101 research outputs found
Morning hyperglycemic excursions. A constant failure in the metabolic control of non-insulin-using patients with type 2 diabetes
WSTÄP. Celem pracy byĆo ustalenie wystÄpowania w ciÄ
gu dnia epizodĂłw hiperglikemii prowadzÄ
cych do zĆej kontroli metabolicznej u chorych na cukrzycÄ typu 2.
MATERIAĆ I METODY. Badana grupa liczyĆa 200 chorych na cukrzycÄ typu 2 leczonych lekami doustnymi i/lub dietÄ
. W populacji tej badano profile dobowe glikemii i insulinemii. PomiarĂłw stÄĆŒenia glukozy dokonywano na czczo bezpoĆrednio przed Ćniadaniem o 8.00 rano, nastÄpnie w okresie poposiĆkowym o godz. 11.00 i 14.00) oraz w okresie poabsorpcyjnym o 17.00.
WYNIKI. W caĆej populacji wartoĆci glikemii przed obiadem (12,0 mmol/l) byĆy znamiennie podwyĆŒszone (p < 0,0001) w porĂłwnaniu z glikemiÄ
mierzonÄ
o godzinie 8.00 (8,8 mmol/l), 14.00 (10,5 mmol/l) i 17.00 (8,6 mmol/l). Podobny wzrost glikemii przedobiedniej (p < 0,0001) obserwowano w grupach chorych dobranych wedĆug kryteriĂłw: 1) masy ciaĆa; 2) wieku; 3) HbA1c; 4) sposobu leczenia;
5) rezydualnej funkcji komĂłrek b. Z obliczeĆ pĂłl
pod krzywÄ
dziennego przebiegu glikemii wynika, ĆŒe w caĆkowitym podwyĆŒszeniu stÄĆŒenia glukozy w surowicy wzglÄdny udziaĆ glikemii na czczo i poposiĆkowej
jest zbliĆŒony.
WNIOSKI. Wysokie stÄĆŒenia glukozy w surowicy w okresie przedpoĆudniowym sÄ
doĆÄ charakterystycznym wykĆadnikiem niepowodzenia leczenia cukrzycy typu 2 z zastosowaniem diety i lekĂłw doustnych. Hiperglikemie przedobiednie wystÄpujÄ
niezaleĆŒnie od cech klinicznych (wskaĆșnik masy ciaĆa [BMI, body mass index]), biologicznych (hemoglobina glikowana[HbA1c]), terapeutycznych i patofizjologicznych (rezydualna funkcja komĂłrek b). W celu
wykrycia takich zaburzeĆ powinno siÄ zalecaÄ dodatkowe pomiary glikemii przed obiadem. PrzedpoĆudniowe hiperglikemie wymagajÄ
zmiany w leczeniu chorego.INTRODUCTION. To determine whether, over daytime,
one or several hyperglycemic excursions exist
that can be general failures in the glycemic control
of patients with type 2 diabetes.
MATERIAL AND METHODS. In 200 non-insulin-using
patients with type 2 diabetes, diurnal plasma glucose
and insulin profiles were studied. Plasma glucose
concentrations were measured after an overnight
fast (at 8:00 A.M. immediately before breakfast),
during the postprandial period (at 11:00 A.M. and 2:00 P.M.), and during the postabsorptive period (at
5:00 P.M., extended postlunch time).
RESULTS. In the population considered as a whole,
prelunch glucose concentrations (12.0 mmol/l) were
found to be significantly increased (P < 0.0001)
when compared with those observed at 8:00 A.M.
(8.8 mmol/l), at 2:00 P.M. (10.5 mmol/l), and at 5:00
P.M. (8.6 mmol/l). Similar significant excursions (P <
< 0.0001) in prelunch glucose were observed within
subsets of patients selected from the following criteria:
1) body weight; 2) HbA1c; 3) categories of treatment
and 4) residual β-cell function. From the calculation
of areas under the daytime glucose curves,
the relative contributions of postprandial and fasting
glucose to the total glucose increment were found
to be similar.
