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Buysschaert M, Bergman M, Valensi P. 1-h post-load plasma glucose for detecting early stages of prediabetes. Diabetes Metab 2022; 48:101395. [PMID: 36184047 DOI: 10.1016/j.diabet.2022.101395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Revised: 09/28/2022] [Accepted: 09/28/2022] [Indexed: 06/16/2023]
Abstract
Prediabetes is a very prevalent condition associated with an increased risk of developing diabetes and/or other chronic complications, in particular cardiovascular disorders. Early detection is therefore mandatory since therapeutic interventions may limit the development of these complications. Diagnosis of prediabetes is currently based on glycemic criteria (fasting plasma glucose (PG), and/or glycemia at 120 min during a 75 g oral glucose tolerance test (OGTT) and/or glycated hemoglobin (HbA1c). Accumulating longitudinal evidence suggests that a 1-hour PG ≥155 mg/dl (8.6 mmol/l) during the OGTT is an earlier marker of prediabetes than fasting PG, 2-h post-load PG, or HbA1c. There is substantial evidence demonstrating that the 1-h post-load PG is a more sensitive predictor of type 2 diabetes, cardiovascular disease, microangiopathy and mortality compared with conventional glucose criteria. The aim of this review is to highlight the paramount importance of detecting prediabetes early in its pathophysiological course. Accordingly, as recommended by an international panel in a recent petition, 1-h post-load PG could replace current criteria for diagnosing early stages of "prediabetes" before prediabetes evolves as conventionally defined.
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Affiliation(s)
- M Buysschaert
- Service d'Endocrinologie et Nutrition, Cliniques universitaires UCLouvain Saint-Luc, B-1200 Brussels, Belgium.
| | - M Bergman
- NYU Grossman School of Medicine, Division of Endocrinology, Diabetes and Metabolism, New York, NY, USA
| | - P Valensi
- Unit of Endocrinology-Diabetology-Nutrition. Jean Verdier Hospital, APHP, Paris 13 University, Sorbonne Paris Cité, CINFO, CRNH-IdF. Bondy, France
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Younes N, Pinto S, Valensi P. SEVERE REFRACTORY HYPOTHYROIDISM IN A 48-YEAR-OLD FEMALE: ROLE OF LOW-DOSE THYROXINE ABSORPTION TEST IN ESTABLISHING DIAGNOSIS OF NONCOMPLIANCE. Acta Endocrinol (Buchar) 2022; 18:375-378. [PMID: 36699170 PMCID: PMC9867820 DOI: 10.4183/aeb.2022.375] [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] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
A 48-year-old female presented with severe chronic hypothyroidism despite progressively increasing doses of levothyroxine. Poor adherence was suspected based on previous laboratory investigations. A low dose thyroxine absorption test using 400 µg of levothyroxine taken orally was performed. FT4 increased by 4.7 pmol/L at 3 hours and 6.6 pmol/L at 5 hours, following ingestion, effectively ruling out malabsorption. Her cardiac hemodynamic profile, measured noninvasively, also improved following levothyroxine intake, further supporting our diagnosis. Poor adherence was successfully managed by implementing twice weekly visits by a registered nurse and an improvement in both thyroid function tests and cardiac parameters was seen at the one-month follow-up visit. We suggest using a lower dose thyroxine absorption test, owing to its efficacy in establishing diagnosis and a safer alternative compared to higher doses in particular in high-risk cardiac patients.
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Affiliation(s)
- N. Younes
- Hôpital Jean-Verdier, Service d’Endocrinologie Diabétologie et Nutrition, Bondy, Île-de-France, France
| | - S. Pinto
- Hôpital Jean-Verdier, Service d’Endocrinologie Diabétologie et Nutrition, Bondy, Île-de-France, France
| | - P. Valensi
- Hôpital Jean-Verdier, Service d’Endocrinologie Diabétologie et Nutrition, Bondy, Île-de-France, France
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Abdennbi K, Mouine N, Vallee A, Duval M, Amah G, Gagey S, Guiti C, Blacher J, Valensi P. High prevalence of unkown dysglycemia and chronotropic response to exercise in patients admitted in cardiac rehabilitation program. Eur J Prev Cardiol 2021. [DOI: 10.1093/eurjpc/zwab061.302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Introduction : Some studies suggest a high rate of unknown glycemic abnormalities in coronary patients. The aim of the study was to determine the prevalence of dysglycemia detected by oral glucose load (OGL) in patients ongoing Cardiac Rehab , and to analyse chronotropic response to exercise before and after Cardiac rehab in dysglycemic patients.
Patients and methods : We included 838 patients, mostly coronary patients after acute coronary syndrome, including 79% men and 375 were diabetics. OGL has been performed in non-diabetics and ergospirometry test performed in all patients before and after rehabilitation.
Results : At OGL, 189 of 463 non-diabetics (41%) had dysglycemia: Diabetes (n = 42 including 17 according to fasting glycemia), Glucose intolerance (GI) (n = 102 including 32 with fasting hyperglycemia (FH), FH isolated (n = 45). We compared 417 patients with known or discovered diabetes, GI and 319 normoglycemic or FH. Diabetics were older and had a higher BMI than GI and normoglycemic-FH (p <0.001). Resting heart rate (HR) was higher and maximal HR on exercise is lower in diabetics than other 2 groups (p <0.001) without significantly differing between GI and normoglycaemia-FH. VO2max was lower in diabetics and GI than normoglycemic-FH s (p <0.001 and 0.01). After cardiac rehabilitation, resting HR is changed little, HR max and VO2max increased in 3 groups but kept the same inter-group differences
Conclusion :This data confirms the high prevalence of unknown dysglycemia and the importance of OGL for their screening, especially in coronary patients. In diabetics, the higher resting HR and the lack of chronotropic reserve probably indicate autonomic dysregulation which partially improves after cardiac rehabilitation.
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Affiliation(s)
- K Abdennbi
- Léopold Bellan Hospital, Cardiac Rehabilitation Center, URC, paris, France
| | - N Mouine
- Military Hospital Mohammed V, cardiac rehabilitation unit, cardiology centre , Rabat, Morocco
| | - A Vallee
- Hospital Hotel-Dieu, Paris, France
| | - M Duval
- Léopold Bellan Hospital, Cardiac Rehabilitation Center, URC, paris, France
| | - G Amah
- Léopold Bellan Hospital, Cardiac Rehabilitation Center, URC, paris, France
| | - S Gagey
- Léopold Bellan Hospital, Cardiac Rehabilitation Center, URC, paris, France
| | - C Guiti
- Léopold Bellan Hospital, Cardiac Rehabilitation Center, URC, paris, France
| | | | - P Valensi
- Jean Verdier Hospital of Bondy, Endocrinology-diabetes-nutrition unit, Paris Nord University, CRNH-IdF CINFO, Bondy, France
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4
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Cosson E, Vicaut E, Sandre-Banon D, Gary F, Pharisien I, Portal JJ, Baudry C, Cussac-Pillegand C, Costeniuc D, Valensi P, Carbillon L. Performance of a selective screening strategy for diagnosis of hyperglycaemia in pregnancy as defined by IADPSG/WHO criteria. Diabetes & Metabolism 2020; 46:311-318. [DOI: 10.1016/j.diabet.2019.09.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/10/2019] [Revised: 08/12/2019] [Accepted: 09/29/2019] [Indexed: 12/20/2022]
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Cosson E, Vicaut E, Sandre-Banon D, Gary F, Pharisien I, Portal JJ, Baudry C, Cussac-Pillegand C, Valensi P, Carbillon L. Initially untreated fasting hyperglycaemia in early pregnancy: prognosis according to occurrence of gestational diabetes mellitus after 22 weeks' gestation: a case-control study. Diabet Med 2020; 37:123-130. [PMID: 31536661 DOI: 10.1111/dme.14141] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [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] [Accepted: 09/17/2019] [Indexed: 12/25/2022]
Abstract
AIMS To evaluate the percentage of women with untreated fasting hyperglycaemia in early pregnancy who develop gestational diabetes mellitus after 22 weeks' gestation, the determinants of gestational diabetes development in such women and the prognosis of early fasting hyperglycaemia according to whether the women go on to develop gestational diabetes. METHODS From a large cohort of women who delivered in our hospital between 2012 and 2016, we retrospectively selected all those who had untreated early fasting hyperglycaemia and separated them into a 'gestational diabetes' and a 'no-gestational diabetes' group according to oral glucose tolerance test results after 22 weeks' gestation. We compared the incidence of a predefined composite outcome (preeclampsia or large-for-gestational-age infant or shoulder dystocia or neonatal hypoglycaemia) in both groups. RESULTS A total of 268 women (mean fasting plasma glucose 5.3 ± 0.3 mmol/l at a mean ± sd of 10.2 ± 4.2 weeks' gestation) were included. Gestational diabetes developed in 134 women and was independently associated with early fasting plasma glucose ≥ 5.5 mmol/l [odds ratio 3.16 (95% CI 1.57, 6.33)], age ≥ 30 years [odds ratio 2.78 (95% CI 1.46, 5.31)], preconception obesity [odds ratio 2.12 (95% CI 1.11, 4.02)], family history of diabetes [odds ratio 1.87 (95% CI 1.00, 3.50)] and current employment [odds ratio 0.46 (95% CI 0.26, 0.83)]. Despite treatment, gestational diabetes induced a significant increase in the composite outcome as compared to no gestational diabetes (odds ratio 2.16 [95% CI 1.08, 4.34]). The association disappeared after adjustment for risk factors. CONCLUSIONS Only half of the women with early fasting hyperglycaemia and no specific care subsequently developed gestational diabetes, and these women had a poor prognosis despite gestational diabetes treatment. Poor prognosis was mostly attributable to risk factors. Our results suggest that only women with certain risk factors should be screened for early fasting hyperglycaemia.
