistry, Nantes University Hospital, G et R Laënnec Hospital, Bd Jacques Monod, Nantes, France
| | - Lyse Bordier
- Department of Endocrinology, Bégin Hospital, Saint-Mandé, France
| | - Sophie Borot
- Department of Endocrinology, Diabetology and Nutrition, Besançon University Hospital, Besançon, France
| | - Muriel Bourgeon
- Department of Endocrinology, Diabetology and Nutrition, Assistance Publique Hôpitaux de Paris, Paris Saclay University, Antoine Béclère Hospital, Clamart, Bicêtre Hospital, Le Kremlin Bicêtre, France
| | - Olivier Bourron
- Department of Diabetology, Sorbonne University, Assistance Publique Hôpitaux de Paris, La Pitié Salpêtrière-Charles Foix University Hospital, Inserm, UMR_S 1138, Cordeliers Research Center, Paris 06, Institute of Cardiometabolism and Nutrition ICAN, Paris, France
| | - Sybil Charrière
- Federation of Endocrinology – Louis Pradel Cardiovascular Hospital, Hospices Civils de Lyon, INSERM UMR 1060 Carmen, Claude Bernard Lyon 1 University, Lyon, France
| | - Nicolas Chevalier
- University of Côte d’Azur, University Hospital, Inserm U1065, C3M, Nice, France
| | - Emmanuel Cosson
- Department of Endocrinology, Diabetology and Nutrition, Assistance Publique Hôpitaux de Paris, Avicenne Hospital, Paris 13 University, Sorbonne Paris Cité, CRNH-IdF, CINFO, Bobigny, France
- Paris 13 University, Sorbonne Paris Cité, UMR U557 Inserm/U11125 INRAE/CNAM/Paris13 University, Nutritional Epidemiological Research Unit, Bobigny, France
| | - Bruno Fève
- Department of Endocrinology, Assistance Publique Hôpitaux de Paris, Saint-Antoine Hospital, Reference Center of Rare Diseases of Insulin Secretion and Insulin Sensitivity (PRISIS), Paris, France
- Sorbonne University, Inserm UMRS 938, Saint-Antoine Research Center, Paris, France
| | - Anna Flaus-Furmaniuk
- Department of Endocrinology-Diabetology, Felix Guyon Site, University Hospital of la Réunion, Saint-Denis de la Réunion, France
| | - Pierre Fontaine
- Department of Endocrinology, Diabetology and Nutrition, Hospital of Huriez, Lille University Hospital, Lille, France
| | - Amandine Galioot
- Department of Endocrinology, Diabetology and Nutrition, Bordeaux University Hospital and University of Bordeaux, Bordeaux, France
| | | | - Bruno Guerci
- Lorraine University and Endocrinology, Diabetology, Metabolic Diseases and Nutrition, Nancy University Hospital, Nancy, France
| | - Sandrine Lablanche
- Grenoble Alpes University, INSERM U1055, LBFA, Endocrinology, Grenoble Alpes University Hospital, France
| | - Jean-Daniel Lalau
- Department of Endocrinology, Diabetes Mellitus and Nutrition, Amiens University Hospital, Amiens, France
- PériTox=UMR_I 01, University of Picardie Jules Verne, Amiens, France
| | - Etienne Larger
- Department of Diabetology, Cochin Hospital, AP-HP, Paris University, Paris, France
| | - Adèle Lasbleiz
- Department of Endocrinology, Diabetology and Nutrition, Hospital of la Conception, Assistance Publique-Hôpitaux de Marseille, Marseille, France
- Aix Marseille University, INSERM, INRA, C2VN, Marseille, France
| | - Bruno Laviolle
- Rennes University, Rennes University Hospital, Inserm, CIC 1414 (Clinical Investigation Center), Rennes, France
| | - Michel Marre
- Ambroise Paré Neuilly-sur-Seine Hospital, Cordeliers Research Center, Paris Diderot University, Paris, France
| | - Marion Munch
- Department of Endocrinology, Diabetology and Nutrition, Strasbourg University Hospitals, Strasbourg, France
| | - Louis Potier
- Department of Endocrinology, Diabetology and Nutrition, Bichat Hospital, Assistance Publique Hôpitaux de Paris, Paris, France
- Cordeliers Research Center, Inserm, U-1138, Paris University, Paris, France
| | - Gaëtan Prevost
- Department of Endocrinology, Diabetes and Metabolic Diseases, Normandie University, UNIROUEN, Rouen University Hospital, Rouen, France
| | - Eric Renard
