Increased glycemic variability and decrease of the postprandial glucose contribution to HbA1c in obese subjects across the glycemic continuum from normal glycemia to first time diagnosed diabetes.

International audienceObjective. The contribution of postprandial glycemia (PPG) to hyperglycemia has been shown to decrease as HbA1c increased in type 2 diabetic patients. This study aimed at examining, in a series of overweight/obese patients without known glycemic disorder, the contribution of PPG to a "relative" hyperglycemia (glucose values >= 5.5 mmol/L) and the presence of glycemic variability according to HbA1c levels. Methods. Seventy overweight/obese inpatients (body mass index 35.2 +/- 6.8 kg/m(2)) without known glycemic disorder were included. Participants were classified according to an oral glucose tolerance test (according to the American Diabetes Association criteria) as patients with normoglycemia (n = 33), with intermediate hyperglycemia (n = 24) or diabetes (n = 13). They were separated into HbA1c quartiles (Q1 to Q4). A 24 hour continuous glucose monitoring was used under a 1800 kcal diet and minimal physical activity. We assessed PPG contribution (3 hour period after each meal) to the "relative" 24 hour hyperglycemia (glucose values >= 5.5 mmol/L); the remaining time was considered as the fasting/post-absorptive period. Results. HbA1c range was from 5.1% to 7.4% (32 to 57 mmol/mmol). From the lowest to the highest HbA1c quartile, the area under the curve (AUC) for the "relative" hyperglycemia presented a 17-fold increase for the fasting/post-absorptive (p < 0.001) period and a 7-fold increase postprandially (p < 0.001). The percent of PPG contribution to the "relative" hyperglycemia was calculated with the following formula [100 x (postprandial 3 hour AUC - 3 h AUC for a constant 5.5 mmol/L glycemia)/(total 24 h AUC - 24 h AUC for constant 5.5 mmol/L glycemia)] and decreased from Q1 to Q4 of HbA1c (81.2%, 66%, 65.8%, 57%; p < 0.001). Increasing HbA1c quartiles were associated with higher daily mean blood glucose level (p < 0.001) and higher levels of daily glucose variability indices, including mean amplitude of glycemic excursions (p < 0.01). Conclusions. In overweight/obese patients, HbA1c was associated with lower PPG contribution to "relative" hyperglycemia and greater glycemic variability. The present findings support the importance of postprandial period in glycemic exposure even before the appearance of diabetes. (C) 2014 Elsevier Inc. All rights reserved

Evidence for a specific diabetic cardiomyopathy: an observational retrospective echocardiographic study in 656 asymptomatic type 2 diabetic patients

International audienceAim. Our aim was to assess the prevalence of subclinical diabetic cardiomyopathy, occurring among diabetic patients without hypertension or coronary artery disease (CAD). Methods. 656 asymptomatic patients with type 2 diabetes for 14 +/- 8 years (359 men, 59.7 +/- 8.7 years old, HbA1c 8.7 +/- 2.1%) and at least one cardiovascular risk factor had a cardiac echography at rest, a stress cardiac scintigraphy to screen for silent myocardial ischemia (SMI), and, in case of SMI, a coronary angiography to screen for silent CAD. Results. SMI was diagnosed in 206 patients, and 71 of them had CAD. In the 157 patients without hypertension or CAD, left ventricular hypertrophy (LVH: 24.1%) was the most frequent abnormality, followed by left ventricular dilation (8.6%), hypokinesia (5.3%), and systolic dysfunction (3.8%). SMI was independently associated with hypokinesia (odds ratio 14.7 [2.7-81.7], p < 0.01) and systolic dysfunction (OR 114.6 [1.7-7907], p < 0.01), while HbA1c (OR 1.9 [1.1-3.2], p < 0.05) and body mass index (OR 1.6 [1.1-2.4], p < 0.05) were associated with systolic dysfunction. LVH was more prevalent among hypertensive patients and hypokinesia in the patients with CAD. Conclusion. In asymptomatic type 2 diabetic patients, diabetic cardiomyopathy is highly prevalent and is predominantly characterized by LVH. SMI, obesity, and poor glycemic control contribute to structural and functional LV abnormalities

Glycation Gap Is Associated With Macroproteinuria but Not With Other Complications in Patients With Type 2 Diabetes