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Affiliation(s)
- E Cosson
- Department of Endocrinology-Diabetology-Nutrition, Paris 13 University, Sorbonne Paris Cité, AP-HP, CRNH-IdF, CINFO, Bondy, France
- EREN, UMR U557 INSERM/U11125 INRA/CNAM/Université Paris 13, Bobigny, Université Denis Diderot, Paris, France
| | - E Vicaut
- AP-HP Clinical research Unit St-Louis-Lariboisière, Université Denis Diderot, Paris, France
| | - D Sandre-Banon
- Department of Endocrinology-Diabetology-Nutrition, Paris 13 University, Sorbonne Paris Cité, AP-HP, CRNH-IdF, CINFO, Bondy, France
| | - F Gary
- Department of Endocrinology-Diabetology-Nutrition, Paris 13 University, Sorbonne Paris Cité, AP-HP, CRNH-IdF, CINFO, Bondy, France
| | - I Pharisien
- Department of Obstetrics and Gynecology, Paris 13 University, Sorbonne Paris Cité, AP-HP, Bondy, France
| | - J-J Portal
- AP-HP Clinical research Unit St-Louis-Lariboisière, Université Denis Diderot, Paris, France
| | - C Baudry
- Department of Endocrinology-Diabetology-Nutrition, Paris 13 University, Sorbonne Paris Cité, AP-HP, CRNH-IdF, CINFO, Bondy, France
| | - C Cussac-Pillegand
- Department of Endocrinology-Diabetology-Nutrition, Paris 13 University, Sorbonne Paris Cité, AP-HP, CRNH-IdF, CINFO, Bondy, France
| | - P Valensi
- Department of Endocrinology-Diabetology-Nutrition, Paris 13 University, Sorbonne Paris Cité, AP-HP, CRNH-IdF, CINFO, Bondy, France
| | - L Carbillon
- Department of Obstetrics and Gynecology, Paris 13 University, Sorbonne Paris Cité, AP-HP, Bondy, France
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Valensi P, Picard S, Pathak A. Type 2 diabetes: Why should diabetologists and cardiologists work more closely together? Diabetes & Metabolism 2019; 45:501-504. [DOI: 10.1016/j.diabet.2019.07.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Accepted: 07/26/2019] [Indexed: 01/09/2023]
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Cosson E, Vicaut E, Sandre-Banon D, Gary F, Pharisien I, Portal JJ, Banu I, Bianchi L, Cussac-Pillegand C, Dina R, Chiheb S, Valensi P, Carbillon L. Early screening for gestational diabetes mellitus is not associated with improved pregnancy outcomes: an observational study including 9795 women. Diabetes & Metabolism 2019; 45:465-472. [DOI: 10.1016/j.diabet.2018.11.006] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/28/2018] [Revised: 10/29/2018] [Accepted: 11/15/2018] [Indexed: 01/09/2023]
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Belenfant X, Michault A, Kaba D, Vasmant D, Basse O, Valensi P, Develay A. Campagnes de co-dépistage des facteurs de risque de maladie rénale et de diabète en Île-de-France. Résultats de trois années d’action. Nephrol Ther 2019. [DOI: 10.1016/j.nephro.2019.07.290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Borel AL, Tamisier R, Böhme P, Priou P, Avignon A, Benhamou PY, Hanaire H, Pépin JL, Kessler L, Valensi P, Darmon P, Gagnadoux F. Obstructive sleep apnoea syndrome in patients living with diabetes: Which patients should be screened? Diabetes & Metabolism 2019; 45:91-101. [DOI: 10.1016/j.diabet.2018.08.006] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/15/2018] [Revised: 07/16/2018] [Accepted: 08/11/2018] [Indexed: 12/27/2022]
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Morin E, Meier J, El Guennouni K, Moigne AM, Lebreton L, Rusch L, Valensi P, Conolly J, Cochard D. New evidence of broader diets for archaic Homo populations in the northwestern Mediterranean. Sci Adv 2019; 5:eaav9106. [PMID: 30854435 PMCID: PMC6402852 DOI: 10.1126/sciadv.aav9106] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/31/2018] [Accepted: 01/28/2019] [Indexed: 06/09/2023]
Abstract
Investigating diet breadth is critical for understanding how archaic Homo populations, including Neanderthals, competed for seasonally scarce resources. The current consensus in Western Europe is that ungulates formed the bulk of the human diet during the Lower and Middle Paleolithic, while small fast prey taxa were virtually ignored. Here, we present a multisite taphonomic study of leporid assemblages from Southern France that supports frequent exploitation of small fast game during marine isotope stages 11 to 3. Along with recent evidence from Iberia, our results indicate that the consumption of small fast game was more common prior to the Upper Paleolithic than previously thought and that archaic hominins from the northwestern Mediterranean had broader diets than those from adjacent regions. Although likely of secondary importance relative to ungulates, the frequent exploitation of leporids documented here implies that human diet breadths were substantially more variable within Europe than assumed by current evolutionary models.
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Affiliation(s)
- E. Morin
- Department of Anthropology, Trent University, DNA Block C, 2140 East Bank Drive, Peterborough, Ontario K9J 7B8, Canada
- Université de Bordeaux, PACEA, B18, UMR 5199, Allée Geoffroy St-Hilaire, CS50023, 33615 Pessac Cedex, France
| | - J. Meier
- Department of Sociology, Anthropology and Social Work, University of North Florida, 1 UNF Drive, Jacksonville, FL 32224, USA
| | - K. El Guennouni
- Laboratoire de Préhistoire Nice Côte d’Azur, 15 boulevard Maurice Maeterlinck, 06300 Nice, France
| | - A.-M. Moigne
- UMR 7194 CNRS, Département de Préhistoire, Muséum National d’Histoire Naturelle, Paris, France
| | - L. Lebreton
- UMR 7194 CNRS, Département de Préhistoire, Muséum National d’Histoire Naturelle, Paris, France
| | - L. Rusch
- Université de Perpignan Via Domitia, UMR 7194 HNHP, Avenue Léon-Jean Grégory, 66720 Tautavel, France
| | - P. Valensi
- UMR 7194 CNRS, Musée de Préhistoire, 06690 Tourrette-Levens, France
| | - J. Conolly
- Department of Anthropology, Trent University, DNA Block C, 2140 East Bank Drive, Peterborough, Ontario K9J 7B8, Canada
| | - D. Cochard
- Université de Bordeaux, PACEA, B18, UMR 5199, Allée Geoffroy St-Hilaire, CS50023, 33615 Pessac Cedex, France
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Borel AL, Tamisier R, Böhme P, Priou P, Avignon A, Benhamou PY, Hanaire H, Pépin JL, Kessler L, Valensi P, Darmon P, Gagnadoux F. [Reprint of : Management of obstructive sleep apnea syndrome in people living with diabetes: context, screening, indications and treatment modalities: context, screening, indications and treatment modalities: a French position statement]. Rev Mal Respir 2018; 35:1067-1089. [PMID: 30429090 DOI: 10.1016/j.rmr.2018.10.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Affiliation(s)
- A-L Borel
- Hôpital universitaire Grenoble Alpes, Département d'Endocrinologie, Diabétologie, Nutrition, 38043 Grenoble cedex 9, France; Université Grenoble Alpes, laboratoire "Hypoxie physiopahologie" INSERM U1042, Grenoble, France.
| | - R Tamisier
- Université Grenoble Alpes, laboratoire "Hypoxie physiopahologie" INSERM U1042, Grenoble, France; Hôpital universitaire Grenoble Alpes, Pôle "Thorax et Vaisseaux", clinique de physiologie, sommeil et exercice, Grenoble, France
| | - P Böhme
- Hôpital universitaire de Nancy, Département d'Endocrinologie, Diabétologie, Nutrition, Nancy, France; Université de Lorraine, EA4360 APEMAC, Nancy, France
| | - P Priou
- Hôpital universitaire d'Angers, Département des maladies respiratoires, Angers, France; Université d'Angers, INSERM UMR 1063, Angers, France
| | - A Avignon
- PhyMedExp, Université de Montpellier, INSERM, CNRS, Montpellier, France; Hôpital universitaire de Montpellier, département de Nutrition, Montpellier, France
| | - P-Y Benhamou
- Hôpital universitaire Grenoble Alpes, Département d'Endocrinologie, Diabétologie, Nutrition, 38043 Grenoble cedex 9, France
| | - H Hanaire
- Hôpital universitaire de Toulouse, Université de Toulouse, Toulouse, France
| | - J-L Pépin
- Université Grenoble Alpes, laboratoire "Hypoxie physiopahologie" INSERM U1042, Grenoble, France; Hôpital universitaire Grenoble Alpes, Pôle "Thorax et Vaisseaux", clinique de physiologie, sommeil et exercice, Grenoble, France
| | - L Kessler
- Hôpital universitaire de Strasbourg, département de diabétologie, INSERM UMR 1260, Strasbourg, France
| | - P Valensi
- Departement d'Endocrinologie Diabétologie Nutrition, APHP, Hôpital Jean Verdier, Université Paris Nord, CRNH-IdF, CINFO, Bondy, France
| | - P Darmon
- Hôpital universitaire de Marseille, département d'Endocrinologie, et Université de France & Aix Marseille, INSERM, INRA, C2VN, Marseille, France
| | - F Gagnadoux
- Hôpital universitaire d'Angers, Département des maladies respiratoires, Angers, France; Université d'Angers, INSERM UMR 1063, Angers, France
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Cosson E, Catargi B, Cheisson G, Jacqueminet S, Ichai C, Leguerrier AM, Ouattara A, Tauveron I, Bismuth E, Benhamou D, Valensi P. Practical management of diabetes patients before, during and after surgery: A joint French diabetology and anaesthesiology position statement. Diabetes Metab 2018; 44:200-216. [PMID: 29496345 DOI: 10.1016/j.diabet.2018.01.014] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/20/2017] [Revised: 01/08/2018] [Accepted: 01/15/2018] [Indexed: 12/12/2022]
Affiliation(s)
- E Cosson
- Département d'endocrinologie-diabétologie-nutrition, CRNH-IdF, CINFO, hôpital Jean-Verdier, université Paris 13, Sorbonne Paris Cité, AP-HP, 93140 Bondy, France; UMR U1153 Inserm, U1125 Inra, CNAM, université Paris 13, Sorbonne Paris Cité, 93000 Bobigny, France
| | - B Catargi
- Service d'endocrinologie-maladies métaboliques, hôpital Saint-André, CHU de Bordeaux, 1, rue Jean-Burguet, 33000 Bordeaux, France.
| | - G Cheisson
- Service d'anesthésie-réanimation chirurgicale, hôpitaux universitaires Paris-Sud, hôpital de Bicêtre, AP-HP, 78, rue du Général-Leclerc, 94275 Le Kremlin-Bicêtre, France
| | - S Jacqueminet
- Institut de cardio-métabolisme et nutrition, hôpital de la Pitié-Salpêtrière, AP-HP, 75013 Paris, France; Département du diabète et des maladies métaboliques, hôpital de la Pitié-Salpêtrière, 75013 Paris, France
| | - C Ichai
- Service de la réanimation polyvalente, hôpital Pasteur 2, CHU de Nice, 30, voie Romaine, 06001 Nice cedex 1, France; IRCAN, Inserm U1081, CNRS UMR 7284, university hospital of Nice, 06000 Nice, France
| | - A-M Leguerrier
- Service de diabétologie-endocrinologie, CHU hôpital Sud, CHU de Rennes, 16, boulevard de Bulgarie, 35056 Rennes, France
| | - A Ouattara
- Department of anaesthesia and critical care II, Magellan medico-surgical center, CHU de Bordeaux, 33000 Bordeaux, France; Inserm, UMR 1034, biology of cardiovascular diseases, université Bordeaux, 33600 Pessac, France
| | - I Tauveron
- Service d'endocrinologie-diabétologie, CHU de Clermont-Ferrand, 58, rue Montalembert, 63000 Clermont-Ferrand, France; UFR médecine, université Clermont-Auvergne, 28, place Henri-Dunant, 63000 Clermont-Ferrand, France; UMR CNRS 6293, Inserm U1103, génétique reproduction et développement, université Clermont-Auvergne, 63170 Aubière, France; Endocrinologie-diabétologie, CHU G.-Montpied, BP 69, 63003 Clermont-Ferrand, France
| | - E Bismuth
- Service d'endocrinologie-pédiatrie-diabète, hôpital Robert-Debré, AP-HP, 75019 Paris, France
| | - D Benhamou
- Service d'anesthésie-réanimation chirurgicale, hôpitaux universitaires Paris-Sud, hôpital de Bicêtre, AP-HP, 78, rue du Général-Leclerc, 94275 Le Kremlin-Bicêtre, France
| | - P Valensi
- Département d'endocrinologie-diabétologie-nutrition, CRNH-IdF, CINFO, hôpital Jean-Verdier, université Paris 13, Sorbonne Paris Cité, AP-HP, 93140 Bondy, France
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14
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Cosson E, Gary F, Nguyen MT, Bianchi L, Sandre-Banon D, Biri L, Jaber Y, Cussac-Pillegand C, Banu I, Chiheb S, Carbillon L, Valensi P. Gradual increase in advanced glycation end-products from no diabetes to early and regular gestational diabetes: A case-control study. Diabetes Metab 2018; 45:586-589. [PMID: 29402596 DOI: 10.1016/j.diabet.2018.01.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/08/2017] [Revised: 01/05/2018] [Accepted: 01/06/2018] [Indexed: 10/18/2022]
Affiliation(s)
- E Cosson
- Department of endocrinology-diabetology-nutrition, CRNH-IdF, CINFO, Jean-Verdier hospital, Paris 13 university, AP-HP, 93143 Bondy cedex, France; Unité de recherche épidémiologique nutritionnelle, UMR U1153 Inserm, U11125 Inra, CNAM, université Paris13, 93000 Bobigny, France.
