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Le Floch J.-P.,Service de Diabetologie endocrinologie | Doucet J.,Service de Medecine Interne Geriatrie Therapeutique | Bauduceau B.,Service Dgendocrinologie | Verny C.,Service de Gerontologie
Medecine des Maladies Metaboliques | Year: 2013

This analysis aimed to investigate regional differences in the aged type 2 diabetic (T2D) population of the GÉRODIAB cohort at inclusion.Five regions, based on telephone area codes, were used to divide the GÉRODIAB population of 987 T2D outpatients aged 70-yr and older. The history of diabetes, physical examination, laboratory assays and other exams, including geriatric scales, were recorded and compared between regions using the one-way Anova and the chi-square test.Significant differences were found between regions for age, social factors, body mass index, waist-to-hip ratio, cholesterol and HbA1c levels, frequency of chronic diabetic complications, geriatric scale scores and treatment with metformin, glinides and glitazones, but not for duration of diabetes, hypertension, treatment with insulin or sulfonylureas. Scoring these differences in four domains (individual, metabolic, diabetes complications and geriatric data) enhanced the regional differences, showing that the North-West and North-East regions had the population with the highest frequencies of risk factors, complications and impaired geriatric scores. The Île-De-France and the South-East regions had a healthier, less at-risk population, with lower frequencies of complications and better geriatric scores.Although regional recruitment bias cannot be ruled out, regional differences found in this study should be discussed according to regional socioeco © 2013 Elsevier Masson SAS- Tous droits réservés.


Doucet J.,University of Rouen | Bauduceau B.,Service de Diabetologie endocrinologie | Blickle J.-F.,Hopitaux Universitaires Of Strasbourg
Geriatrie et Psychologie Neuropsychiatrie du Vieillissement | Year: 2011

The increase in prevalence and the particularities of care in old diabetic patients, which accumulate consequences of both, age and diabetes, the treatment must be well tolerated. The main adverse event is a hypoglycemia risk because of its major consequences for the elderly diabetic subjects. Since few years, three dipeptydil-peptidase-4 inhibitors (DPP-4), for which some studies have included type 2 diabetic old subjects are available in Europe. Their efficiency and their tolerance do not differ significantly from those noted at the younger diabetics. The reduced risk of hypoglycemia and the absence of influence on the weight are two interesting arguments to use them in the old diabetic patients. It remains however necessary to realize studies led specifically to old and even oldest subjects, corresponding to those in daily practice. If the data on their tolerance is confirmed, it could intend to revise therapeutic target for the old diabetic patients.


Doucet J.,University of Rouen | Le Floch J.-P.,Service de diabetologie endocrinologie | Bauduceau B.,Service dendocrinologie | Verny C.,Service de gerontologie
Diabetes and Metabolism | Year: 2012

Aims: The GERODIAB study is the first French multicentre, prospective, observational study that aims, through a 5-year cohort follow-up, to evaluate the link between glycaemic control and morbidity/mortality of type 2 diabetic (T2D) patients aged 70 years and older. This first report describes the study population at inclusion. Patients and methods: A total of 987 T2D autonomous patients, aged ≥ 70 years, were recruited between June 2009 and July 2010 at 56 investigator centres. Their general parameters, diabetes characteristics and standard geriatric parameters were recorded. Results: The patients' mean age was 77±5 years, with 65.2% aged 75 years or more. The mean BMI was close to 30kg/m2. Hypertension was found in 89.7% of patients, and 85.0% had at least one cholesterol abnormality. The mean duration of the diabetes was around 18 years, and the mean HbA1c level was about 7.5%. During the previous six months, 33.6% of patients had experienced one or several hypoglycaemias. Also, 26% of patients presented with diabetic retinopathy, 37.3% had a GFR<60mL/min, 31.2% had coronary insufficiency, 10.1% had heart failure, 15.8% had cerebrovascular involvement and 25.6% had peripheral vascular disease of the lower extremities. In addition, 30.5% of patients had orthostatic hypotension, 12.4% had malnutrition and 28.8% had cognitive impairment, all of which were often diagnosed at inclusion. Three-quarters of patients were taking an oral antidiabetic drug and nearly six in every 10 patients were using insulin. Conclusion: This population can be considered representative of elderly, autonomous T2D patients, and its follow-up should clarify the link between glycaemic control and mortality/morbidity. © 2012 Elsevier Masson SAS.