International audienceOBJECTIVE-We investigated whether glycation gap (G-Gap), an index of intracellular glycation of proteins, was associated with diabetes complications. RESEARCH DESIGN AND METHODS-We measured concomitantly HbA(1c) and fructosamine in 925 patients with type 2 diabetes to calculate the G-Gap, defined as the difference between measured HbA(1c), and fructosamine-based predicted HbA(1c). Patients were explored for retinopathy, nephropathy, peripheral neuropathy, cardiac autonomic neuropathy (n =512), and silent myocardial ischemia (n = 506). RESULTS-Macroproteinuria was the only complication that was associated with G-Gap (prevalence in the first, second, and third tertile of G-Gap: 2.9, 6.2, and 11.0%, respectively; P < 0.001). The G-Gap was higher in patients with macroproteinuria than in those without (1.06 +/- 1.62 vs. 0.03 +/- 1.30%; P < 0.0001). Because HbAi, was associated with both G-Gap (HbA(1c) 7.0 +/- 1.4, 7.9 +/- 1.4, and 10.1 +/- 1.8% in the first, second, and third G-Gap tertile, respectively; P < 0.0001) and macroproteinuria (HbA(1c) 8.8 +/- 2.2% if macroproteinuria, 8.3 +/- 2.0% if none; P < 0.05), and because it could have been a confounder, we matched 54 patients with macroproteinuria and 200 patients without for HbA(1c). Because macroproteinuria was associated with lower serum albumin and fructosamine levels, which might account for higher G-Gap, we calculated in this subpopulation albumin-indexed fructosamine and G-Gap; macroproteinuria was independently associated with male sex (odds ratio [OR] 3.2 [95% CI 1.5-6.7]; P < 0.01), hypertension (2.9 [1.1-7.5]; P < 0.05), and the third tertile of albumin-indexed G-Gap (2.3 [1.1-4.4]; P < 0.05) in multivariate analysis. CONCLUSIONS-In type 2 diabetic patients, G-Gap was associated with macroproteinuria, independently of HbA(1c), albumin levels, and confounding factors, suggesting a specific role of intracellular glycation susceptibility on kidney glomerular changes

Poor reliability and poor adherence to self-monitoring of blood glucose are common in women with gestational diabetes mellitus and may be associated with poor pregnancy outcomes

International audienceOBJECTIVETo evaluate the compliance with self-monitoring of blood glucose (SMBG) and the reliability of diabetes logbooks in women with gestational diabetes mellitus (GDM), as well as the associated determinants and outcomes.RESEARCH DESIGN AND METHODSWe prospectively selected French-speaking women with newly diagnosed GDM who had been referred to our diabetes management program and understood SMBG principles. At the next follow-up visit, we collected SMBG results from glucose meters and logbooks. We analyzed pregnancy outcomes.RESULTSData were analyzed over 13 3 days in 91 women. Only 61.5% had performed 80% of the required tests. Poor compliance was associated with a family history of diabetes, social deprivation, and non-European origin. The average time between pre- and postprandial tests was 141 +/- 20 min, with 46.5% of women performing 80% of postprandial measurements 100-140 min after meals. Inadequate timing was associated with ethnicity and higher HbA(1c) at baseline. A total of 23.1% of women had <90% matched values in diary and meter memory, and a poor concordance was associated with a family history of diabetes. Poor adherence was associated with more preeclampsia (12.2 vs. 1.9%, P = 0.049), and inadequate postprandial test timing with a higher HbA(1c) at delivery (5.3 +/- 0.4 vs. 5.0 +/- 0.3% [34 +/- 2 vs. 31 +/- 2 mmol/mol], P < 0.01), despite more frequent insulin therapy.CONCLUSIONSAlthough women with GDM are considered to be highly motivated, SMBG adherence and reliability are of concern and may be associated with poor gestational prognosis, suggesting that caregivers should systematically check the glucose meter memory to improve GDM management

Impact of gastric electrical stimulation on economic burden of refractory vomiting: a French nationwide multicentre study

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Additional file 2: Figure S1. of Longitudinal immune profiles in type 1 leprosy reactions in Bangladesh, Brazil, Ethiopia and Nepal

IFN-γ in response to M.leprae-unique protein ML2478 in 6 day cultures of PBMC (see Figure 3). Simultaneously, PBMC were cultured with proteins: ML0009, ML0121, ML0141, ML0188, ML1601, ML1976, ML1989, ML1990, ML2283, ML2478, ML2531, ML2532 and ML2567 (data not shown). Figure S2. IP-10 (A), TNF (B), IL-17 (C), VEGF (D) , IL1-β (E) and G-CSF (F) production in same cultures as described in Figure S1. Figure S3. IP-10 and IL-17 (A) after stimulation with M. leprae. IP-10/ IL-10 and IL-17/ IL-10 ratios are indicated (B, C). ROC curves were calculated for IP-10/ IL-10 and IL-17 /IL-10. Ratios for patients without reactions are shown as controls (D). Figure S4. IP-10 (A), IFN-β (B) and CCL18 (C) in sera. Figure S5. Antibodies against M.leprae protein ML2028 in sera determined by ELISA. Optical density readings were performed using a 1:200 dilution. Median values are indicated by horizontal lines. Figure S6. IFN-β in sera derived from patients developing RR in the absence of clinical signs of reactions and at least three months before reaction (before RR), at diagnosis of reaction before steroids (RR) or after MDT and RR, at least one month after end of steroids (after RR). For ROC values, timepoints at least three months before RR and at RR diagnosis before steroids were considered. IFN-β levels for controls were not detectable. (DOCX 260 kb

Longitudinal immune profiles in type 1 leprosy reactions in Bangladesh, Brazil, Ethiopia and Nepal

Immunogenetics and cellular immunology of bacterial infectious disease