| | - F Gary
- Department of endocrinology-diabetology-nutrition, CRNH-IdF, CINFO, Jean-Verdier hospital, Paris 13 university, AP-HP, 93143 Bondy cedex, France
| | - M T Nguyen
- Department of endocrinology-diabetology-nutrition, CRNH-IdF, CINFO, Jean-Verdier hospital, Paris 13 university, AP-HP, 93143 Bondy cedex, France
| | - L Bianchi
- Department of endocrinology-diabetology-nutrition, CRNH-IdF, CINFO, Jean-Verdier hospital, Paris 13 university, AP-HP, 93143 Bondy cedex, France
| | - D Sandre-Banon
- Department of endocrinology-diabetology-nutrition, CRNH-IdF, CINFO, Jean-Verdier hospital, Paris 13 university, AP-HP, 93143 Bondy cedex, France
| | - L Biri
- Department of endocrinology-diabetology-nutrition, CRNH-IdF, CINFO, Jean-Verdier hospital, Paris 13 university, AP-HP, 93143 Bondy cedex, France
| | - Y Jaber
- Department of endocrinology-diabetology-nutrition, CRNH-IdF, CINFO, Jean-Verdier hospital, Paris 13 university, AP-HP, 93143 Bondy cedex, France
| | - C Cussac-Pillegand
- Department of endocrinology-diabetology-nutrition, CRNH-IdF, CINFO, Jean-Verdier hospital, Paris 13 university, AP-HP, 93143 Bondy cedex, France
| | - I Banu
- Department of endocrinology-diabetology-nutrition, CRNH-IdF, CINFO, Jean-Verdier hospital, Paris 13 university, AP-HP, 93143 Bondy cedex, France
| | - S Chiheb
- Department of endocrinology-diabetology-nutrition, CRNH-IdF, CINFO, Jean-Verdier hospital, Paris 13 university, AP-HP, 93143 Bondy cedex, France
| | - L Carbillon
- Department of gynecology-obstetrics, Jean-Verdier hospital, Paris 13 university, AP-HP, 93143 Bondy cedex, France
| | - P Valensi
- Department of endocrinology-diabetology-nutrition, CRNH-IdF, CINFO, Jean-Verdier hospital, Paris 13 university, AP-HP, 93143 Bondy cedex, France
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Migdalis I, Czupryniak L, Lalic N, Leslie RD, Papanas N, Valensi P. Diabetic Microvascular Complications. Int J Endocrinol 2018; 2018:5683287. [PMID: 29997650 PMCID: PMC5994569 DOI: 10.1155/2018/5683287] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [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] [Received: 03/14/2018] [Accepted: 03/14/2018] [Indexed: 01/22/2023] Open
Affiliation(s)
- I. Migdalis
- Second Medical Department and Diabetes Centre, NIMTS Hospital, 12 Monis Petraki, 11521 Athens, Greece
| | - L. Czupryniak
- Department of Diabetology and Internal Medicine, Warsaw Medical University, Warsaw, Poland
| | - N. Lalic
- Faculty of Medicine, University of Belgrade, Clinic for Endocrinology, Diabetes and Metabolic Diseases, CCS, Belgrade, Serbia
| | - R. D. Leslie
- Department of Diabetes, Saint Bartholomew's Hospital, University of London and Blizard Institute, EC1A 7BE London, UK
| | - N. Papanas
- Diabetic Foot Clinic-Diabetes Centre, Second Department of Internal Medicine, Democritus University of Thrace, 68100 Alexandroupolis, Greece
| | - P. Valensi
- Department of Endocrinology, Diabetology and Nutrition, Jean Verdier Hospital, AP-HP, Paris Nord University, CRNH-IdF, CINFO, 93140 Bondy, France
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Affiliation(s)
- I. Migdalis
- Second Medical Department and Diabetes Centre, NIMTS Hospital, 12 Monis Petraki, 11521 Athens, Greece
| | - L. Czupryniak
- Department of Diabetology and Internal Medicine, Warsaw Medical University, Warsaw, Poland
| | - N. Lalic
- Clinic for Endocrinology, Diabetes and Metabolic Diseases, CCS, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - R. D. Leslie
- Department of Diabetes, Saint Bartholomew's Hospital, University of London and Blizard Institute, EC1A 7BE, London, UK
| | - N. Papanas
- Diabetic Foot Clinic-Diabetes Centre, Second Department of Internal Medicine, Democritus University of Thrace, 68100 Alexandroupolis, Greece
| | - P. Valensi
- Department of Endocrinology, Diabetology and Nutrition, Jean Verdier Hospital, AP-HP, Paris Nord University, CRNH-IdF, CINFO, 93140 Bondy, France
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Cosson E, Carbillon L, Valensi P. High Fasting Plasma Glucose during Early Pregnancy: A Review about Early Gestational Diabetes Mellitus. J Diabetes Res 2017; 2017:8921712. [PMID: 29181414 PMCID: PMC5664285 DOI: 10.1155/2017/8921712] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [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: 07/27/2017] [Accepted: 09/19/2017] [Indexed: 01/20/2023] Open
Abstract
Fasting plasma glucose (FPG) is nowadays routinely measured during early pregnancy to detect preexisting diabetes (FPG ≥ 7 mmol/L). This screening has concomitantly led to identify early intermediate hyperglycemia, defined as FPG in the 5.1 to 6.9 mmol/L range, also early gestational diabetes mellitus (eGDM). Early FPG has been associated with poor pregnancy outcomes, but the recommendation by the IADPSG to refer women with eGDM for immediate management is more pragmatic than evidence based. Although eGDM is characterized by insulin resistance and associated with classical risk factors for type 2 diabetes and incident diabetes after delivery, it is not necessarily associated with preexisting prediabetes. FPG ≥ 5.1 mmol/L in early pregnancy is actually poorly predictive of gestational diabetes mellitus diagnosed after 24 weeks of gestation. An alternative threshold should be determined but may vary according to ethnicity, gestational age, and body mass index. Finally, observational data suggest that early management of intermediate hyperglycemia may improve prognosis, through reduced gestational weight gain and potential early introduction of hypoglycemic agents. Considering all these issues, we suggest an algorithm for the management of eGDM based on early FPG levels that would be measured in case of risk factors. Nevertheless, interventional randomized trials are still missing.
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Affiliation(s)
- E. Cosson
- Department of Endocrinology-Diabetology-Nutrition, AP-HP, Jean Verdier Hospital, Paris 13 University, Sorbonne Paris Cité, CRNH-IdF, CINFO, Bondy, France
- Sorbonne Paris Cité, UMR U1153 Inserm/U1125 Inra/Cnam/Université Paris 13, Bobigny, France
| | - L. Carbillon
- Department of Gynecology-Obstetrics, AP-HP, Jean Verdier Hospital, Paris 13 University, Sorbonne Paris Cité, Bondy, France
| | - P. Valensi
- Department of Endocrinology-Diabetology-Nutrition, AP-HP, Jean Verdier Hospital, Paris 13 University, Sorbonne Paris Cité, CRNH-IdF, CINFO, Bondy, France
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Benmohammed K, Valensi P, Balkau B, Lezzar A. Metabolic syndrome in adolescents: definition based on regression of IDF adult cut-off points. Public Health 2016; 141:88-94. [DOI: 10.1016/j.puhe.2016.09.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2016] [Accepted: 09/01/2016] [Indexed: 01/28/2023]
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Valensi P, Ceriello A. Welcome to the 9th Annual meeting of the Diabetes & Cardiovascular disease. Diabetes Metab 2016; 42:292-293. [PMID: 27520830 DOI: 10.1016/j.diabet.2016.07.003] [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] [Subscribe] [Scholar Register] [Received: 07/08/2016] [Accepted: 07/08/2016] [Indexed: 06/06/2023]
Affiliation(s)
- P Valensi
- Department of Endocrinology Diabetology Nutrition, Jean-Verdier Hospital, AP-HP, Paris Nord University, CRNH-IdF, CINFO, 93143 Bondy, France.
| | - A Ceriello
- Institut d' Investigación Biomédiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
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Bathaei S, Chiheb S, Pillegand C, Banu I, Valensi P. Neuropathie périphérique carentielle et encéphalopathie de Gayet-Wernicke après chirurgie bariatrique restrictive. NUTR CLIN METAB 2016. [DOI: 10.1016/j.nupar.2016.09.082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Gautier JF, Monguillon P, Verier-Mine O, Valensi P, Fiquet B, Dejager S, Charbonnel B. Which oral antidiabetic drug to combine with metformin to minimize the risk of hypoglycemia when initiating basal insulin?: A randomized controlled trial of a DPP4 inhibitor versus insulin secretagogues. Diabetes Res Clin Pract 2016; 116:26-8. [PMID: 27321312 DOI: 10.1016/j.diabres.2016.04.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [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: 10/27/2015] [Revised: 02/12/2016] [Accepted: 04/15/2016] [Indexed: 11/25/2022]
Abstract
We conducted a pilot study to evaluate two therapeutic strategies at the time of insulin initiation in type 2 diabetic patients insufficiently controlled with metformin+insulin-secretagogues (IS, sulfonylureas or glinides). Patients were randomized to remain under the same dual therapy or to receive metformin+DPP4 inhibitors while starting insulin. Similar glycemic control was achieved in both groups. However less hypoglycemia was observed with DPP4 inhibitors despite higher doses of insulin.