Dupuy O.,Service dEndocrinologie | Bordier L.,Service dEndocrinologie | Garcia C.,Service dEndocrinologie | Brinkane A.,Center Hospitalier Intercommunal Of Meulan | And 6 more authors.
Medecine des Maladies Metaboliques | Year: 2014

The aim of this study, based on clinical data collected from six Paris area diabetes centers, was to determine predictors of response to liraglutide, as defined by HbA1c level and weight loss in type 2 diabetic patients after 1-year liraglutide treatment. The response criteria were defined as a reduction of more than 1.0 percentage point in HbA1c and a weight loss more than 3kg of initial body weight. All patients were categorized into four groups: non-responders, HbA1c responders, weight responders, and double responders for both HbA1c and weight. 243 patients were included during 8 months but 18% of them discontinued the treatment at 6 months. Data were exploited for 162 patients still on liraglutide treatment at the 1-year visit. The average HbA1c reduction was 0.98±1.5% and weight loss was 4.7±7.1kg. More than one quarter (25.5%) of patients were non-responders, 23% weight responders only, 21% HbA1c responders only, and 25.5% both HbA1c and weight responders. Comparing to non-responders, double responders (HbA1c and weight) were significantly younger with shorter diabetes duration and higher initial BMI. This type of survey in routine practice allows to precise the best indications, while waiting for results of the large ongoing interventional studies. © 2014 Elsevier Masson SAS.


Hartemann A.,University Pierre and Marie Curie | Attal N.,French Institute of Health and Medical Research | Bouhassira D.,French Institute of Health and Medical Research | Dumont I.,Center du pied | And 4 more authors.
Diabetes and Metabolism | Year: 2011

The prevalence of painful diabetic peripheral neuropathy (PDN) is about 20% in patients with type 2 diabetes and 5% in those with type 1. Patients should be systematically questioned concerning suggestive symptoms, as they are not usually volunteers. As PDN is due to small-fibre injury, the 10 g monofilament pressure test as well as the standard electrophysiological procedures may be normal. Diagnosis is based on clinical findings: type of pain (burning discomfort, electric shock-like sensation, aching coldness in the lower limbs); time of occurrence (mostly at rest and at night); and abnormal sensations (such as tingling or numbness). The DN4 questionnaire is an easy-to-use validated diagnostic tool. Three classes of drugs are of equal value in treating PDN: tricyclic antidepressants; anticonvulsants; and selective serotonin-reuptake inhibitors. These compounds may be prescribed as first-line therapy following pain assessment using a visual analogue scale. If the initial drug at its maximum tolerated dose does not lead to a decrease in pain of at least 30%, another drug class should be prescribed; if the pain is decreased by 30% but remains greater than 3/10, a drug from a different class may be given in association. © 2011 Elsevier Masson SAS.


Ruppe E.,Center National Of Reference Associe Resistance Dans Les Flores Commensales | Ruppe E.,University Paris Diderot | Armand-Lefevre L.,Center National Of Reference Associe Resistance Dans Les Flores Commensales | Armand-Lefevre L.,University Paris Diderot | And 12 more authors.
Journal of Clinical Microbiology | Year: 2011

We report incidental isolation of an OXA-48-producing Escherichia coli strain in urine of a 62-year-old woman recently returning from a 2-month vacation in Morocco. Commercially available extended-spectrum beta-lactamase (ESBL)-targeting medium failed to detect it in the patient's stools, although a locally developed and easy-to-implement method using ertapenem-supplemented brain heart infusion (BHI) broths could. Copyright © 2011, American Society for Microbiology. All Rights Reserved.