CONCLUSIONS. High plasma glucose excursions over
morning periods seem to be a permanent failure in
non–insulin-using patients with type 2 diabetes, whatever
the clinical (BMI), biological (HbA1c), therapeutic,
and pathophysiological (residual β-cell function)
status. Midmorning glucose testing should be recommended
for detecting such abnormalities and for
correcting them with appropriate therapies
Triglycerides and glycated hemoglobin for screening insulin resistance in obese patients
International audienceOBJECTIVE: Assessment of insulin resistance (IR) is essential in non-diabetic patients with obesity. Thus study aims to identify the best determinants of IR and to propose an original approach for routine assessment of IR in obesity. DESIGN AND PATIENTS: All adult with obesity defined by a body mass index >=30kg/m2, evaluated in the Nutrition Department between January 2010 and January 2015 were included in this cross-sectional study. Patients with diabetes were excluded. IR was diagnosed according to the HOMA-IR. Based on a logistic regression, we determined a composite score of IR. We then tested the variables with a principal component analysis and a hierarchical clustering analysis. RESULTS: A total of 498 patients with obesity were included. IR was associated with grade III obesity (OR=2.6[1.6-4.4], p\textless0.001), HbA1c>=5.7% (OR=2.6[1.7-4.0], p\textless0.001), hypertriglyceridemia \textgreater1.7mmol/l (OR=3.0[2.0-4.5], p\textless0.001) and age (OR=0.98[0.96-0.99], p=0.002). Exploratory visual analysis using factor map and clustering analysis revealed that lipid and carbohydrates metabolism abnormalities were correlated with insulin resistance but not with excessive fat accumulation and low-grade inflammation. CONCLUSIONS: Our results highlight the interest of simple blood tests such as HbA1c and triglyceride determination, which associated with BMI, may be widely available tools for screening IR in obese patients
Comparison of HbA1c detection in whole blood and dried blood spots using an automated ion-exchange HPLC system
International audienceAIM: Hemoglobin A1c (HbA1c) is a widely recognized analyte for diagnosing and monitoring diabetes. Dried blood spot (DBS) constitutes a useful alternative to blood collection by venipuncture. Analytical and clinical validation of DBS use is, however, necessary before implementation.Results/methodology: HbA1c levels from whole blood or DBS from a cohort patients with diabetes were compared. DBS specimens were stable at ambient temperature. HbA1c detection on DBS was accurate, robust, and the correlation and agreement with whole blood values was excellent.CONCLUSION: this study provides for the first time a complete method comparison and validation under the ISO15189 guideline using an automated HPLC system. This approach constitutes, therefore, a useful tool for diagnosing diabetes
Systems medicine and integrated care to combat chronic noncommunicable diseases
We propose an innovative, integrated, cost-effective health system to combat major non-communicable diseases (NCDs), including cardiovascular, chronic respiratory, metabolic, rheumatologic and neurologic disorders and cancers, which together are the predominant health problem of the 21st century. This proposed holistic strategy involves comprehensive patient-centered integrated care and multi-scale, multi-modal and multi-level systems approaches to tackle NCDs as a common group of diseases. Rather than studying each disease individually, it will take into account their intertwined gene-environment, socio-economic interactions and co-morbidities that lead to individual-specific complex phenotypes. It will implement a road map for predictive, preventive, personalized and participatory (P4) medicine based on a robust and extensive knowledge management infrastructure that contains individual patient information. It will be supported by strategic partnerships involving all stakeholders, including general practitioners associated with patient-centered care. This systems medicine strategy, which will take a holistic approach to disease, is designed to allow the results to be used globally, taking into account the needs and specificities of local economies and health systems
Effets sur la santé des alimentations végétariennes (données bibliographiques)
MONTPELLIER-BU MĂ©decine UPM (341722108) / SudocMONTPELLIER-BU MĂ©decine (341722104) / SudocPARIS-BIUM (751062103) / SudocSudocFranceF
Ăvaluation Ă 6,5 ans de la prise en charge des plaies du pied diabĂ©tique (suivi d'une cohorte de 94 patients)
MONTPELLIER-BU MĂ©decine UPM (341722108) / SudocPARIS-BIUM (751062103) / SudocMONTPELLIER-BU MĂ©decine (341722104) / SudocSudocFranceF
Facteurs prédictifs d'ischémie myocardique silencieuse et de sténoses coronaires dans une population de diabétiques asymptomatiques à haut risque vasculaire
MONTPELLIER-BU MĂ©decine UPM (341722108) / SudocPARIS-BIUM (751062103) / SudocMONTPELLIER-BU MĂ©decine (341722104) / SudocSudocFranceF
Analyse critique des enquĂȘtes alimentaires
MONTPELLIER-BU MĂ©decine (341722104) / SudocMONTPELLIER-BU MĂ©decine UPM (341722108) / SudocPARIS-BIUM (751062103) / SudocSudocFranceF
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