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Affiliation(s)
- J F Gautier
- Diabetes, Endocrinology and Nutrition Department, Lariboisière Hospital, Paris, France
| | | | - O Verier-Mine
- Diabetes, Endocrinology and Nutrition Department, Jean Bernard Hospital, Valenciennes, France
| | - P Valensi
- Endocrinology, Diabetology and Nutrition Department, Jean Verdier Hospital, APHP, Paris Nord University, CRNH-IdF, CINFO, Bondy, France
| | - B Fiquet
- Scientific and Medical Affairs, Novartis Pharma, Rueil Malmaison, France.
| | - S Dejager
- Endocrinology and Metabolism Department, Pitié Salpétrière Hospital, Paris, France
| | - B Charbonnel
- Endocrinology and Metabolism Department, CHU Nantes, France
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Chiheb S, Cosson E, Banu I, Hamo-Tchatchouang E, Cussac-Pillegand C, Nguyen M, Valensi P. Are Obese Individuals with no Feature of Metabolic Syndrome but Increased Waist Circumference Really Healthy? A Cross Sectional Study. Exp Clin Endocrinol Diabetes 2016; 124:410-6. [DOI: 10.1055/s-0035-1569264] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [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: 10/21/2022]
Affiliation(s)
- S. Chiheb
- Department of Endocrinology-Diabetology-Nutrition, AP-HP, Jean Verdier Hospital, Paris Nord University, CRNH-IdF, CINFO, Bondy, France
| | - E. Cosson
- Department of Endocrinology-Diabetology-Nutrition, AP-HP, Jean Verdier Hospital, Paris Nord University, CRNH-IdF, CINFO, Bondy, France
| | - I. Banu
- Department of Endocrinology-Diabetology-Nutrition, AP-HP, Jean Verdier Hospital, Paris Nord University, CRNH-IdF, CINFO, Bondy, France
| | - E. Hamo-Tchatchouang
- Department of Endocrinology-Diabetology-Nutrition, AP-HP, Jean Verdier Hospital, Paris Nord University, CRNH-IdF, CINFO, Bondy, France
| | - C. Cussac-Pillegand
- Department of Endocrinology-Diabetology-Nutrition, AP-HP, Jean Verdier Hospital, Paris Nord University, CRNH-IdF, CINFO, Bondy, France
| | - M. Nguyen
- Department of Endocrinology-Diabetology-Nutrition, AP-HP, Jean Verdier Hospital, Paris Nord University, CRNH-IdF, CINFO, Bondy, France
| | - P. Valensi
- Department of Endocrinology-Diabetology-Nutrition, AP-HP, Jean Verdier Hospital, Paris Nord University, CRNH-IdF, CINFO, Bondy, France
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23
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Cosson E, Diallo A, Docan M, Sandre-Banon D, Banu I, Cussac-Pillegand C, Chiheb S, Pharisien I, Valensi P, Carbillon L. Fetal gender is not associated with either gestational diabetes mellitus or placental weight: A cohort study. Diabetes Metab 2016; 42:276-9. [PMID: 27037011 DOI: 10.1016/j.diabet.2016.02.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/28/2015] [Revised: 02/22/2016] [Accepted: 02/28/2016] [Indexed: 10/22/2022]
Abstract
AIM This study assessed whether male fetal gender increases the risk of maternal gestational diabetes mellitus (GDM) and investigated the association with placental weight. METHODS The study included 20,149 women without pregestational diabetes who delivered singletons at our hospital between January 2002 and December 2010. There was universal screening for GDM, and all placentas were weighed at delivery. RESULTS GDM (affecting 14.2% of women) was not associated with fetal gender (male fetuses in women without and with GDM: 51.8% vs. 51.7%, respectively; P=0.957), and remained likewise after logistic-regression analysis of risk factors for GDM (OR: 1.007, 95% CI: 0.930-1.091; P=0.858). Placental weights were 600±126g, 596±123g, 584±118g and 587±181g in women with GDM/female, GDM/male, no GDM/female and no GDM/male fetuses, respectively (GDM effect: P=0.017; gender effect: P=0.41; GDM * gender effect: P=0.16). CONCLUSION The present results suggest that fetal gender is not associated with GDM and, while placental weights were higher in cases of GDM, there were still no gender effects.
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Affiliation(s)
- E Cosson
- Paris 13 University, Sorbonne Paris Cité, AP-HP, Jean-Verdier Hospital, Department of Endocrinology-Diabetology-Nutrition, CRNH-IdF, CINFO, 93000 Bondy, France; Paris 13 University, Sorbonne Paris Cité, UMR U1153 Inserm, U11125 Inra, CNAM, Université Paris13, Unité de Recherche Épidémiologique Nutritionnelle, Bobigny, France.
| | - A Diallo
- AP-HP, Unité de Recherche Clinique Lariboisière Saint-Louis, Paris, France
| | - M Docan
- Paris 13 University, Sorbonne Paris Cité, AP-HP, Jean-Verdier Hospital, Department of Endocrinology-Diabetology-Nutrition, CRNH-IdF, CINFO, 93000 Bondy, France
| | - D Sandre-Banon
- Paris 13 University, Sorbonne Paris Cité, AP-HP, Jean-Verdier Hospital, Department of Endocrinology-Diabetology-Nutrition, CRNH-IdF, CINFO, 93000 Bondy, France
| | - I Banu
- Paris 13 University, Sorbonne Paris Cité, AP-HP, Jean-Verdier Hospital, Department of Endocrinology-Diabetology-Nutrition, CRNH-IdF, CINFO, 93000 Bondy, France
| | - C Cussac-Pillegand
- Paris 13 University, Sorbonne Paris Cité, AP-HP, Jean-Verdier Hospital, Department of Endocrinology-Diabetology-Nutrition, CRNH-IdF, CINFO, 93000 Bondy, France
| | - S Chiheb
- Paris 13 University, Sorbonne Paris Cité, AP-HP, Jean-Verdier Hospital, Department of Endocrinology-Diabetology-Nutrition, CRNH-IdF, CINFO, 93000 Bondy, France
| | - I Pharisien
- Paris 13 University, Sorbonne Paris Cité, AP-HP, Jean-Verdier Hospital, Department of Obstetrics and Gynecology, 93000 Bondy, France
| | - P Valensi
- Paris 13 University, Sorbonne Paris Cité, AP-HP, Jean-Verdier Hospital, Department of Endocrinology-Diabetology-Nutrition, CRNH-IdF, CINFO, 93000 Bondy, France
| | - L Carbillon
- Paris 13 University, Sorbonne Paris Cité, AP-HP, Jean-Verdier Hospital, Department of Obstetrics and Gynecology, 93000 Bondy, France
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Chen Q, Chiheb S, Fysekidis M, Jaber Y, Brahimi M, Nguyen MT, Millasseau S, Cosson E, Valensi P. Arterial stiffness is elevated in normotensive type 2 diabetic patients with peripheral neuropathy. Nutr Metab Cardiovasc Dis 2015; 25:1041-1049. [PMID: 26474725 DOI: 10.1016/j.numecd.2015.08.001] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [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: 07/06/2014] [Revised: 06/19/2015] [Accepted: 08/02/2015] [Indexed: 12/22/2022]
Abstract
BACKGROUND AND AIMS Arterial stiffness, a measure of macrovascular damage predictive of poor cardio-vascular outcomes, is strongly related to age and hypertension (HT). In diabetic patients peripheral neuropathy (PN) has been found to be associated with increased arterial stiffness, which might be due to the concomitant presence of HT. The aim of this study was to examine in type-2 diabetic patients, the relationship between arterial stiffness and presence or absence of PN and HT separately. METHODS AND RESULTS Arterial stiffness was measured with the gold standard carotid-femoral pulse wave velocity (PWV) in 447 type-2 diabetic subjects of whom 66% were hypertensive, 53% had PN, and 40% had both. Patients with PN were older, more often hypertensive and had higher PWV than those free of PN. Patients were separated according to the presence or absence of PN and HT. PWV values above the 90th percentile age- and blood pressure-adjusted reference range (PWV+) were different across these groups (p < 0.005) with the following respective prevalences: 27.2%, 53.4%, 33.3% and 30.6%. Only PWV+ was significantly associated with PN and hypertension in the interaction analysis. CONCLUSION Well controlled hypertensive patients did not have elevated arterial stiffness compared to normotensive patients. This might be due to anti-hypertensive treatment although our study design does not allow us to confirm it. A strong association between PN and arterial stiffness was only present in normotensive patients, suggesting that normotensive type 2 diabetic patients with PN and elevated arterial stiffness should be carefully managed to prevent future macrovascular complications.
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Affiliation(s)
- Q Chen
- Department of Endocrinology-Diabetology-Nutrition, Jean Verdier Hospital, AP-HP, Paris-Nord University, CRNH-IdF, CINFO, Bondy, France; Shanghai Institute of Endocrine and Metabolic Diseases, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shangai, China
| | - S Chiheb
- Department of Endocrinology-Diabetology-Nutrition, Jean Verdier Hospital, AP-HP, Paris-Nord University, CRNH-IdF, CINFO, Bondy, France
| | - M Fysekidis
- Department of Endocrinology-Diabetology-Nutrition, Jean Verdier Hospital, AP-HP, Paris-Nord University, CRNH-IdF, CINFO, Bondy, France
| | - Y Jaber
- Department of Endocrinology-Diabetology-Nutrition, Jean Verdier Hospital, AP-HP, Paris-Nord University, CRNH-IdF, CINFO, Bondy, France
| | - M Brahimi
- Department of Endocrinology-Diabetology-Nutrition, Jean Verdier Hospital, AP-HP, Paris-Nord University, CRNH-IdF, CINFO, Bondy, France
| | - M T Nguyen
- Department of Endocrinology-Diabetology-Nutrition, Jean Verdier Hospital, AP-HP, Paris-Nord University, CRNH-IdF, CINFO, Bondy, France
| | - S Millasseau
- Pulse Wave Consulting, Saint Leu la Foret, France
| | - E Cosson
- Department of Endocrinology-Diabetology-Nutrition, Jean Verdier Hospital, AP-HP, Paris-Nord University, CRNH-IdF, CINFO, Bondy, France; UMR U1153 Inserm/U1125 Inra/Cnam/Univ Paris 13, Research Center in Epidemiology and Biostatistic Sorbonne-Paris-Cité, Bobigny, France
| | - P Valensi
- Department of Endocrinology-Diabetology-Nutrition, Jean Verdier Hospital, AP-HP, Paris-Nord University, CRNH-IdF, CINFO, Bondy, France.
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Valensi P, de Pouvourville G, Benard N, Chanut-Vogel C, Kempf C, Eymard E, Moisan C, Dallongeville J. Treatment maintenance duration of dual therapy with metformin and sitagliptin in type 2 diabetes: The ODYSSEE observational study. Diabetes Metab 2015; 41:231-8. [PMID: 25976701 DOI: 10.1016/j.diabet.2015.03.007] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/11/2015] [Revised: 03/17/2015] [Accepted: 03/22/2015] [Indexed: 10/23/2022]
Abstract
AIM The study compared the duration of maintenance of treatment in patients with type 2 diabetes (T2D) using dual therapy with either metformin and sitagliptin (M-Sita) or metformin and a sulphonylurea (M-SU). MATERIALS AND METHODS This observational study included adult patients with T2D who had responded inadequately to metformin monotherapy and therefore had started de-novo treatment with Met-Sita or Met-SU within the previous eight weeks. Patient follow-up and changes to treatment were performed according to their general practitioner's usual clinical practice. The primary outcome was time to change in treatment for whatever cause. HbA1c and symptomatic hypoglycaemia were also documented. RESULTS The median treatment duration for patients in the M-Sita group (43.2 months) was significantly longer (P < 0.0001) than in the M-SU group (20.2 months). This difference persisted after adjusting for baseline differences and confounders. A similar reduction in HbA1c was noted in both arms (-0.6%), and the incidence of hypoglycaemia prior to treatment modification was lower with M-Sita (9.7%) than with M-SU (21.0%). Adverse events potentially related to treatment were reported in 2.8% (n = 52) and 2.7% (n = 20) of patients in the M-Sita and M-SU arms, respectively. CONCLUSION Under everyday conditions of primary diabetes care, dual therapy with M-Sita can be maintained for longer than M-SU. In addition, while efficacy, as measured by changes in HbA1c, was similar between treatments, the incidence of hypoglycaemia was lower in patients taking M-Sita.
