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Artigues-près-Bordeaux, France

One third of the patients with Diabetes present a Chronic Kidney Disease. Despite cardiovascular events and increased mortality, Diabetes is the first cause of End Stage Renal Disease. The nutritional status of theses patients widely varies, from obesity to malnutrition, according to their type of diabetes, the severity of the renal disease, and the frequent concurrent diseases: it conditions their dietary counselling. The patients with type 2 diabetes and obesity have to moderate and well choose their alimentary lipids, for body weight control and to reduce their cardiovascular risk; this works in the context of a multifactorial approach as demonstrated by the Steno 2 trial. The use of insulin or conventional insulin-secretagogues (sulfonylureas, glinids) needs patients to be educated about their carbohydrate intake, especially when the good glucose control exposes to hypoglycaemia. Moderation of protein intake reduces proteinuria, an improved outcome has been demonstrated for patients with type 1 diabetes and nephropathy on a Low Protein Diet. The patients who require dialysis often deteriorate their nutritional status, the protein intake must be increased at this stage. 2010 Elsevier Masson SAS. All rights reserved. Source

Genevieve M.,Nutrition Diabetologie | Genevieve M.,University of Bordeaux Segalen | Vivot A.,University of Bordeaux Segalen | Gonzalez C.,Nutrition Diabetologie | And 10 more authors.
Diabetes and Metabolism | Year: 2013

As skin autofluorescence (AF) can assess subcutaneous accumulation of fluorescent advanced glycation end-products (AGEs), this study aimed to investigate whether it was linked to glycaemic control and complications in patients with type 1 diabetes mellitus (T1DM). Using the AGE Reader™, AF was measured in T1DM patients referred to Haut-Levêque Hospital (Bordeaux, France); data on their HbA1c levels measured every 6months as far back as the last 5years were also collected. The association of AF with the patients' past glucose control, based on their latest HbA1c values, and the means of the last five and 10 HbA1c values, and with diabetic complications was also examined by linear regression analysis. The sample included 300 patients: 58% were male; the mean age was 49 (SD 17) years and the mean diabetes duration was 21 (SD 13) years. The median skin AF measurement was 2.0 [25th-75th percentiles: 1.7-2.4] arbitrary units (AU), and this was associated with age (β=0.15 per 10years, P<0.001) and diabetes duration (β=0.17 per 10years, P<0.001). After adjusting for age and estimated glomerular filtration rate (eGFR), the skin AF measurement was also related to the means of the last five and 10 HbA1c values (β=0.10 per 1% of HbA1c, P=0.005, and β=0.13 per 1% of HbA1c, P=0.001, respectively). In addition, the skin AF was associated with retinopathy (P<0.001), albuminuria (P<0.001) and decreased eGFR (P<0.001). In conclusion, the skin AF is related to the long-term glucose control and diabetic complications. © 2013 Elsevier Masson SAS. Source

Fagour C.,Endocrinologie diabetologie nutrition | Gonzalez C.,Nutrition Diabetologie | Pezzino S.,Nutrition Diabetologie | Florenty S.,Nutrition Diabetologie | And 3 more authors.
Diabetes and Metabolism | Year: 2013

Aims: Few studies have described ambulatory activity in free-living individuals with type 2 diabetes mellitus (T2DM) using motion sensors, and none included a control group. For this reason, our study compared the physical-activity levels of outpatients with T2DM with subjects without diabetes, and examined the relationship between body mass index (BMI) and physical-activity parameters. Methods: Physical-activity levels in 70 outpatients with T2DM and 30 age-, gender- and employment-matched individuals without diabetes were measured using the SenseWear Armband™, a monitoring device validated against doubly labelled water, to assess total energy expenditure. Patients wore the SenseWear Armband™ on their right arm continuously every day for 1 week. Results: Total energy expenditure (< 300. kcal/day), number of steps (< 1500/day), physical-activity duration (< 130. min/day) and active energy expenditure/day (< 300. kcal) were all significantly lower (P< 0.05) in patients with T2DM. These measures were inversely correlated with BMI, and remained significant after adjusting for age, gender, employment status and the presence of diabetes. Conclusion: Outpatients with T2DM have lower physical-activity levels than their matched controls, a characteristic that is related to their higher BMI. © 2012 Elsevier Masson SAS. Source

Rigalleau V.,Nutrition Diabetologie | Rigalleau V.,University of Bordeaux 1 | Rigalleau V.,French Institute of Health and Medical Research | Cougnard-Gregoire A.,University of Bordeaux 1 | And 14 more authors.
Journal of Diabetes and its Complications | Year: 2015

Aims Accumulation of advanced glycation end-products (AGEs), may explain the major contribution of chronic kidney disease (CKD) to cardiovascular events in patients with type 2 diabetes (T2D) related to their impaired renal function. The aim of this study was to analyze the factors associated with AGE assessed by skin autofluorescence and their association with macroangiopathy in T2D. Methods We measured skin autofluorescence in patients hospitalized for T2D. Glomerular filtration rates were estimated (eGFR) by the EPI-CKD formula. Associations between skin autofluorescence, renal function and macroangiopathy were explored by multivariate analyses adjusting for diabetes duration and control. Results The 418 patients had T2D since 13.3 (SD 9.8) years on average, high mean HbA1C: 8.9%, (SD 1.8), (74 mmol/mol, (SD 15)) and often renal complications (49.4% with CKD). Their mean skin autofluorescence was 2.53 (SD 0.62) A.U. In multivariate linear regression, skin autofluorescence was significantly associated with age (+ 0.20 for ten more years, p < 0.0001), renal insufficiency (- 0.07 for less 10 mL/min/1.73 m2 eGFR, p < 0.0001) and smoking (+ 0.21, p = 0.0004). Autofluorescence (p = 0.01), but not CKD, was associated with macroangiopathy independent of diabetes duration and control. Conclusions Accumulation of AGEs is independently associated with renal insufficiency and macroangiopathy in patients with T2D. © 2015 Elsevier Inc. All rights reserved. Source

Pezzino S.,Nutrition Diabetologie | Florenty S.,Nutrition Diabetologie | Fagour C.,Nutrition Diabetologie | Gin H.,Nutrition Diabetologie | Rigalleau V.,Nutrition Diabetologie
Diabetes Care | Year: 2010

OBJECTIVE - Physical inactivity is often suspected in hospitalized patients with type 2 diabetes but has yet to be quantified. RESEARCH DESIGN AND METHODS - We measured the level of physical activity of 36 hospitalized (H) and 36 free-living nonhospitalized (NH) type 2 diabetic subjects with actimeters (SenseWear Arm-Band). RESULTS - The number of steps (H: 4,381 ± 3,742 steps/24 h, NH: 7,220 ± 4,763 steps/24 h; P < 0.01), duration of physical activity (H: 45 ± 57 min/24 h, NH: 148 ± 116 min/24 h; P < 0.005), and physical activity expenditure (H: 287 ± 390 kcal/24 h, NH: 1,035 ± 1,006 kcal/24 h; P < 0.005) were two- to threefold lower in the hospitalized patients. Simple advice enabled us to increase their recorded levels of physical activity by ∼50% (P < 0.005), and a further 50% (P < 0.05) was obtained by the use of a pedometer. CONCLUSIONS - The physical inactivity of hospitalized patients with type 2 diabetes is significant and remediable, although the advice given must take into account the existence of sensory neuropathy and silent myocardial ischemia. © 2010 by the American Diabetes Association. Source

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