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Prevost G.,Service dEndocrinologie et Diabetologie | Boulanger E.,Biologie du Vieillissement Vasculaire | Fontaine P.,Service Endocrinologie Diabetologie Metabolismes
Medecine des Maladies Metaboliques | Year: 2010

Epidemiologic and pathologic data have demonstrated that diabetic patients are prematurely exposed to atherosclerotic lesions thus it has been suggested that diabetes confers an equivalent risk to ageing 15 years more. Ageing and diabetes share common vascular abnormalities. Structural modifications include intima-media thickness, matrix remodeling, and calcifications. Functional changes are representated by arterial stiffness and endothelial dysfunction. Common pathophysiologic mechanisms including advanced glycation endproducts (AGEs) and oxidative stress are also described and suggest novel therapeutic targets. © 2010 - Elsevier Masson SAS.

Monnier L.,Montpellier University | Dejager S.,Novartis | Serusclat P.,Service dendocrinologie diabetologie | Petit C.,Center Hospitalier Sud Francilien | And 8 more authors.
Medecine des Maladies Metaboliques | Year: 2014

Aim: To compare continuous glucose monitoring (CGM) profiles on vildagliptin vs. sitagliptin given as add-on to metformin, in patients with inadequately controlled type 2 diabetes mellitus (HbA1c 6.5-8.0%). Methods: A multicenter, prospective, randomised, open-label study with blinded analysis of the primary endpoint (CGM data, with glucose variability - mean amplitude of glucose excursions [MAGE] and standard deviation around the mean blood glucose concentration - and daily glycemic control). CGM data acquired over 3 days - firstly on metformin alone and then 8 weeks after the addition of either vildagliptin (n=14) or sitagliptin (n=16) - were centrally analyzed. Results: In comparable populations with a mean baseline HbA1c of 7.1%, 24-h glucose variability showed similar improvement on both drugs vs. metformin alone. In contrast, a series of predefined parameters reflecting daily glycemic control - mean 24-h blood glucose concentration and times spent within the optimal glycemic range (70-140 mg/dL) and above the hyperglycemic thresholds of 140 and 180 mg/dL together with the corresponding AUC values - were significantly improved from baseline only in the vildagliptin arm. In addition, overall hyperglycemia (AUC24h ≥100 mg/dL) significantly dropped from baseline on vildagliptin (-37%) but not on sitagliptin (-9%). Postprandial hyperglycemia (AUC0-4hx3) was significantly reduced on both drugs whilst basal hyperglycemia was reduced only on vildagliptin (-41% vs. baseline; P= 0.04]). Conclusion: The addition of each DPP-4 inhibitor significantly reduced glycemic variability with no difference between the two drugs. However, vildagliptin was associated with better circadian glycemic control than sitagliptin and with a significant decrease in overall hyperglycemia, mainly driven by a reduction in basal hyperglycemia. © 2014 - Elsevier Masson SAS.

Ducry J.,Service dEndocrinologie et Diabetologie | Berthold D.,Center Coordonne dOncologie | Pralong F.,Service dendocrinologie
Revue Medicale Suisse | Year: 2012

Adrenocortical carcinomas are rare and aggressive malignant tumors, with an incidence of 1 to 2 cases per million inhabitants. Their diagnosis is made in three clinical situations: during the work up of a syndrome of hormonal hypersecretion, during the work up of locoregional symptoms, or incidentally during an unrelated radiological procedure. Surgery is usually indicated except in situations of advanced metastatic disease. Adjuvant chemotherapy with mitotane is associated with a significant increase in disease-free survival when the drug is administered at adequate therapeutic dosage. Novel anti-mitotic therapies have recently been described for treating recurrent adrenocortical carcinoma under mitotane treatment, but their overall efficacy remains unsatisfactory.

Lassmann-Vague V.,Center Medical Paul Paret | Clavel S.,Service de Diabetologie | Guerci B.,Service de Diabetologie | Hanaire H.,Service de Diabetologie | And 6 more authors.
Diabetes and Metabolism | Year: 2010

For years, external insulin pumps have enjoyed proven efficacy as an intensive diabetes treatment to improve glycaemic control and reduce hypoglycaemia. Since the last ALFEDIAM guidelines in 1995, however, basal-bolus treatment using a combination of long- and short-acting insulin analogues have emerged and could challenge, at a lower cost, the efficacy of pumps using rapid-acting insulin analogues, considered the 'gold standard' of insulin treatment. Nevertheless, given its theoretical and practical advantages, some patients will derive more benefit from pump treatment. These cases have been carefully evaluated in the literature by a panel of experts appointed by ALFEDIAM to determine the indications for pump treatment. In patients with type 1 diabetes, persistent elevated HbA1c despite multiple daily injections (MDI), and repeated hypoglycaemia and high glycaemic variability, represent the most validated indications. In patients with type 2 diabetes, pump treatment may be indicated in cases of MDI failure to achieve HbA1c targets. Absolute contraindications are rare, and comprise severe psychiatric disorders, rapidly progressing ischaemic or proliferative retinopathy before laser treatment and exposure to high magnetic fields. Relative contraindications are mostly related to the patient's lack of compliance or inability to cope with the treatment, and need to be evaluated individually to clearly assess the benefit/risk ratio for the given patient. However, as these conditions are progressive, there should also be annual reassessment of the appropriateness of pump treatment. Specific education on pump treatment initially and throughout the follow-up, delivered by experienced medical and paramedical teams, are the best guarantees of treatment efficacy and safety. © 2010 Elsevier Masson SAS. All rights reserved.

Debussche X.,Service dEndocrinologie Diabetologie et Nutrition | Rollot O.,French Institute of Health and Medical Research | Le Pommelet C.,Service dEndocrinologie et Diabetologie | Fianu A.,French Institute of Health and Medical Research | And 7 more authors.
Diabetes and Metabolism | Year: 2012

Aims: This study aimed to describe the 1-year evolution of type 2 diabetes (T2D) patients who attended inpatients education, and to assess whether quarterly outpatients counseling visits by nurses and dietitians can improve metabolic control and health-related behaviours. Methods: Following in-hospital educational sessions, 398 adult T2D patients were randomized to either attend quarterly individual lifestyle counseling visits by a nurse and a dietitian (intervention group), or receive the usual care (control group). Primary (HbA 1c) and secondary endpoints (fasting blood glucose, lipids, body mass index, waist circumference, fat mass, blood pressure, diet, physical activity) were assessed at baseline and at 12months. Results: HbA 1c changes from baseline to 12months were -1.74±2.64% (P<0.0001) for the intervention group and -2.02±2.57% (P<0.0001) for the control group. There was no statistically significant difference between the intervention group (n=153) and the controls (n=166) for any of the clinical and biological outcomes. In both groups, total energy and fat intakes decreased significantly from baseline levels. Also, no difference was found between the groups for any dietary outcome. A slight enhancement in sports activity was observed in the intervention group, but the difference between the two groups did not reach statistical significance, and no difference was found concerning any other physical activity scores. Conclusion: In this study of adults with T2D, patients significantly improved their metabolic control, and dietary and exercise habits, 1. year after receiving intensive inpatients education, whereas subsequent quarterly outpatients counseling visits with nurses and dietitians have not demonstrated any superiority compared with the usual care. © 2011 Elsevier Masson SAS.

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