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Affiliation(s)
- P Valensi
- Department of Endocrinology-Diabetology-Nutrition, Jean-Verdier Hospital, AP-HP, Paris Nord University, CRNH-IdF, CINFO, Bondy, France
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26
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Cosson E, Bihan H, Vittaz L, Khiter C, Carbillon L, Faghfouri F, Leboeuf D, Dauphin H, Lepagnol A, Reach G, Valensi P. Improving postpartum glucose screening after gestational diabetes mellitus: a cohort study to evaluate the multicentre IMPACT initiative. Diabet Med 2015; 32:189-97. [PMID: 25393823 DOI: 10.1111/dme.12631] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [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] [Accepted: 11/07/2014] [Indexed: 02/05/2023]
Abstract
AIMS To evaluate a mobilization campaign, the IMPACT initiative, which included multidisciplinary meetings, provision of information and a systematic prescription of an oral glucose tolerance test to improve the rate of glucose screening in women with gestational diabetes mellitus in the four largest maternity units in our area, starting in March 2011. METHODS We retrospectively compared the level of self-reported screening during the first 6 months postpartum of women who gave birth after having been diagnosed with gestational diabetes before (January 2009 to December 2010) and after the IMPACT campaign (April 2011 to February 2012). RESULTS We included 961 women (589 in the period before and 372 in the period after the campaign was initiated) with a mean ± SD age of 33.2 ± 5.3 years and BMI of 27.8 ± 5.3 kg/m². Multivariate analysis, stratified using a propensity score in order to limit bias caused by imbalance between both periods, showed that the postpartum screening rate was higher after the campaign began (48.9 vs 33.3%, odds ratio 1.7, 95% CI 1.1-2.5; P = 0.019) and higher in women who received insulin treatment during pregnancy (odds ratio 2.3, 95% CI 1.5-3.6; P < 0.001), consumed fruit and vegetables daily (odds ratio 1.6, 95% CI 1.1-2.4; P = 0.035) and did not smoke (smoking vs non-smoking: odds ratio 0.3, 95% CI 0.1-0.7; P = 0.01). There was no interaction between the campaign effect and these particular conditions. The proportion of oral glucose tolerance tests performed in women who underwent screening increased from 6.3 to 33.0%. CONCLUSIONS The IMPACT campaign increased postpartum screening, and the use the oral glucose tolerance test in particular. The effect of this initiative might be reinforced in women who are non-daily consumers of fruit and vegetables, smokers and those who do not receive insulin treatment during pregnancy.
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Affiliation(s)
- E Cosson
- AP-HP, Jean Verdier Hospital, Department of Endocrinology, Diabetology and Nutrition, Université Paris 13, Sorbonne Paris Cité, Bondy; Sorbonne Paris Cité, UMR U1153 Inserm / U1125 Inra / Cnam / Université Paris 13, Bobigny, France
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Leproust S, Dallongeville J, Valensi P, Boutmy E, Moisan C, Chanut-Vogel C, de Pouvourville G. Treatment Maintenance Duration of Dual Therapy with Metformin and Sitagliptin in Type 2 Diabetes - Real-World Data From Odyssee Study. Value Health 2014; 17:A334-A335. [PMID: 27200591 DOI: 10.1016/j.jval.2014.08.640] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Affiliation(s)
| | | | - P Valensi
- Service d'Endocrinologie-Diabétologie-Nutrition, Bondy, France
| | - E Boutmy
- Cegedim Strategic Data, Boulogne-Billancourt, France
| | - C Moisan
- Merck (MSD France), Paris, France
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Cosson E, Valensi P, Carbillon L. Screening for dysglycaemia during pregnancy: Proposals conciliating International Association of Diabetes and Pregnancy Study Group (IADPSG) and US National Institutes of Health (NIH) panels. Diabetes Metab 2014; 41:239-43. [PMID: 25282605 DOI: 10.1016/j.diabet.2014.08.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/27/2014] [Revised: 08/05/2014] [Accepted: 08/22/2014] [Indexed: 10/24/2022]
Abstract
The International Association of Diabetes and Pregnancy Study Group (IADPSG) has proposed that blood glucose levels for the diagnosis of gestational diabetes mellitus (GDM) be the values associated with a 1.75-fold increase in the risk of neonatal complications in the Hyperglycaemia and Adverse Pregnancy Outcomes (HAPO) study. However, this recommendation was not adopted by the US National Institutes of Health (NIH) panel as it would have been responsible for a huge increase in the prevalence of GDM with no clear evidence of a reduction of events at such blood glucose values. Considering this aspect, we now propose the use of a blood glucose threshold combination associated with an odds-ratio of 2.0 for neonatal disorders [fasting plasma glucose (FPG)≥ 95 mg/dL, or a 1-h glucose value after a 75-g oral glucose tolerance test (OGTT)≥ 191 mg/dL or a 2-h glucose value ≥ 162 mg/dL] for GDM diagnosis. This would lead to a lower prevalence of GDM and concentrate medical resources on those with the highest risk of complications. This would also allow the use of a similar FPG value for both the diagnosis and therapeutic target of GDM. The IADPSG also proposed screening for dysglycaemia during early pregnancy, using FPG measurement with a similar threshold after 24 weeks of gestation. We propose the same strategy considering an FPG value ≥ 95 mg/dL as abnormal, but only after confirmatory measurements. We also believe that an OGTT should not be used before 24 weeks of gestation as normal values during that time are as yet unknown.
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Affiliation(s)
- E Cosson
- Department of Endocrinology-Diabetology-Nutrition, CRNH-IdF, CINFO, Jean-Verdier Hospital, Paris 13 University, Sorbonne Paris Cité, AP-HP, Bondy, France; UMR U1143 Inserm/U1125 Inra/Cnam/Université Paris 13, Sorbonne Paris Cité, Bobigny, France.
| | - P Valensi
- Department of Endocrinology-Diabetology-Nutrition, CRNH-IdF, CINFO, Jean-Verdier Hospital, Paris 13 University, Sorbonne Paris Cité, AP-HP, Bondy, France
| | - L Carbillon
- Department of Gynaecology-Obstetrics, Jean-Verdier Hospital, Paris 13 University, Sorbonne Paris Cité, AP-HP, Bondy, France
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Ryden L, Grant PJ, Anker SD, Berne C, Cosentino F, Danchin N, Deaton C, Escaned J, Hammes HP, Huikuri H, Marre M, Marx N, Mellbin L, Ostergren J, Patrono C, Seferovic P, Uva MS, Taskinen MR, Tendera M, Tuomilehto J, Valensi P, Zamorano JL. ESC Guidelines on diabetes, pre-diabetes, and cardiovascular diseases developed in collaboration with the EASD. Eur Heart J 2014. [DOI: 10.1093/eurheartj/ehu076] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Bihan H, Cosson E, Khiter C, Vittaz L, Faghfouri F, Leboeuf D, Carbillon L, Dauphin H, Reach G, Valensi P. Factors associated with screening for glucose abnormalities after gestational diabetes mellitus: baseline cohort of the interventional IMPACT study. Diabetes Metab 2014; 40:151-7. [PMID: 24503190 DOI: 10.1016/j.diabet.2013.12.002] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/01/2013] [Revised: 11/29/2013] [Accepted: 12/02/2013] [Indexed: 11/17/2022]
Abstract
INTRODUCTION Although it is important to screen women who have had gestational diabetes mellitus (GDM) for abnormal post-partum glucose levels, such testing is rarely performed. The aim of this study was to use data from the first observational phase of the IMPACT study to determine rates of screening within 6 months of delivery in a multiethnic cohort, focusing in particular on the effects of social deprivation and the risk of future diabetes. PATIENTS AND METHODS To investigate the frequency of post-partum screening, charts were analyzed, and all women attending four centres located in a deprived area who had had GDM between January 2009 and December 2010 were contacted by phone. The Evaluation of Precarity and Inequalities in Health Examination Centres (EPICES) deprivation index and Finnish Diabetes Risk Score (FINDRISK) questionnaire were also evaluated. RESULTS Data were evaluable for 589 of the 719 women contacted (mean age: 33.4 ± 5.2 years; mean body mass index: 27.6 ± 5.4 kg/m(2)), and 196 (33.3%) reported having been screened. On multivariate analysis, factors associated with a lack of screening were smoking [odds ratio (OR): 0.42 (0.20-0.90), P<0.05], low consumption of fruit and vegetables [OR: 0.58 (0.39-0.82), P<0.01] and heavier offspring birth weight (P<0.05), although there were no differences in FINDRISK and EPICES scores between screened and unscreened women. CONCLUSION One-third of women who had had GDM reported having been screened for dysglycaemia at 6 months post-partum. However, it is expected that the interventional phase of the IMPACT study will increase screening rates, especially in women with the risk factors associated with lower screening rates during this observational phase.
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Affiliation(s)
- H Bihan
- AP-HP, Avicenne Hospital, Paris 13 University, Sorbonne Paris Cité, Department of Diabetology, Metabolic Diseases, CRNH-IdF, CINFO, Bobigny, France; Sorbonne Paris Cité, UMR U557 Inserm/U1125 Inra/Cnam/Université Paris 13, Bobigny, France.
