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Le Touquet – Paris-Plage, France

Romano S.,University of LAquila | Di Mauro M.,University of LAquila | Fratini S.,University of LAquila | Guarracini L.,Cardiac Rehabilitation | And 3 more authors.
Cardiovascular Diabetology | Year: 2010

Background: The aim of the present study was to verify whether BNP might detect pre-clinical diastolic dysfunction (LVDD) in type-2 diabetic patients.Methods: One-hundred and twenty-seven consecutive outpatients with type-2 diabetes mellitus were enrolled into the study. Subjects with overt heart failure or NYHA class > 1, history of coronary artery disease, severe valvulopathy or chronic atrial fibrillation were excluded from the study. All patients underwent clinical evaluation, laboratory assessment of brain natriuretic peptide (BNP) and echocardiographic examination.Results: No patients showed systolic impairment of left ventricular function, whereas diastolic dysfunction was detected in 53 (42%) cases (all impaired relaxation). Median BNP was 27 pg/ml without any significant difference between 76 patients with normal left ventricular function and 53 with diastolic dysfunction; in 54 (43%) patients showing HBA1C≥8 (uncontrolled diabetes) normal function was found in 32 and diastolic dysfunction in 22, with a significant difference of BNP at multivariate analysis (OR = 1.02, 95%CI = 1.05-1.09, p = 0.003). In uncontrolled diabetic cohort, BNP was a strong predictor for LVDD (OR = 2.7, 95%CI = 1.3-5.6, p = 0.006) along with the duration of diabetes (OR = 1.6, 95%CI = 1.1-2.9, p = 0.046). BNP > 25 pg/ml was a cut-off value with high accuracy to detect a LVDD.Discussion: Early screening of high-risk patients for diabetic cardiomyopathy development might be useful to better control glycemic profile in order to reduce heart disease progression or even to reverse it. Conclusions: BNP could be a cheap, easy and useful tool to screen those ones with preclinical ventricular diastolic dysfunction in a subset of patients particularly prone to develop cardiovascular complications, like uncontrolled diabetic patients. © 2010 Romano et al; licensee BioMed Central Ltd. Source

Mannucci E.,Diabetology | Mosenzon O.,Hadassah Medical Center | Avogaro A.,University of Padua
Diabetes Care | Year: 2016

The U.S. Food and Drug Administration requires that the cardiovascular (CV) safety of all new drugs for diabetes be demonstrated through pooled analyses of phase III studies or specifically designed trials. This requirement prompted several placebo-controlled, noninferiority CV safety trials in high-risk patients; to date, all completed trials showed that dipeptidyl peptidase (DPP)-4 inhibitors do not increase or reduce the risk of major CV events. These results apparently contrast with those of pooled analyses and meta-analyses of previous, smaller trials with metabolic end points, which had suggested a reduction of risk. However, the design of CV trials, which were required to demonstrate safety, is not adequate (for duration, management of concurrent therapies, etc.) for the assessment of potential therapeutic benefits. In addition, CV safety trials enroll patients at high risk of CV events, who are different from those included in earlier trials with metabolic end points. Differences in characteristics of patients enrolled probably account for most of the discrepancy in CV outcomes between CV safety studies and earlier trials. The availability of several large-scale trials with longer duration provides the unique opportunity for assessment of the safety of DPP-4 inhibitors not only with respect to major CV events but also with reference to other safety issues. For example, CV safety trials can be a source of information for pancreatitis, cancer, or hypoglycemia. Source

Valensi P.,Diabetology | Picard S.,Point Medical
Diabetes and Metabolism | Year: 2011

Cardiovascular disease (CVD) remains the primary cause of morbidity and mortality in patients with diabetes. Lipid-lowering therapy (LLT) is often required, and statin drugs are usually the first-line therapy. However, even when LDL-cholesterol values are within the target range, a substantial residual risk persists. Fibrates may help to lower this risk, especially in patients with high triglyceride and low HDL-cholesterol levels, as suggested by the lipid ACCORD trial. Furthermore, they may even have beneficial effects on the development of microvascular complications such as nephropathy and especially retinopathy, as suggested by the results of the FIELD study. Data suggest benefit with fenofibrate on diabetic retinopathy, with significant effects on the requirement for first laser treatment and macular oedema. Fibrates, like statins, may act directly to decrease the progression of diabetic complications through their lipid-lowering effects, but may also go beyond that via pleiotropic effects. Recent data and the possible underlying mechanisms are analyzed in this review. © 2010 Elsevier Masson SAS. Source

Penfornis A.,University of Franche Comte | San-Galli F.,Endocrinology and Fenarediam | Cimino L.,Diabetology | Huet D.,Saint Joseph Hospital
Diabetes and Metabolism | Year: 2011

Aim: In France, the Afssaps/HAS 2006 guidelines for insulin-treated type 2 diabetic patients recommend a target glycated haemoglobin level (HbA 1c) of less than 7%, achieved by optimalizing the insulin dose or increasing the number of daily injections. The present study investigated to what extent these recommendations are followed in clinical practice by general practitioners (GPs) and diabetologists (DTs). Methods: The ADHOC study (observational, transversal) was a survey of 267 GPs and 180 DTs prescribing insulin in France (participation rate: 4.45% and 11.6% of GPs and DTs, respectively). Physicians answered a questionnaire focused on aspects of insulin therapy in type 2 diabetic patients receiving oral antidiabetic drugs (OADs) and insulin for at least six months. Results: A total of 1874 patients were included in the study (959 from GPs and 915 from DTs). Insulin was initiated about 10 years after the diagnosis of diabetes, when patients had high HbA 1c levels (mean value: 9.2%). At the time of the survey, patients had been treated with insulin for 3.4 ± 3.5 years (mean ± SD), and the mean HbA 1c was significantly reduced (P<0.05) to 7.8% and 7.9% in patients treated by GPs and DTs, respectively. However, almost 80% of patients had HbA 1c levels greater than 7%, and 35% had levels greater than 8%. The last fasting blood glucose level was 144 ± 45mg/dL. More than 60% of patients with HbA 1c greater than 8% were using single daily injection therapy. On consultation day, insulin treatment (dose, number of injections and type of insulin) was not optimalized in more than 40% of the latter patients. Differences in data between patients treated by GPs and DTs were small and often not statistically significant. Conclusion: In this study, the main therapeutic goals of insulin therapy, as defined by the Afssaps/HAS 2006 guidelines, were only attained in around 20% of type 2 diabetic patients, irrespective of follow-up by a GP or DT. During consultation, insulin therapy was not optimalized in a large proportion of inadequately controlled patients. © 2011 Elsevier Masson SAS. Source

Arnaud A.,Observatoire du Samusocial de Paris | Fagot-Campagna A.,French Institute for Public Health Surveillance | Reach G.,Diabetology | Basin C.,Cochin Hospital | Laporte A.,Observatoire du Samusocial de Paris
European Journal of Public Health | Year: 2010

Chronic diseases are frequent in homeless people. The aims of this study were to estimate the prevalence of diabetes in people living in shelters and to describe the characteristics of homeless people previously diagnosed with diabetes. Diabetes screening was systematically performed in nine shelters in Paris, from October to December 2006. We found a high prevalence of diabetes comparable with those of the general population, but a high frequency of major complications, in spite of a relatively young age, short duration since diabetes diagnosis and moderate glycaemic control. This study underlines the burden of diabetes among precarious people and supports the development of more effective strategies to improve diabetes management in this population, especially regarding podiatric care. © The Author 2009. Published by Oxford University Press on behalf of the European Public Health Association. All rights reserved. Source

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