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Saint-Antoine-du-Rocher, France

Insulinotherapy is a necessary transition for many type 2 diabetics and is very difficult to accept for patients and also physicians. Both are resistant to the idea of starting insulin despite many progresses have been done as noted in the French L&Vous study. Progresses concern improvement of injection equipment, self-monitoring of blood glucose tools, and basal insulins that are usually recommended for type 2 diabetes. Education programs are often defaulting. A better coordination in health care is absolutly necessary to improve coordinated healthcare circuit. © 2015 Elsevier Inc.

Giusti V.,Service dendocrinologie
Revue Medicale Suisse | Year: 2010

Bariatric surgery techniques can usually increase either sensitivity or insulin resistance, acting on three different levels: decrease of food intake, malabsorption and modifications of entero-insulaire axis activity. This latter is taken into account in order to develop a new protocol to obtain diabetes remission without Important weight loss and nutritional deficiencies. Preliminary results are interesting but they come from very short time studies with few patients. Moreover, complications rate is at present very high. Knowing better gastrointestinal mechanisms of diabetes control and especially incretins role is absolutely necessary before identifying surgery as a true metabolic treatment.

Obesity appears multifactorial but some cases may involve viral infections. Several species of viruses have been linked to obesity in chickens, mice and monkeys. In humans, only adenovirus-36 (Ad-36) is strongly associated. Further studies are still needed to confirm a causal relationship and to try to identify possible predisposing factors to the effects of Ad-36. Effects of Ad-36 pass by the expression of viral gene E4Orfl promoting the differentiation of fat stem cells. Future progress in understanding the cellular mechanisms underlying the relationship between the Ad-36 (and other viruses) and obesity can lead to identify new targets for the prevention and the treatment.

Carney J.A.,Mayo Medical School | Gaillard R.C.,University of Lausanne | Bertherat J.,Service dendocrinologie | Stratakis C.A.,U.S. National Institutes of Health
American Journal of Surgical Pathology | Year: 2010

We present the pathologic findings in the adrenal glands of 4 patients, aged 10 to 38 years, with Cushing syndrome and germline inactivating mutations of the gene PDE11A4 that encodes phosphodiesterase11A4. The gene is expressed in the adrenal cortex and catalyses the hydrolysis of cyclic adenosine monophosphate and cyclic guanosine monophosphate. Two of the patients were mother and daughter; the third had no affected relative; the fourth patient inherited the mutation from her father. Three of the group, including the mother and daughter, had the same pathology, primary pigmented nodular adrenocortical disease, a disorder known to be caused by inactivating mutations of the PRKAR1A gene. In these cases, the adrenal glands were small and the pathologic change was deep in the cortex in which numerous pigmented micronodules developed. In the remaining patient, the glands were slightly enlarged primarily owing to a diffuse hyperplasia of the superficial cortex that extended into the epi-adrenal fat. © 2010 Lippincott Williams & Wilkins.

Epidemiological studies among diabetic populations have clearly shown a positive association between hyperglycemia and the risk for cardiovascular events independently of other riskfactors. Moreover, manypathophysiological data indicate the deleterious role of hyperglycemia on the arterial wall through promotion of inflammation and oxidation, and through the local accumulation of Advanced Glycosylation End products (AGE). However, the demonstration of the cardiovascular benefit secondary to the reduction of hyperglycemia is not clear. Indeed, in the UKPDS, VADT and ADVANCE trials no significant reduction of the risk for major cardiovascular events has been observed among the patients enrolled in the "intensive treatment of diabetes" group. However, the prolonged follow-up of the patients from UKPDS, VADT and ACCORD, in type 2 diabetes, and from DCCT/EDIC, in type 1 diabetes, has clearly shown a significant reduction of major cardiovascular events in the patients initially enrolled in the "intensive treatment" groups. Thus, the present data seems to indicate a real cardiovascular benefit secondary to the reduction of hyperglycemia that is "late". This rather "late" effect could partly be due to the prolonged modification of the arterial wall promoted by the local accumulation of AGE. © 2015 Elsevier Masson SAS - Tous droits réservés.

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