| | - E Cosson
- Sorbonne Paris Cité, UMR U557 Inserm/U1125 Inra/Cnam/Université Paris 13, Bobigny, France; AP-HP, Jean-Verdier Hospital, Paris 13 University, Sorbonne Paris Cité, Department of Endocrinology-Diabetology-Nutrition, CRNH-IdF, CINFO, Bondy, France
| | - C Khiter
- De La Fontaine Hospital, Department of Obstetrics and Gynecology, Saint-Denis, France
| | - L Vittaz
- Ballanger Hospital, Department of Endocrinology-Diabetology, Aulnay-Sous-Bois, France
| | - F Faghfouri
- AP-HP, Jean-Verdier Hospital, Paris 13 University, Sorbonne Paris Cité, Department of Endocrinology-Diabetology-Nutrition, CRNH-IdF, CINFO, Bondy, France
| | - D Leboeuf
- Seine-Saint-Denis Private Hospital, Department of Obstetrics and Gynecology, Le Blanc Mesnil, France
| | - L Carbillon
- AP-HP, Jean-Verdier Hospital, Paris 13 University, Sorbonne Paris Cité, Department of Gynaecology-Obstetrics, Bondy, France
| | - H Dauphin
- Ballanger Hospital, Department of Gynecology, Aulnay-Sous-Bois, France
| | - G Reach
- AP-HP, Avicenne Hospital, Paris 13 University, Sorbonne Paris Cité, Department of Diabetology, Metabolic Diseases, CRNH-IdF, CINFO, Bobigny, France
| | - P Valensi
- AP-HP, Jean-Verdier Hospital, Paris 13 University, Sorbonne Paris Cité, Department of Endocrinology-Diabetology-Nutrition, CRNH-IdF, CINFO, Bondy, France
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Nguyen MT, Pham I, Chemla D, Valensi P, Cosson E. Decreased stroke volume−brachial pulse pressure ratio in patients with type 2 diabetes over 50 years: the role of peripheral neuropathy. Nutr Metab Cardiovasc Dis 2013; 23:1093-1100. [PMID: 23541167 DOI: 10.1016/j.numecd.2013.01.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [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: 08/05/2012] [Revised: 01/11/2013] [Accepted: 01/15/2013] [Indexed: 11/29/2022]
Abstract
BACKGROUND AND AIMS To document the stroke volume to pulse pressure ratio (SV/PP, an index of total arterial compliance) and its correlates in patients with type 2 diabetes (T2DM) aged over 50 years whose peripheral neuropathy and silent myocardial ischemic (SMI) status were known. METHODS AND RESULTS A total of 360 patients with T2DM aged ≥ 50 years, without cardiac history or symptom, left ventricular systolic dysfunction, dilatation and hypokinesia, were retrospectively enrolled. The SV/PP was calculated from echocardiographic left ventricular measurements and brachial blood pressure at rest. Peripheral neuropathy was defined as the presence of any two or more of the following: neuropathic symptoms, decreased distal sensation, or decreased or absent ankle reflexes. SMI was defined as an abnormal stress myocardial scintigraphy and/or stress echocardiography. A low SV/PP ratio (<0.53 ml/m²/mmHg, first tertile) was associated with age, creatinine clearance, 24 h urinary albumin excretion rate, peripheral neuropathy, hypertension, serum total cholesterol and triglycerides levels (p < 0.05-0.0001). In multivariate analysis, age (OR 1.1 [1.0-1.2], p < 0.01), triglycerides (OR 1.5 [1.2-2.0], p = 0.01) and peripheral neuropathy (OR 2.2 [1.2-3.9], p = 0.009) were independently associated with a low SV/PP. The patients with peripheral neuropathy had lower SV (p < 0.01) and higher PP (p < 0.05) than those without, and only lower SV after adjustment for age and nephropathy. Similar results were obtained in the patients with and without SMI. CONCLUSION Peripheral neuropathy was independently associated with decreased SV/PP, mainly through decreased SV, in patients with T2DM over 50 years.
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Affiliation(s)
- M T Nguyen
- AP-HP, Jean Verdier Hospital, Department of Endocrinology-Diabetology-Nutrition, Paris Nord University, CRNH-IdF, Bondy, France; UMR U557 Inserm, U1125 Inra, Cnam, Paris 13 University, Bobigny, France
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Ferrieres J, Bongard V, Arveiler D, Dallongeville J, Wagner A, Amouyel P, Valensi P, Ruidavets JB. Long-term impact on mortality of residual dyslipidemia. Eur Heart J 2013. [DOI: 10.1093/eurheartj/eht308.p1561] [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: 11/14/2022] Open
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Valensi P, Chiheb S, Fysekidis M. Insulin- and glucagon-like peptide-1-induced changes in heart rate and vagosympathetic activity: why they matter. Diabetologia 2013; 56:1196-200. [PMID: 23584434 DOI: 10.1007/s00125-013-2909-x] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [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: 02/06/2013] [Accepted: 03/07/2013] [Indexed: 12/24/2022]
Abstract
Heart rate (HR) predicts cardiovascular morbidity and mortality in individuals either with or without diabetes. In type 2 diabetic patients, cardiac autonomic neuropathy is a risk marker for cardiac morbidity and mortality. A major pathogenic potential may be attributed to vagal depression and sympathetic predominance. In this issue of Diabetologia, Berkelaar et al (DOI: 10.1007/s00125-013-2848-6 ) examined the effects of euglycaemic, and hyperglycaemic clamp with the addition of glucagon-like-peptide-1 (GLP-1) and arginine, on cardiac vagal control in a large number of healthy subjects. After adjustments for age, BMI and insulin sensitivity, insulin associations with HR remained partially intact while those with vagal control disappeared. This suggested that BMI and insulin sensitivity, but not insulin levels, were the main drivers of cardiac vagal control. GLP-1 infusion during hyperglycaemia increased HR and BP and produced a statistically non-significant decrease in measures of cardiac vagal control compared with values before any manipulation of insulin levels. This commentary summarises how, and to what extent, insulin and GLP-1 affect autonomic nervous system activity, HR and BP. More information is needed on the mechanisms through which acute administration of, and long-term treatment with, GLP-1 may affect haemodynamics and autonomic activity in diabetic and obese patients, since this may influence cardiovascular outcomes.
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Affiliation(s)
- P Valensi
- Department of Endocrinology-Diabetology-Nutrition, AP-HP, Jean Verdier Hospital, Paris-Nord University, CRNH-IdF, Avenue du 14 juillet, 93143 Bondy Cedex, France.
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Cosson E, Nguyen MT, Chanu B, Balta S, Takbou K, Valensi P. The report of male gender and retinopathy status improves the current consensus guidelines for the screening of myocardial ischemia in asymptomatic type 2 diabetic patients. Nutr Metab Cardiovasc Dis 2013; 23:557-565. [PMID: 22502874 DOI: 10.1016/j.numecd.2012.01.009] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2011] [Revised: 12/30/2011] [Accepted: 01/25/2012] [Indexed: 11/21/2022]
Abstract
BACKGROUND AND AIMS American Diabetes Association (ADA), French-speaking Societies for diabetes & cardiology (ALFEDIAM-SFC) and Cardiac Radionuclide Imaging (CRI) have proposed guidelines for the screening of silent myocardial ischemia (SMI). The aim of the study was to evaluate their diagnostic values and how to improve them. METHODS AND RESULTS 731 consecutive type 2 diabetic patients with ≥1 additional risk factor were screened between 1992 and 2006 for SMI by stress myocardial scintigraphy and for silent coronary artery disease (CAD) by coronary angiography. A total of 215 (29.4%) patients had SMI, and 79 of them had CAD. ADA (Odds Ratio 1.7 [95% Confidence Interval: 1.2-2.5]; p < 0.05), ALFEDIAM-SFC (OR 1.5 [1.0-2.5], p < 0.05) and CRI criteria (OR 2.0 [1.4-2.8], p < 0.01) predicted SMI. Considering the presence of male gender and retinopathy added to the prediction of SMI allowed by ADA criteria (c statistic: area under the curve AROC 0.651 [0.605-0.697] versus 0.582 [0.534-0.630]), p < 0.01 and ALFEDIAM-SFC criteria (AROC 0.672 [0.620-0.719] versus 0.620 [0.571-0.670], p < 0.05). CRI prediction of SMI was improved by considering the presence of macroproteinuria and retinopathy (AROC 0.621 [0.575-0.667] versus 0.594 [0.548-0.641], p < 0.01). Severe retinopathy (OR 3.4 [1.2-9.4], p < 0.05), smoking habits (OR 2.1 [1.1-4.2], p < 0.05) and triglyceride levels (OR 1.3 [1.0-1.6], p < 0.05) were independent predictors of CAD in the patients with SMI. CONCLUSION Current guidelines criteria are able to predict SMI but prediction may be improved by considering male gender and the presence of retinopathy. CAD is more frequent in the patients with SMI who are current smokers, have severe retinopathy and higher triglyceride levels.
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Affiliation(s)
- E Cosson
- AP-HP, Jean Verdier Hospital, Department of Endocrinology-Diabetology-Nutrition and Paris-Nord University, CRNH-IdF, Bondy, France.
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Papanas N, Boulton AJM, Malik RA, Manes C, Schnell O, Spallone V, Tentolouris N, Tesfaye S, Valensi P, Ziegler D, Kempler P. A simple new non-invasive sweat indicator test for the diagnosis of diabetic neuropathy. Diabet Med 2013; 30:525-34. [PMID: 22924579 DOI: 10.1111/dme.12000] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
A simple non-invasive indicator test (Neuropad(®)) has been developed for the assessment of sweating and, hence, cholinergic innervation in the diabetic foot. The present review summarizes current knowledge on this diagnostic test. The diagnostic ability of this test is based on a colour change from blue to pink at 10 min, with excellent reproducibility, which lends itself to patient self-examination. It has a high sensitivity (65.1-100%) and negative predictive value (63-100%), with moderate specificity (32-78.5%) and positive predictive value (23.3-93.2%) for the diagnosis of diabetic peripheral neuropathy. It also has moderate to high sensitivity (59.1-89%) and negative predictive value (64.7-91%), but low to moderate specificity (27-78%) and positive predictive value (24-48.6%) for the diagnosis of diabetic cardiac autonomic neuropathy. There are some data to suggest that Neuropad can detect early diabetic neuropathy, but this needs further evaluation. It remains to be established whether this test can predict foot ulceration and amputation, thereby contributing to the identification of high-risk patients.
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Affiliation(s)
- N Papanas
- Outpatient Clinic of the Diabetic Foot, Second Department of Internal Medicine, Democritus University of Thrace, Alexandroupolis, Greece University of Manchester and Manchester Diabetes Centre, Manchester, UK.
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Cosson E, Chiheb S, Cussac-Pillegand C, Banu I, Hamo-Tchatchouang E, Nguyen MT, Aout M, Charnaux N, Valensi P. Haemoglobin glycation may partly explain the discordance between HbA1c measurement and oral glucose tolerance test to diagnose dysglycaemia in overweight/obese subjects. Diabetes & Metabolism 2013; 39:118-25. [DOI: 10.1016/j.diabet.2012.08.013] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/30/2012] [Revised: 07/19/2012] [Accepted: 08/01/2012] [Indexed: 11/27/2022]
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Bosi E, Bax G, Scionti L, Spallone V, Tesfaye S, Valensi P, Ziegler D. Frequency-modulated electromagnetic neural stimulation (FREMS) as a treatment for symptomatic diabetic neuropathy: results from a double-blind, randomised, multicentre, long-term, placebo-controlled clinical trial. Diabetologia 2013; 56:467-75. [PMID: 23238789 PMCID: PMC3563945 DOI: 10.1007/s00125-012-2795-7] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [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: 08/13/2012] [Accepted: 11/06/2012] [Indexed: 12/30/2022]
Abstract
AIMS/HYPOTHESIS The aim was to evaluate the efficacy and safety of transcutaneous frequency-modulated electromagnetic neural stimulation (frequency rhythmic electrical modulation system, FREMS) as a treatment for symptomatic peripheral neuropathy in patients with diabetes mellitus. METHODS This was a double-blind, randomised, multicentre, parallel-group study of three series, each of ten treatment sessions of FREMS or placebo administered within 3 weeks, 3 months apart, with an overall follow-up of about 51 weeks. The primary endpoint was the change in nerve conduction velocity (NCV) of deep peroneal, tibial and sural nerves. Secondary endpoints included the effects of treatment on pain, tactile, thermal and vibration sensations. Patients eligible to participate were aged 18-75 years with diabetes for ≥ 1 year, HbA(1c) <11.0% (97 mmol/mol), with symptomatic diabetic polyneuropathy at the lower extremities (i.e. abnormal amplitude, latency or NCV of either tibial, deep peroneal or sural nerve, but with an evocable potential and measurable NCV of the sural nerve), a Michigan Diabetes Neuropathy Score ≥ 7 and on a stable dose of medications for diabetic neuropathy in the month prior to enrolment. Data were collected in an outpatient setting. Participants were allocated to the FREMS or placebo arm (1:1 ratio) according to a sequence generated by a computer random number generator, without block or stratification factors. Investigators digitised patients' date of birth and site number into an interactive voice recording system to obtain the assigned treatment. Participants, investigators conducting the trial, or people assessing the outcomes were blinded to group assignment. RESULTS Patients (n = 110) with symptomatic neuropathy were randomised to FREMS (n = 54) or placebo (n = 56). In the intention-to-treat population (50 FREMS, 51 placebo), changes in NCV of the three examined nerves were not different between FREMS and placebo (deep peroneal [means ± SE]: 0.74 ± 0.71 vs 0.06 ± 1.38 m/s; tibial: 2.08 ± 0.84 vs 0.61 ± 0.43 m/s; and sural: 0.80 ± 1.08 vs -0.91 ± 1.13 m/s; FREMS vs placebo, respectively). FREMS induced a significant reduction in day and night pain as measured by a visual analogue scale immediately after each treatment session, although this beneficial effect was no longer measurable 3 months after treatment. Compared with the placebo group, in the FREMS group the cold sensation threshold was significantly improved, while non-significant differences were observed in the vibration and warm sensation thresholds. No relevant side effects were recorded during the study. CONCLUSIONS/INTERPRETATION FREMS proved to be a safe treatment for symptomatic diabetic neuropathy, with immediate, although transient, reduction in pain, and no effect on NCV. TRIAL REGISTRATION ClinicalTrials.gov NCT01628627. FUNDING The clinical trial was sponsored by Lorenz Biotech (Medolla, Italy), lately Lorenz Lifetech (Ozzano dell'Emilia, Italy).