Halbron M.,Groupe hospitalier Pitie Salpetriere | Joubert M.,Caen University Hospital Center | Sonnet E.,Service de diabetologie endocrinologie
Medecine des Maladies Metaboliques | Year: 2016

Mobile technology in general, and Smartphones in particular, are increasingly used among the general population. There are many mobile health applications (m-health), especially for patients with diabetes. These applications include virtual glycemic logbooks, dietary counseling, or physical activity coaching. Although the contents they provide can be seen as diverse and eclectic, their relevance is sometimes questionable as applications that do not need any certification from health care providers. Patients and healthcare professionals may therefore well be at best lost, or at worse dispirited. To avoid this and address this issue, all French applications dedicated to diabetes care were identified, categorized, and their main features were described. This practical guide should help diabetes physicians advise their patients on how to use those new tools efficiently. © 2016 Elsevier Masson SAS


Janin C.,Service de Diabetologie endocrinologie | Janin C.,University of Paris Descartes | Fontanie M.,Service de Diabetologie endocrinologie | Sallee F.-X.,Service de Diabetologie endocrinologie | And 4 more authors.
Medecine des Maladies Metaboliques | Year: 2014

Women with a history of gestational diabetes mellitus are characterized by a high risk of type 2 diabetes mellitus (×7). Glucose tolerance abnormalities can occur from postpartum (21%) to several years later, up to 25 years. However, studies analyzing practices show low adhesion to screening after deliverance. Postpartum screening is important because of two issues. First, to screen early glucose regulation disturbances thanks to a fasting plasma glucose, HbA1c or a fasting-75g, 2-hour-oral-glucose-tolerance test. Second, to sensitize women about the fact that lifestyle modifications can decrease by 50% the risk of type 2 diabetes. All practitioners, endocrinologists, gynecologists and primary physicians have to be concerned to stop the pandemic of diabetes in a population of young women with recent knowledge about diet rules and with very minor glucose tolerance abnormalities. © 2014 - Elsevier Masson SAS - Tous droits réservés.


The prevalence of type 2 diabetes is higher among patients from emerging countries such as North Africa, the Middle East and sub-Saharan Africa, regions of the world with large Muslim populations. The question of the observance of Ramadan for diabetic patients often arises in these countries as in ours, where the proportion of Muslims in the general population is between 3% and nearly 10%. Today the majority of these Muslim diabetic patients elect to fast during the month of Ramadan. Moreover, in recent years and for the years to come, this fast takes place in the summer, where it can last up to 16-18 hours, and occurs during the months of extreme heat. For patients treated with insulin or insulin-secreting agents (sulfonylureas or repaglinide alone, or combined to metformin) there is a health risk, primarily of hypoglycemia, sometimes severe. In this review we illustrate the benefit that the use of DPP-4 inhibitors can provide to these patients in combination with metformin, offering the best risk-benefit ratio with equivalent metabolic control compared with sulfonylureas or glinides. In this class, sitagliptin, and mostly vildagliptin, brought the studies/data to favor this therapeutic class, whenever the health care system allows. Nevertheless, regardless of the treatment choices, one must ensure to prepare for the fast, by implementing general and targeted therapeutic education approaches, which are even more important for these populations at higher risk of noncompliance or iatrogenic accidents essentially with some sulfonylureas or glinides. © 2014 - Elsevier Masson SAS - Tous droits réservé s.


PubMed | Service de diabetologie endocrinologie
Type: | Journal: Soins; la revue de reference infirmiere | Year: 2011

Since the recent recommendations by the French speaking association for research on diabetes and metabolic illnesses (Alfediam), treatment by insulin pump has found itself in competition with basal-bolus, a procedure using similar injections of insulin which has become a benchmark treatment. The latest Alfediam guidelines focus on defining ways of treating diabetics with an external insulin pump.

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