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Villecresnes, France

Bouhanick B.,Toulouse University Hospital Center | Meliani S.,Toulouse University Hospital Center | Doucet J.,University of Rouen | Bauduceau B.,Endocrinology | And 3 more authors.
Annales de Cardiologie et d'Angeiologie | Year: 2014

Orthostatic hypotension (OH) has deleterious effects on patients' cardiovascular prognoses. The combination of increased age and diabetes adds to the risk of OH. The aim of the study was to describe the elderly diabetic population relative to the degree of hypertension, the occurrence of complications, medications and cognitive function. Methods: In the Gerodiab study (a 5-year French multicentre, prospective, observational study), a total of 987 type 2 diabetic autonomous patients, aged 77 ± 5 years, were recruited between June 2009 and July 2010. Clinical blood pressure measurements were taken supine and then after 1, 3 and 5. minutes in a standing position. OH was defined as a decrease in systolic blood pressure (SBP) of at least 20. mmHg and/or a decrease in diastolic blood pressure (DBP) of at least 10. mmHg at any of the measurements while standing. Results: At inclusion 301 (30.5%) patients had OH; SBP and DBP at rest were higher in patients with OH than in those without (146 ± 21/78 ± 11 mmHg vs. 138 ± 17/72 ± 10 mmHg; P< 0.001). Individuals with OH exhibited higher pulse pressure (PP) than individuals without (68 ± 18 vs. 65 ± 15. mmHg; P< 0.05). A significant increase in waist-to-hip ratio was recorded in those with OH versus patients without (P < 0.01). Despite more severe hypertension (SBP. >. 160. mmHg at inclusion; P< 0.01), no significant difference was recorded in the mean number of antihypertensive drugs (1.7 ± 1.1), or in the class of antihypertensive drugs, including beta-blockers (P=0.19) and diuretics (P= 0.84). Patients with OH were more likely to have a history of peripheral arterial disease and amputations (31% vs. 24%, P< 0.05, and 3.3% vs. 1.5%, P= 0.056). There was no significant association between OH and history of peripheral neuropathy (P = 0.37), stroke, heart failure or ischemic heart disease. In multivariate analysis, OH remained associated with severe hypertension (P < 0.01), increased waist-to-hip ratio (P < 0.05) and amputations (P < 0.05). Conclusion: About one-third of elderly, autonomous diabetic patients had OH. They had more severe hypertension, with higher SBP, DBP and PP at rest. However, the number of anti-hypertensive drugs did not differ compared to patients without OH. This could reflect the medical teams' fears about intensifying treatment. © 2014 Elsevier Masson SAS. Source

Le Floch J.-P.,Diabetology Endocrinology | Doucet J.,University of Rouen | Bauduceau B.,Endocrinology | Verny C.,Bicetre University Hospital
Diabetic Medicine | Year: 2014

Aims: To analyse the relationships between retinopathy, nephropathy, peripheral neuropathy and geriatric scale scores in elderly people with Type 2 diabetes. Methods: GERODIAB is the first French multi-centre, prospective, observational study designed to assess the influence of glycaemic control on mortality and morbidity through a 5-year follow-up study in people with Type 2 diabetes aged 70 years and older. In this report the relationships at baseline between retinopathy, nephropathy and peripheral neuropathy, and five geriatric scale scores in 987 people, using bivariate and multivariate analyses are analysed. Results: Retinopathy (26%) was significantly associated with impaired scores on the Mini Geriatric Depression Scale, the Mini Nutritional Assessment and the Instrumental Activities of Daily Living scale. Logistic regression showed that the duration of diabetes, BMI, Mini Geriatric Depression Scale, hypoglycaemia and HbA1c were associated with retinopathy (concordance 69.1%; P < 0.001). Nephropathy (47.4%, including 34.8% with Modification of Diet in Renal Disease < 60 ml/min) was significantly associated with impaired Activities of Daily Living and Instrumental Activities of Daily Living scale scores. Using the logistic model, the most significant factors were age, duration of diabetes, triglycerides, HDL cholesterol, hypoglycaemia, hypertension and BMI (concordance 66.3%; P < 0.001). Peripheral neuropathy (28.2%) was associated with impaired scores on the Mini Mental State Examination, Activities of Daily Living, Instrumental Activities of Daily Living and Mini Geriatric Depression Scales. In the logistic model, diastolic blood pressure, duration of diabetes and the Instrumental Activities of Daily Living, Mini Geriatric Depression Scale and Mini Mental State Examination scales were included (concordance 69.8%; P < 0.001). Conclusion: In this specific sample, classical microvascular complications of diabetes were found to be associated with impaired geriatric scale scores. This highlights the benefits of systematic assessment in elderly people with Type 2 diabetes. © 2013 The Authors. Diabetic Medicine © 2013 Diabetes UK. Source