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Affiliation(s)
- E Bosi
- Diabetes & Endocrinology Unit, Department of Internal Medicine, San Raffaele Hospital and San Raffaele Vita Salute University, Via Olgettina 60, 20132 Milan, Italy.
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Cosson E, Chiheb S, Hamo-Tchatchouang E, Nguyen MT, Aout M, Banu I, Pillegand C, Vicaut E, Valensi P. Use of clinical scores to detect dysglycaemia in overweight or obese women. Diabetes & Metabolism 2012; 38:217-24. [DOI: 10.1016/j.diabet.2011.11.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/04/2011] [Revised: 11/28/2011] [Accepted: 11/29/2011] [Indexed: 12/16/2022]
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Vergès B, Avignon A, Bonnet F, Catargi B, Cattan S, Cosson E, Ducrocq G, Elbaz M, Fredenrich A, Gourdy P, Henry P, Lairez O, Leguerrier A, Monpère C, Moulin P, Vergès-Patois B, Roussel R, Steg G, Valensi P. Consensus statement on the care of the hyperglycaemic/diabetic patient during and in the immediate follow-up of acute coronary syndrome. Diabetes & Metabolism 2012; 38:113-27. [DOI: 10.1016/j.diabet.2011.11.003] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/23/2011] [Accepted: 11/24/2011] [Indexed: 01/19/2023]
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Kempler P, Amarenco G, Freeman R, Frontoni S, Horowitz M, Stevens M, Low P, Pop-Busui R, Tahrani AA, Tesfaye S, Várkonyi T, Ziegler D, Valensi P. Management strategies for gastrointestinal, erectile, bladder, and sudomotor dysfunction in patients with diabetes. Diabetes Metab Res Rev 2011; 27:665-77. [PMID: 21748841 DOI: 10.1002/dmrr.1223] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2011] [Accepted: 06/06/2011] [Indexed: 02/06/2023]
Abstract
There are substantial advances in understanding disordered gastrointestinal autonomic dysfunction in diabetes. It occurs frequently. The underlying pathogenesis is complex involving defects in multiple interacting cell types of the myenteric plexus as well. These defects may be irreversible or reversible. Gastrointestinal symptoms represent a major and generally underestimated source of morbidity for escalating health care costs in diabetes. Acute changes in glycaemia are both determinants and consequences of altered gastrointestinal motility. 35-90% of diabetic men have moderate-to-severe erectile dysfunction (ED). ED shares common risk factors with CVD. Diagnosis is based on medical/sexual history, including validated questionnaires. Physical examination and laboratory testing must be tailored to patient's complaints and risk factors. Treatment is based on PDE5-inhibitors (PDE5-I). Other explorations may be useful in patients who do not respond to PDE5-I. Patients at high cardiovascular risk should be stabilized by their cardiologists before sexual activity is considered or ED treatment is recommended. Estimates on bladder dysfunction prevalence are 43-87% of type 1 and 25% of type 2 diabetic patients, respectively. Common symptoms include dysuria, frequency, urgency, nocturia and incomplete bladder emptying. Diagnosis should use validated questionnaire for lower urinary tract symptoms. The type of bladder dysfunction is readily characterized with complete urodynamic testing. Sudomotor dysfunction is a cause of dry skin and is associated with foot ulcerations. Sudomotor function can be assessed by thermoregulatory sweat testing, quantitative sudomotor axon reflex test, sympathetic skin response, quantitative direct/indirect axon reflex testing and the indicator plaster.
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Affiliation(s)
- P Kempler
- I Department of Medicine, Semmelweis University, Budapest, Hungary.
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Nguyen M, Cosson E, Valensi P, Poignard P, Nitenberg A, Pham I. Transthoracic echocardiographic abnormalities in asymptomatic diabetic patients: Association with microalbuminuria and silent coronary artery disease. Diabetes & Metabolism 2011; 37:343-50. [DOI: 10.1016/j.diabet.2010.12.006] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/12/2010] [Revised: 12/15/2010] [Accepted: 12/16/2010] [Indexed: 11/17/2022]
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Cosson E, Nguyen MT, Hamo-Tchatchouang E, Banu I, Chiheb S, Charnaux N, Valensi P. What would be the outcome if the American Diabetes Association recommendations of 2010 had been followed in our practice in 1998-2006? Diabet Med 2011; 28:567-74. [PMID: 21480967 DOI: 10.1111/j.1464-5491.2010.03215.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
AIMS In 2010, the American Diabetes Association has published recommendations on the population to be screened for dysglycaemia; the diagnostic criteria for intermediate hyperglycaemia and diabetes using oral glucose tolerance testing and HbA(1c); and the patients eligible for treatment with metformin. We aimed to evaluate the consequences of screening with oral glucose tolerance test or HbA(1c) in an at-risk population. METHODS Among 1177 overweight or obese consecutive adults without known diabetes who were referred to our department for weight management, we selected 1157 individuals (83% female; 80% European) fulfilling the American Diabetes Association 2010 criteria for dysglycaemia screening. RESULTS Mean age was 41.2 ± 13 years, BMI 37.0 ± 7.2 kg/m(2), fasting plasma glucose 4.9 ± 0.8 mmol/l and HbA(1c) (turbidimetric immunoassay) 5.7 ± 0.7% (39 mmol/mol). Based on oral glucose tolerance test and HbA(1c), respectively, 76 (6.6%) and 113 (9.8%) patients had diabetes, including 34 sharing both criteria; 307 (26.5%) and 478 (41.3%) had intermediate hyperglycaemia; and 130 (11.2%) and 255 (22.0%) would be treated with metformin. The sensitivity/specificity of HbA(1c) ≥ 6.5% (48 mmol/mol) for the diagnosis of diabetes according to the oral glucose tolerance test were 44.7/92.7%. Diabetes risk scores and UK Prospective Diabetes Study cardiovascular risk score were the highest in the 130 patients having both an abnormal oral glucose tolerance test and HbA(1c) ≥ 5.7%. CONCLUSIONS In a population at risk for diabetes, the HbA(1c) strategy could lead to diagnosing more cases of dysglycaemia and to treating more patients with metformin than the oral glucose tolerance test strategy. The consistency of either diagnostic criteria was low. The patients with the highest a priori risk of diabetes and cardiovascular disease were those fulfilling both oral glucose tolerance test and HbA(1c) criteria.
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Affiliation(s)
- E Cosson
- AP-HP, Department of Endocrinology-Diabetology-Nutrition, Paris-Nord University, CRNH-IdF, Bondy, France.
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Valensi P, Extramiana F, Lange C, Cailleau M, Haggui A, Maison Blanche P, Tichet J, Balkau B. Influence of blood glucose on heart rate and cardiac autonomic function. The DESIR study. Diabet Med 2011; 28:440-9. [PMID: 21204961 DOI: 10.1111/j.1464-5491.2010.03222.x] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
OBJECTIVES To evaluate in a general population, the relationships between dysglycaemia, insulin resistance and metabolic variables, and heart rate, heart rate recovery and heart rate variability. METHODS Four hundred and forty-seven participants in the Data from an Epidemiological Study on the Insulin Resistance syndrome (DESIR) study were classified according to glycaemic status over the preceding 9 years. All were free of self-reported cardiac antecedents and were not taking drugs which alter heart rate. During five consecutive periods: rest, deep breathing, recovery, rest and lying to standing, heart rate and heart rate varability were evaluated and compared by ANCOVA and trend tests across glycaemic classes. Spearman correlation coefficients quantified the relations between cardio-metabolic risk factors, heart rate and heart rate varability. RESULTS Heart rate differed between glycaemic groups, except during deep breathing. Between rest and deep-breathing periods, patients with diabetes had a lower increase in heart rate than others (P(trend) < 0.01); between deep breathing and recovery, the heart rate of patients with diabetes continued to increase, for others, heart rate decreased (P(trend) < 0.009). Heart rate was correlated with capillary glucose and triglycerides during the five test periods. Heart rate variability differed according to glycaemic status, especially during the recovery period. After age, sex and BMI adjustment, heart rate variability was correlated with triglycerides at two test periods. Change in heart rate between recovery and deep breathing was negatively correlated with heart rate variability at rest, (r=-0.113, P < 0.05): lower resting heart rate variability was associated with heart rate acceleration. CONCLUSIONS Heart rate, but not heart rate variability, was associated with glycaemic status and capillary glucose. After deep breathing, heart rate recovery was altered in patients with known diabetes and was associated with reduced heart rate variability. Being overweight was a major correlate of heart rate variability.
