Normative Values for Electrochemical Skin Conductances and Impact of Ethnicity on Quantitative Assessment of Sudomotor Function

Background: Sudomotor dysfunction is one of the earliest pathophysiologic abnormalities in diabetes. Sudoscan? (Impeto Medical, Paris, France) was developed as a noninvasive, rapid, and quantitative assessment of sudomotor function and has been shown to be sensitive in the detection of neuropathy. This global collaborative analysis aimed to establish reference values in healthy subjects of different ethnic groups, age, and gender, to define factors potentially affecting results, and to provide standardization of the methodology. Materials and Methods: Data from 1,350 generally healthy study participants who underwent sudomotor function testing were collected and analyzed. The relationship between age, height, weight, gender, glycemic and lipid profiles, ethnicity, and hand and foot electrochemical skin conductance (ESC) was assessed among subgroups of participants. Results: Lower mean hands and feet ESC values were observed in African American, Indian, and Chinese subjects (P?Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/140359/1/dia.2015.0396.pd

Efficacité à 5 ans de la prise en charge des patients présentant un syndrome métabolique

Introduction : Le syndrome métabolique (Met S) devient un véritable challenge pour nos sociétés. Avec l augmentation de la prévalence de l'obésité et le vieillissement de la population, sa prévalence devrait exploser dans les prochaines décennies entrainant une augmentation secondaire des cas de diabète de type 2 et de maladies cardiovasculaires. Matériel et méthodes : EPIMIL (étude épidémiologique du syndrome métabolique en milieu militaire) est une étude épidémiologique prospective débutée en 2003, portant sur une population de 2045 militaires de sexe masculin. Le but de l'étude est de déterminer si les militaires sont, au même titre que la population française, touchés par l accroissement de la prévalence du syndrome métabolique. La base de données à 5 ans a été utilisée afin d évaluer l'efficacité de la prise en charge des patients atteints du syndrome métabolique. Résultats : la prévalence du Met S est relativement stable après 5 ans (6.8% en 2003 et 5.5% en 2008). Alors que l'incidence du Met S progressait de 4.5% en 5 ans chez les patients initialement indemnes, la prévalence diminuait de plus de 80% dans le groupe initialement atteint. La prise en charge des patients a permis une amélioration significative de la glycémie (- 0.79 +- 1.84 mmol/l, p<0.002), du taux d'HDL (+0.14 +- 0.35 mmol/l, p<0.05) et de la pression artérielle diastolique (- 4.53 +- 12.55 mmHg, p<0.05). L'amélioration des autres paramètres n'atteint pas le seuil de significativité. Conclusion : la prise en charge par le médecin traitant renforcée par l intervention d'une diététicienne permet la stabilisation voire l amélioration de la plupart des paramètres du Met S, quand ceux-ci ont tendance à se dégrader chez les patients non pris en charge. Toute la difficulté réside dans le maintien de ces nouvelles habitudes de vie à long terme.Context : The metabolic syndrome becomes a real challenge for our societies. With the increase of prevalency of the obesity and the ageing of the population, its prevalency should explode in the next decades, consequently the cases of type 2 diabetes and the cardiovascular diseases will increase too. Material and methods: EPIMIL (epidemiological study of the metabolic syndrome in military environment) is a forward-looking epidemiological study begun in 2003, concerning a population of 2045 male servicemen. The purpose of the study is to determine if the servicemen are, in the same way as the French population, affected by the increase of prevalency of the metabolic syndrome. The 5 years' database was used to estimate the efficiency of the care of the patients affected by the metabolic syndrome. Results : prevalency of Met S is relatively stable after 5 years (6.8 % in 2003 and 5.5 % in 2008). While the incidence of Met S progressed of 4.5 % in 5 years at the initially unhurt patients, prevalency decreased in more than 80 % in the group initially affected. The care of the patients allowed a significant improvement of the glycemia (-0.79 +- 1.84 mmol / l, p < 0.002), of the rate of HDL (0.14 +- 0.35 mmol / l, p < 0.05) and of the diastolic blood pressure (-4.53 +- 12.55 mmHg, p < 0.05). The improvements of the other parameters are not significant. Conclusion: The advice given by family doctor and a dietitian allows the stabilization even the improvement of most of the parameters of Met S, when these tend to degrade at the not taken care patient's. All the difficulty lives in the preservation of these new habits of long-term life.PARIS12-CRETEIL BU Médecine (940282101) / SudocPARIS-Bib. Serv.Santé Armées (751055204) / SudocSudocFranceF

Potential Budgetary Impact of Large Scale Screening of Small Fiber Neuropathy in the Follow-Up of Patients with Type 2 Diabetes in France

Aims: The burden of diabetes-related complications is important and increasing in France. Early screening of microvascular complications could avoid the occurrence of more severe consequences. An economic model using a 5-year time horizon was developed to estimate the potential impact in France of large screening of diabetic autonomic neuropathy using Sudoscan, a quick, non-invasive and quantitative method developed for screening of small fiber neuropathy. Methods: A disease progression model was first developed to describe the long-term evolution of patients with type 2 diabetes regarding microvascular complications over successive time periods and patients were classified in 4 groups according to the severity. Complication-related costs were then calculated for a cohort of patients treated according to the current pattern of care and compared with the costs incurred by the same cohort assuming the introduction and widespread use of a large screening of small fiber neuropathy using the Sudoscan method. Comparison of treatment costs between the two situations was used to evaluate the potential budget impact of such a prevention policy in France. Results: According to this general screening of early complications more than 25,000 patients could avoid more severe complications. The gross benefit of such a new prevention strategy would be around € 280 million at 5th year. After 5 years of follow-up, the cumulated gross benefit would be € 837 million and in the worst case scenario (decrease of 20% for each uncertain parameter, namely the distribution of patients among severity groups, the death rates in each severity group, and the distribution of newly diagnosed patients in each severity group) gross benefit would remain at more than € 50 million for the first year and more than € 255 million at the 5th year (using 6% as global efficacy of screening method as basal value). Conclusion: Large screening of small fiber neuropathy could avoid more severe peripheral neuropathy and consequently decrease the burden related to such complications for a limited investment.nonouirechercheInternationa

