Design and baseline characteristics of the finerenone in reducing cardiovascular mortality and morbidity in diabetic kidney disease trial

Background: Among people with diabetes, those with kidney disease have exceptionally high rates of cardiovascular (CV) morbidity and mortality and progression of their underlying kidney disease. Finerenone is a novel, nonsteroidal, selective mineralocorticoid receptor antagonist that has shown to reduce albuminuria in type 2 diabetes (T2D) patients with chronic kidney disease (CKD) while revealing only a low risk of hyperkalemia. However, the effect of finerenone on CV and renal outcomes has not yet been investigated in long-term trials. Patients and Methods: The Finerenone in Reducing CV Mortality and Morbidity in Diabetic Kidney Disease (FIGARO-DKD) trial aims to assess the efficacy and safety of finerenone compared to placebo at reducing clinically important CV and renal outcomes in T2D patients with CKD. FIGARO-DKD is a randomized, double-blind, placebo-controlled, parallel-group, event-driven trial running in 47 countries with an expected duration of approximately 6 years. FIGARO-DKD randomized 7,437 patients with an estimated glomerular filtration rate >= 25 mL/min/1.73 m(2) and albuminuria (urinary albumin-to-creatinine ratio >= 30 to <= 5,000 mg/g). The study has at least 90% power to detect a 20% reduction in the risk of the primary outcome (overall two-sided significance level alpha = 0.05), the composite of time to first occurrence of CV death, nonfatal myocardial infarction, nonfatal stroke, or hospitalization for heart failure. Conclusions: FIGARO-DKD will determine whether an optimally treated cohort of T2D patients with CKD at high risk of CV and renal events will experience cardiorenal benefits with the addition of finerenone to their treatment regimen. Trial Registration: EudraCT number: 2015-000950-39; ClinicalTrials.gov identifier: NCT02545049

Analyse critique d'une année d'activité du secteur d'infusion sous cutanée continue d'insuline au Centre hospitalier général de La Rochelle (étude de 67 patients)

POITIERS-BU Médecine pharmacie (861942103) / SudocPARIS-BIUM (751062103) / SudocSudocFranceF

Analyse critique de la place du traitement par glitazone dans la prise en charge du diabétique de type 2 (expérience au Centre hospitalier de La Rochelle)

POITIERS-BU Médecine pharmacie (861942103) / SudocPARIS-BIUM (751062103) / SudocSudocFranceF

1579 NM Fiber Laser Source for Spaceborne Monitoring of Carbon Dioxide.

International audienceWe report on the development of a 1579 nm pulsed fiber laser source with high peak-power, intended to be used as a lidar source for CO2 monitoring from space. We first discuss water-vapor sensitivity of spaceborne CO2 measurements by lidar and point the interest of the 1579 nm wavelength with that respect. Then we detail the current development status of the pulsed fiber laser source

En camino hacia la mejora continua de procesos

International audienceSome applications like range finding, optical counter measures or engine ignition, require lasers capable of delivering high repetition rate bursts of nanosecond pulses with hundreds of microjoules to a few millijoules in terms of energy per pulse. We have developed such a diode pumped Yb:YAG micro-laser with an oscillator comprised of a 2-mm long 10% at. doped Yb:YAG crystal followed by a Cr:YAG passive Q-switch with an initial transmittance of 85 %. The laser plano-concave cavity is 5-cm long. This oscillator emits 250 µJ to 300 µJ per pulse, with a 3-5 ns pulse duration, with an intra-burst pulse repetition frequency that can be tuned continuously from 1 kHz to 20 kHz by increasing the pump power. The pumping diode laser is operated in quasi continuous wave regime, emitting 1-ms to 10-ms long pulses with up to 20 W peak power This qcw pumping results in the emission of a burst of pulses at high repetition rate for the duration of this pump long pulse. These pump pulses, and consequently the bursts of nanosecond pulses, are repeated at very low frequency, between 1 Hz and 5 Hz, so that the average power to handle doesn't require active cooling. This oscillator is then amplified to the millijoule level in a second 3-mm long Yb:YAG crystal pumped by a synchronous qcw emitting diode laser.Nous avons développé un micro-laser Yb:YAG pompé par diode et déclenché passivement par un cristal de Cr:YAG, qui délivre des paquets d’impulsions nanoseconde avec des énergies par impulsions de l’ordre du millijoule.L’oscillateur émet autour de 300 µJ par impulsion, avec une durée d’impulsion de quelques nanosecondes, dont la cadence à l’intérieur du paquet d’impulsions peut être accordée continûment jusqu’à 20 kHz. Il est amplifié jusqu’au millijoule par un second cristal d’Yb:YAG pompé par diode laser. Les diodes laser de pompe sont synchrones et fonctionnent en régime quasi continu. Elles émettent des pulses longs répétés à seulement quelques hertz, de façon à ne pas nécessiter de refroidissement actif