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Affiliation(s)
- P Valensi
- Department of Endocrinology-Diabetology-Nutrition, Paris-Nord University, Jean Verdier Hospital, Bondy, France
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Cosson E, Hamo-Tchatchouang E, Banu I, Nguyen MT, Chiheb S, Ba H, Valensi P. A large proportion of prediabetes and diabetes goes undiagnosed when only fasting plasma glucose and/or HbA1c are measured in overweight or obese patients. Diabetes & Metabolism 2010; 36:312-8. [DOI: 10.1016/j.diabet.2010.02.004] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/24/2009] [Revised: 02/24/2010] [Accepted: 02/26/2010] [Indexed: 11/27/2022]
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Abstract
AIMS To examine the association between cardiac autonomic neuropathy and hypertension and the role of this association in diabetic complications. METHODS We included 310 patients, 138 with Type 1 and 172 with Type 2 diabetes, 62 of them with hypertension. Cardiac autonomic neuropathy was assessed by analysing heart rate variations during three standard tests (deep breathing, lying to standing and Valsalva) and looking for postural hypotension. RESULTS Cardiac autonomic neuropathy was present in 123 patients and 39 also had hypertension. The prevalence of a cardiac autonomic neuropathy/hypertension association was higher in Type 2 patients (P < 0.002). The prevalence of hypertension increased with the severity of cardiac autonomic neuropathy. In multiple logistic regression analysis, cardiac autonomic neuropathy was an independent risk factor for hypertension [odds ratio 2.86 (1.54-5.32); P < 0.001]. Only confirmed or severe cardiac autonomic neuropathy (two or more abnormal function tests, respectively) were independent risk factors for hypertension (P < 0.005 and < 0.0001). Cardiac autonomic neuropathy was found in most of the patients with macrovascular complications, retinopathy or nephropathy, but a large majority of the patients with these complications exhibited the cardiac autonomic neuropathy/hypertension profile. This profile was more prevalent among the patients with coronary or peripheral artery disease or antecedent stroke than among those free of these complications (P < 0.001). In logistic regression analyses, the cardiac autonomic neuropathy/hypertension profile associated significantly with macro- and microvascular complications. CONCLUSIONS These data are strongly in favour of the role of cardiac autonomic neuropathy in hypertension in diabetic patients. The association of the cardiac autonomic neuropathy/hypertension profile with vascular complications is consistent with a deleterious effect on vascular hemodynamics and structure, additional to the effects of hypertension.
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Affiliation(s)
- F Ayad
- Department of Internal Medicine, University Hospital, Oran, Algeria
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Valensi P, Gottlieb I, Le-Mouhaer S, Conte M. P308 EFFICACY AND SAFETY OF A FIXED COMBINATION OF FENOFIBRATE AND METFORMIN IN CO-ADMINISTRATION WITH STATIN THERAPY. THE FAME METFO STUDY. ATHEROSCLEROSIS SUPP 2010. [DOI: 10.1016/s1567-5688(10)70375-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Paineau D, Beaufils F, Boulier A, Cassuto DA, Chwalow J, Combris P, Couet C, Jouret B, Lafay L, Laville M, Mahe S, Ricour C, Romon M, Simon C, Tauber M, Valensi P, Chapalain V, Zourabichvili O, Bornet FRJ. The cumulative effect of small dietary changes may significantly improve nutritional intakes in free-living children and adults. Eur J Clin Nutr 2010; 64:782-91. [PMID: 20502471 DOI: 10.1038/ejcn.2010.78] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
BACKGROUND/OBJECTIVES The ELPAS (Etude Longitudinale Prospective Alimentation et Santé) study was an 8-month randomized controlled dietary modification trial designed to test the hypothesis that family dietary coaching would improve nutritional intakes and weight control in 2026 free-living children and parents. It resulted in significant nutritional changes, with beneficial effects on body mass index in adults. In these ancillary analyses, we investigated dietary changes throughout the intervention. SUBJECTS/METHODS Before the study, modeling analyses were carried out on the French Association Sucre Produits Sucrés Consommation et Communication (ASPCC) food-consumption database to identify the most efficient dietary intervention strategy. During the study, all participants performed monthly three nonconsecutive 24-h dietary recalls: this allowed for measuring changes in the number of servings per day and serving size for each targeted food category throughout the intervention. RESULTS Modeling analyses showed that targeting only the 10 main foods contributing to fat and carbohydrate intakes did not allow for reaching the ELPAS nutritional goals. As a result, it was decided to target more foods and to propose several types of dietary advice (such as change in serving size, change in cooking method, food substitution). This strategy led to many appropriate dietary changes during the intervention, but only a few of them reached significance. The mean number of servings per day was indeed significantly modified for only 7% of the targeted food categories in children and 17% in parents. The mean serving size was modified for only 12% of targeted food categories in children and 9% in parents. CONCLUSIONS The cumulative effect of small dietary changes may induce significant nutritional improvements, with limited burden for populations.
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Affiliation(s)
- D Paineau
- Nutri-Health, Rueil-Malmaison, France
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Valensi P, Cosson E. It is not yet the time to stop screening diabetic patients for silent myocardial ischaemia. Diabetes & Metabolism 2010; 36:91-6. [DOI: 10.1016/j.diabet.2010.01.001] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/13/2009] [Revised: 01/14/2010] [Accepted: 01/18/2010] [Indexed: 10/19/2022]
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Pajunen P, Landgraf R, Muylle F, Neumann A, Lindström J, Schwarz PE, Peltonen M, Acosta T, Adler M, AlKerwi A, Barengo N, Barengo R, Boavida JM, Charlesworth K, Christov V, Claussen B, Cos X, Cosson E, Deceukelier S, Dimitrijevic-Sreckovic V, Djordjevic P, Evans P, Felton AM, Fischer M, Gabriel-Sanchez R, Gilis-Januszewska A, Goldfracht M, Gomez JL, Greaves CJ, Hall M, Handke U, Hauner H, Herbst J, Hermanns N, Herrebrugh L, Huber C, Hühmer U, Huttunen J, Jotic A, Kamenov Z, Karadeniz S, Katsilambros N, Khalangot M, Kissimova-Skarbek K, Köhler D, Kopp V, Kronsbein P, Kulzer B, Kyne-Grzebalski D, Lalic K, Lalic N, Landgraf R, Lee-Barkey YH, Liatis S, Lindström J, Makrilakis K, McIntosh C, McKee M, Mesquita AC, Misina D, Muylle F, Neumann A, Paiva AC, Pajunen P, Paulweber B, Peltonen M, Perrenoud L, Pfeiffer A, Pölönen A, Puhl S, Raposo F, Reinehr T, Rissanen A, Robinson C, Roden M, Rothe U, Saaristo T, Scholl J, Schwarz PE, Sheppard KE, Spiers S, Stemper T, Stratmann B, Szendroedi J, Szybinski Z, Tankova T, Telle-Hjellset V, Terry G, Tolks D, Toti F, Tuomilehto J, Undeutsch A, Valadas C, Valensi P, Velickiene D, Vermunt P, Weiss R, Wens J, Yilmaz T. Quality indicators for the prevention of type 2 diabetes in Europe--IMAGE. Horm Metab Res 2010; 42 Suppl 1:S56-63. [PMID: 20391308 DOI: 10.1055/s-0029-1240976] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND The marked increase of type 2 diabetes necessitates active development and implementation of efficient prevention programs. A European level action has been taken by launching the IMAGE project to unify and improve the various prevention management concepts, which currently exist within the EU. This report describes the background and the methods used in the development of the IMAGE project quality indicators for diabetes primary prevention programs. It is targeted to the persons responsible for diabetes prevention at different levels of the health care systems. METHODS Development of the quality indicators was conducted by a group of specialists representing different professional groups from several European countries. Indicators and measurement recommendations were produced by the expert group in consensus meetings and further developed by combining evidence and expert opinion. RESULTS The quality indicators were developed for different prevention strategies: population level prevention strategy, screening for high risk, and high risk prevention strategy. Totally, 22 quality indicators were generated. They constitute the minimum level of quality assurance recommended for diabetes prevention programs. In addition, 20 scientific evaluation indicators with measurement standards were produced. These micro level indicators describe measurements, which should be used if evaluation, reporting, and scientific analysis are planned. CONCLUSIONS We hope that these quality tools together with the IMAGE guidelines will provide a useful tool for improving the quality of diabetes prevention in Europe and make different prevention approaches comparable.
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Affiliation(s)
- P Pajunen
- Department of Chronic Disease Prevention, National Institute for Health and Welfare, Helsinki, Finland.
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Lindström J, Neumann A, Sheppard KE, Gilis-Januszewska A, Greaves CJ, Handke U, Pajunen P, Puhl S, Pölönen A, Rissanen A, Roden M, Stemper T, Telle-Hjellset V, Tuomilehto J, Velickiene D, Schwarz PE, Acosta T, Adler M, AlKerwi A, Barengo N, Barengo R, Boavida JM, Charlesworth K, Christov V, Claussen B, Cos X, Cosson E, Deceukelier S, Dimitrijevic-Sreckovic V, Djordjevic P, Evans P, Felton AM, Fischer M, Gabriel-Sanchez R, Gilis-Januszewska A, Goldfracht M, Gomez JL, Greaves CJ, Hall M, Handke U, Hauner H, Herbst J, Hermanns N, Herrebrugh L, Huber C, Hühmer U, Huttunen J, Jotic A, Kamenov Z, Karadeniz S, Katsilambros N, Khalangot M, Kissimova-Skarbek K, Köhler D, Kopp V, Kronsbein P, Kulzer B, Kyne-Grzebalski D, Lalic K, Lalic N, Landgraf R, Lee-Barkey YH, Liatis S, Lindström J, Makrilakis K, McIntosh C, McKee M, Mesquita AC, Misina D, Muylle F, Neumann A, Paiva AC, Pajunen P, Paulweber B, Peltonen M, Perrenoud L, Pfeiffer A, Pölönen A, Puhl S, Raposo F, Reinehr T, Rissanen A, Robinson C, Roden M, Rothe U, Saaristo T, Scholl J, Schwarz PE, Sheppard KE, Spiers S, Stemper T, Stratmann B, Szendroedi J, Szybinski Z, Tankova T, Telle-Hjellset V, Terry G, Tolks D, Toti F, Tuomilehto J, Undeutsch A, Valadas C, Valensi P, Velickiene D, Vermunt P, Weiss R, Wens J, Yilmaz T. Take action to prevent diabetes--the IMAGE toolkit for the prevention of type 2 diabetes in Europe. Horm Metab Res 2010; 42 Suppl 1:S37-55. [PMID: 20391307 DOI: 10.1055/s-0029-1240975] [Citation(s) in RCA: 155] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
When we ask people what they value most, health is usually top of the list. While effective care is available for many chronic diseases, the fact remains that for the patient, the tax payer and the whole of society: prevention is better than cure. Diabetes and its complications are a serious threat to the survival and well-being of an increasing number of people. It is predicted that one in ten Europeans aged 20-79 will have developed diabetes by 2030. Once a disease of old age, diabetes is now common among adults of all ages and is beginning to affect adolescents and even children. Diabetes accounts for up to 18 % of total healthcare expenditure in Europe. The good news is that diabetes is preventable. Compelling evidence shows that the onset of diabetes can be prevented or delayed greatly in individuals at high risk (people with impaired glucose regulation). Clinical research has shown a reduction in risk of developing diabetes of over 50 % following relatively modest changes in lifestyle that include adopting a healthy diet, increasing physical activity, and maintaining a healthy body weight. These results have since been reproduced in real-world prevention programmes. Even a delay of a few years in the progression to diabetes is expected to reduce diabetes-related complications, such as heart, kidney and eye disease and, consequently, to reduce the cost to society. A comprehensive approach to diabetes prevention should combine population based primary prevention with programmes targeted at those who are at high risk. This approach should take account of the local circumstances and diversity within modern society (e.g. social inequalities). The challenge goes beyond the healthcare system. We need to encourage collaboration across many different sectors: education providers, non-governmental organisations, the food industry, the media, urban planners and politicians all have a very important role to play. Small changes in lifestyle will bring big changes in health. Through joint efforts, more people will be reached. The time to act is now.
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Affiliation(s)
- J Lindström
- Department of Chronic Disease Prevention, National Institute for Health and Welfare (THL), Helsinki, Finland
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