Verny C.,Bicetre University Hospital | Doucet J.,University of Rouen | Bauduceau B.,Endocrinology | Constans T.,University of Tours | And 2 more authors.
European Geriatric Medicine | Year: 2015

Objective: The GERODIAB follow-up survey is the first French multi-centre, prospective, observational study designed to analyze the influence of glycaemic control onmorbidity-mortality over 5 years in type 2 diabetic patients aged 70 years and over. This report analyses the factors associated with cognitive decline at inclusion. © 2014 Elsevier Masson SAS and European Union Geriatric Medicine Society. All rights reserved. Source

Chantrel F.,Regional Hospital | Sissoko H.,Regional Hospital | Kepenekian L.,University of Strasbourg | Smagala A.,Regional Hospital | And 9 more authors.
Hormone and Metabolic Research | Year: 2014

We sought to investigate the impact of dialysis on glucose profiles of diabetic patients using continuous glucose monitoring (CGM). The study included 33 hemodialyzed patients with diabetes (14 females and 19 males; mean age: 66±8 years; patients with type 2 diabetes: 30; mean duration of dialysis: 3.8±2.6 years) who were under insulin treatment. After a run-in period, CGM was performed for 48 h, including a dialysis session. Three CGM sessions were proposed for each patient over a 3-month period. CGM results were analyzed during and after dialysis at 6 different time points. Moreover, data were analyzed in 7 different day periods according to meals. Of the 99 CGM available, 21 were excluded because of technical issues or patient refusal. The CGM results indicated that mean glucose values (7.5±2.5 mmol/l vs. 9.4±1.9 mmol/l; p<0.001) and variability indices (p<0.001) were lower, whereas the frequency of hypoglycemia (4.4±9.6% vs. 2.1±7.9%; p<0.001) was higher during hemodialysis sessions. Significant differences were observed in glucose values only before and 2 h after breakfast (p<0.001). Compared with other day periods, glucose values were lower during the second half of the night and higher before and after dinner (p<0.001). In summary, CGM allows the identification of a particular glucose profile in hemodialyzed diabetic patients. CGM seems feasible and clinically useful for the analysis of glucose profiles in this group of patients. © Georg Thieme Verlag KG. Source

Bordier L.,Endocrinology | Buysschaert M.,Universitary clinic Saint Luc | Bauduceau B.,Endocrinology | Doucet J.,University of Rouen | And 3 more authors.
Diabetes and Metabolism | Year: 2015

The burden of hypoglycaemia is important, particularly in elderly type 2 diabetes (T2D) patients. Unfortunately, however, few studies are available concerning this population. GERODIAB is a prospective, multicentre, observational study that aims to describe the 5-year morbidity and mortality of 987 T2D patients aged 70. years and older. After analyzing the frequency of and factors associated with hypoglycaemia in the 6. months prior to study inclusion, it was found that hypoglycaemia was associated with retinopathy, lower levels of LDL cholesterol and altered mini-Geriatric Depression Scale (GDS) scores. © 2015 Elsevier Masson SAS. Source

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