Performance and patients' satisfaction with the A7+TouchCare insulin patch pump system: A randomized controlled non-inferiority study.

BackgroundWe assessed the performance and patient satisfaction of a new insulin patch pump, the A7+TouchCare (Medtrum), compared with the Omnipod system.MethodsThis multicenter, randomized, open-label, controlled study enrolled 100 adult patients with type 1 or type 2 diabetes mellitus (A1C ≥ 6.5% and ≤ 9.5%, i.e., 48 to 80 mmol/mol) who were assigned with the Omnipod or with the A7+TouchCare pump for 3 months. The primary study outcome was the glucose management indicator (GMI) calculated with continuous glucose monitoring (CGM).ResultsPremature withdrawals occurs respectively in 2 and 9 participants in the Omnipod and TouchCare groups. In the Per Protocol analysis, the difference in GMI between groups was 0.002% (95% confidence interval -0.251; 0.255). The non-inferiority was demonstrated since the difference between treatments did not overlap the pre-defined non-inferiority margin (0.4%). There was no significant difference in CGM parameters between groups. On average, patients in both groups were satisfied/very satisfied with the insulin pump system. Patients preferred Omnipod as an insulin management system and especially the patch delivery system but preferred the A7+TouchCare personal diabetes manager to control the system.ConclusionsThis study showed that the A7+TouchCare insulin pump was as efficient as the Omnipod pump in terms of performance and satisfaction.Clinical trail registrationThe study was registered in the ClinicalTrials.gov protocol register (NCT04223973)

Association between sleep disturbances, fear of hypoglycemia and psychological well-being in adults with type 1 diabetes mellitus, data from cross-sectional VARDIA study

International audienceAim: To assess the relationship between sleep quality, fear of hypoglycemia, glycemic variability and psychological well-being in type 1 diabetes mellitus.Methods: Our data were provided by the VARDIA Study, a multicentric cross-sectional study conducted between June and December 2015. Sleep characteristics were assessed by the Pittsburgh Sleep Quality Index (PSQI). Fear of hypoglycemia and psychological well-being were measured with the Hypoglycemia Fear Survey version II (HFS-II) and the Hospital Anxiety and Depression Scale (HADS), respectively. Glycemic variability (GV) was determined using the CV of three 7-point self-monitoring blood glucose profiles and the mean amplitude of glycemic excursion (MAGE).Results: 315 patients were eligible for PSQI questionnaire analysis: 54% women, mean age 47 ± 15, mean diabetes duration of 24 ± 13 years, HbA1c of 7.6 ± 0.9% (60 ± 7,5mmol/mol). Average PSQI score was 6.0 ± 3.3 and 59.8% of the patients had a PSQI score > 5. HFS-II score and HADS were significantly higher among "poor" sleepers (p < 0.0001) and PSQI score was positively associated with HADS (β = 0.22; 95% CI = 0.08;0.35). GV evaluated by CV or MAGE did not differ between "poor" and "good" sleepers (p = 0.28 and 0.54, respectively).Conclusions: Adult patients with type 1 diabetes have sleep disturbances which correlate with psychological well-being. This study suggests that psychological management can be a target to improve sleep quality in adults with type 1 diabetes mellitus