Predicting factors of hypoglycaemia in elderly type 2 diabetes patients: Contributions of the GERODIAB study

The burden of hypoglycaemia is important, particularly in elderly type 2 diabetes (T2D) patients. Unfortunately, however, few studies are available concerning this population. GERODIAB is a prospective, multicentre, observational study that aims to describe the 5-year morbidity and mortality of 987 T2D patients aged 70 years and older. After analyzing the frequency of and factors associated with hypoglycaemia in the 6 months prior to study inclusion, it was found that hypoglycaemia was associated with retinopathy, lower levels of LDL cholesterol and altered mini-Geriatric Depression Scale (GDS) scores

Differential prognostic burden of cardiovascular disease and lower-limb amputation on the risk of all-cause death in people with long-standing type 1 diabetes

BACKGROUND: Cardiovascular disease (CVD) and nontraumatic lower-limb amputation (LLA) each results in reduced life expectancy in patients with type 1 diabetes, but the differential burden between these conditions is unknown. We compared the effects of CVD and LLA on the risk of mortality in people with type 1 diabetes. METHODS: We used pooled data from the SURGENE, GENEDIAB, and GENESIS prospective cohorts. Data were divided into: 1/absence of CVD (myocardial infarction and/or stroke) nor LLA, 2/history of CVD alone without LLA, 3/LLA alone without CVD or 4/both conditions at baseline. Participants with baseline history of peripheral artery disease were excluded from groups 1 and 2. The study endpoint was any death occurring during follow-up, regardless of the causes. RESULTS: Among 1169 participants (male 55%, age 40 ± 13 years, diabetes duration 23 ± 11 years), CVD, LLA or both were present at baseline in 49 (4.2%), 62 (5.3%) and 20 (1.7%) subjects, respectively. All-cause death occurred in 304 (26%) participants during 17-year follow-up, corresponding to 18,426 person-years and an incidence rate of 16 (95%CI, 15-18) per 1000 person-years. The risk of death increased in individuals with baseline history of CVD (adjusted HR 2.00 [95% CI 1.34-3.01], p = 0.0008) or LLA (2.26 [1.56-3.28], p < 0.0001), versus no condition, with an additive effect in people with both conditions (5.32 [3.14-9.00], p < 0.0001). No incremental risk of death was observed in people with CVD versus LLA (0.87 [0.54-1.41]). Compared with no condition, CVD and LLA were similarly associated with reduced life expectancy during follow-up: 2.79 (95% CI 1.26-4.32) and 3.38 (1.87-4.88) years, respectively. Combined conditions expose to 7.04 (4.76-9.31) less years of life expectancy (all p < 0.0001). CONCLUSIONS: CVD and LLA conferred a similar burden regarding mortality in type 1 diabetes population. Our findings encourage a careful consideration of people with type 1 diabetes and LLA as usually recommended for those with CVD, in terms of management of risk factors, treatments and prevention

Impact of diabetes on COVID-19 prognosis beyond comorbidity burden: the CORONADO initiative

International audienceAims/hypothesis: Diabetes has been recognised as a pejorative prognostic factor in coronavirus disease 2019 (COVID-19). Since diabetes is typically a disease of advanced age, it remains unclear whether diabetes remains a COVID-19 risk factor beyond advanced age and associated comorbidities. We designed a cohort study that considered age and comorbidities to address this question.Methods: The Coronavirus SARS-CoV-2 and Diabetes Outcomes (CORONADO) initiative is a French, multicentric, cohort study of individuals with (exposed) and without diabetes (non-exposed) admitted to hospital with COVID-19, with a 1:1 matching on sex, age (±5 years), centre and admission date (10 March 2020 to 10 April 2020). Comorbidity burden was assessed by calculating the updated Charlson comorbidity index (uCCi). A predefined composite primary endpoint combining death and/or invasive mechanical ventilation (IMV), as well as these two components separately, was assessed within 7 and 28 days following hospital admission. We performed multivariable analyses to compare clinical outcomes between patients with and without diabetes.Results: A total of 2210 pairs of participants (diabetes/no-diabetes) were matched on age (mean±SD 69.4±13.2/69.5±13.2 years) and sex (36.3% women). The uCCi was higher in individuals with diabetes. In unadjusted analysis, the primary composite endpoint occurred more frequently in the diabetes group by day 7 (29.0% vs 21.6% in the no-diabetes group; HR 1.43 [95% CI 1.19, 1.72], p<0.001). After multiple adjustments for age, BMI, uCCi, clinical (time between onset of COVID-19 symptoms and dyspnoea) and biological variables (eGFR, aspartate aminotransferase, white cell count, platelet count, C-reactive protein) on admission to hospital, diabetes remained associated with a higher risk of primary composite endpoint within 7 days (adjusted HR 1.42 [95% CI 1.17, 1.72], p<0.001) and 28 days (adjusted HR 1.30 [95% CI 1.09, 1.55], p=0.003), compared with individuals without diabetes. Using the same adjustment model, diabetes was associated with the risk of IMV, but not with risk of death, within 28 days of admission to hospital.Conclusions/interpretation: Our results demonstrate that diabetes status was associated with a deleterious COVID-19 prognosis irrespective of age and comorbidity status.Trial registration: ClinicalTrials.gov NCT04324736