- Department of Endocrinology, Diabetes, Nutrition, Montpellier University Hospital, INSERM Clinical Investigation Centre, Institute of Functional Genomics, CNRS, INSERM, University of Montpellier, Montpellier, France
| | - Yves Reznik
- Department of Endocrinology and Diabetology, University Hospital of Côte de Nacre, Caen Cedex, France
| | | | - Paul Sibilia
- Department of Endocrinology, Diabetology and Nutrition, Angers University Hospital, Angers, France
| | - Philippe Thuillier
- Department of Endocrinology, Brest University Hospital, EA 3878 GETBO, Brest, France
| | - Bruno Vergès
- Department of Endocrinology, Diabetology and Metabolic Diseases, Hospital of Bocage, Dijon, France
| | - Jean-François Gautier
- Department of Diabetology and Endocrinology, Lariboisière Hospital, APHP, Paris, France
- INSERM UMRS 1138, Paris Diderot-Paris VII University, Sorbonne Paris Cité, Paris, France
| | - Samy Hadjadj
- Nantes University, Nantes University Hospital, CNRS, INSERM, L’Institut du Thorax, Nantes, France
| | - Bertrand Cariou
- Nantes University, Nantes University Hospital, CNRS, INSERM, L’Institut du Thorax, Nantes, France
| | - Franck Mauvais-Jarvis
- Section of Endocrinology, John W Deming Department of Medicine, Tulane University School of Medicine, New Orleans, Louisiana, USA
- Southeast Louisiana Veterans Health Care System Medical Center, New Orleans, Louisiana, USA
- Tulane Center of Excellence in Sex-Based Biology and Medicine, New Orleans, Louisiana, USA
- Correspondence should be addressed to F Mauvais-Jarvis;
| | - Pierre Gourdy
- Department of Diabetology, Metabolic Diseases and Nutrition, Toulouse University Hospital, Institute of Metabolic and Cardiovascular Diseases, UMR1297 INSERM/UPS, Toulouse University, Toulouse, France
- Correspondence should be addressed to P Gourdy;
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Martin D, Lepeule J, Henocque C, Papin J, Maurige O, Bourgeon M, Bricourt P, Brochard P. Recherche de potentiels effets des aérosols solides de carbone, issus de matériaux composites carbone/carbone. ARCH MAL PROF ENVIRO 2004. [DOI: 10.1016/s1775-8785(04)93117-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Bertherat J, Bouchard P, Chanson P, Benoît A, Bourgeon M, Brémont C, Kahal Z, Mathé C, Requeda E. [Management of acromegaly in 2003]. Ann Endocrinol (Paris) 2003; 64:I-IV. [PMID: 12773933] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 03/02/2023]
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Simon D, Bourgeon M, Balkau B, Eschwege E, Charles MA. [Insulin sensitivity and ethnic groups]. Diabetes Metab 2001; 27:215-21. [PMID: 11452213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/20/2023]
Abstract
Epidemiological surveys show a large variation of type 2 diabetes (DT2) prevalence from one country to another, suggesting ethnic discrepancies in insulin sensitivity. Many data seem to confirm this hypothesis. We will show them while concentrating on data provided by surveys performed in French-speaking countries. The mechanisms of the ethnic differences in insulin sensitivity are unclear and further insights are needed. More than genetic factors, environmental factors appear to be involved in the occurence of insulin resistance and DT2. The epidemic nature of obesity and subsequent DT2 in the world urges health authorities in each country to raise campaigns to promote changes in life style and nutritional habits before the announced pandemy of DT2 becomes reality.
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Affiliation(s)
- D Simon
- Service de Diabétologie-Endocrinologie, Hôpital Henri Mondor, 94000 Créteil, France.
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Bourgeon M. [From the National Socialist time]. Prax Kinderpsychol Kinderpsychiatr 1986; 35:222-8. [PMID: 3774763] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
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