Is there an optimal strategy for real-time continuous glucose monitoring in pediatrics? A 12-month French multi-center, prospective, controlled randomized trial (Start-In!)

AIM: To compare the efficacy of three strategies for real-time continuous glucose monitoring (RT-CGM) over 12 months in children and adolescents with type 1 diabetes. METHODS: A French multicenter trial (NCT00949221) with a randomized, controlled, prospective, open, and parallel-group design was conducted. After 3 months of RT-CGM, patients were allocated to one of three groups: return to self-monitoring of blood glucose, continuous CGM (80% of the time), or discontinuous CGM (40% of the time). The primary outcome was hemoglobin A1c (HbA1c) levels from 3 to 12 months. The secondary outcomes were acute metabolic events, hypoglycemia, satisfaction with CGM and cost. RESULTS: We included 151 subjects, aged 2 to 17 years, with a mean HbA1c level of 8.5% (SD0.7; 69 mmol/mol). The longitudinal change in HbA1c levels was similar in all three groups, at 3, 6, 9 and 12 months. The medical secondary endpoints did not differ between groups. The rate of severe hypoglycemia was significantly lower than that for the pretreatment year for the entire study population. Subjects reported consistent use and good tolerance of the device, regardless of age or insulin treatment. The use of full-time RT-CGM for 3 months costs the national medical insurance system €2629 per patient. CONCLUSION: None of the three long-term RT-CGM strategies evaluated in pediatric type 1 diabetes was superior to the others in terms of HbA1c levels. CGM-use for 3 months decreased rates of severe hypoglycemia. Our results confirm the feasibility of long-term RT-CGM-use and the need to improve educational support for patients and caregivers

Farm Area Segmentation in Satellite Images Using DeepLabv3+ Neural Networks

Farm detection using low resolution satellite images is an important part of digital agriculture applications such as crop yield monitoring. However, it has not received enough attention compared to high-resolution images. Although high resolution images are more efficient for detection of land cover components, the analysis of low-resolution images are yet important due to the low-resolution repositories of the past satellite images used for timeseries analysis, free availability and economic concerns. In this paper, semantic segmentation of farm areas is addressed using low resolution satellite images. The segmentation is performed in two stages; First, local patches or Regions of Interest (ROI) that include farm areas are detected. Next, deep semantic segmentation strategies are employed to detect the farm pixels. For patch classification, two previously developed local patch classification strategies are employed; a two-step semi-supervised methodology using hand-crafted features and Support Vector Machine (SVM) modelling and transfer learning using the pretrained Convolutional Neural Networks (CNNs). For the latter, the high-level features learnt from the massive filter banks of deep Visual Geometry Group Network (VGG-16) are utilized. After classifying the image patches that contain farm areas, the DeepLabv3+ model is used for semantic segmentation of farm pixels. Four different pretrained networks, resnet18, resnet50, resnet101 and mobilenetv2, are used to transfer their learnt features for the new farm segmentation problem. The first step results show the superiority of the transfer learning compared to hand-crafted features for classification of patches. The second step results show that the model trained based on resnet50 achieved the highest semantic segmentation accuracy.acceptedVersionPeer reviewe

Molecular analysis of WNT4 gene in four adolescent girls with mullerian duct abnormality and hyperandrogenism (atypical Mayer-Rokitansky-Küster-Hauser syndrome)

In a collaborative study, we investigated four 46,XX adolescent girls with Mayer-Rokitansky-Küster-Hauser syndrome and hyperandrogenism. Molecular analysis of the WNT4 gene permitted us to identify a new mutation (p.A233T). Functional studies revealed partial repression of steroidogenic enzymes (normal repression of HSD3B2) contrasting with the abnormal reexpression of CYP17A1 enzyme in the OVCAR3 cell line. This fourth new WNT4 mutation confirms that this signaling molecule is involved in mullerian development and androgen biosynthesis repression in the ovary. Interestingly, this mutant partially lacks the capability to repress ovarian steroidogenic enzymes, with abnormal expression of 17α- hydroxylase

Which characteristics and circumstances of exercise do expose to hypo/hyperglycaemic risk and glycaemic variability in children and adolescents with type 1 diabetes: a daily life observational study controlling for confounding impact of food intake and insulin administration

International audienc

Les freins à l’activité physique chez les enfants et adultes avec un diabète de type 1 : Quels liens réels avec les excursions glycémiques lors de l’activité physique ?

International audienceLes freins à l’activité physique chez les enfants et adultes avec un diabète de type 1 : Quels liens réels avec les excursions glycémiques lors de l’activité physique ? Parent C, Lespagnol E, Berthoin S, Tagougui S, Heyman J, Stuckens C, Gueorguieva I, Balestra C, Tonoli C, Kozon B, Weill J, Fontaine P, Savina Y, Rabasa-Lhoret R, Heyman E.Contexte – Les personnes ayant un diabète de type 1 (DT1) présentent des freins à la pratique d’une activité physique (AP) comme la peur de l’hypoglycémie ou la perte de contrôle de leur diabète [1,2]. Cependant, aucune étude n’a vérifié l’association entre ces freins et les mesures objectives du profil glycémique lors de l’AP au quotidien. Méthodes – Chez vingt-six enfants/adolescents DT1 (6-17ans) et leurs parents et 26 adultes DT1, nous avons exploré (régressions linéaires multiples) le lien entre les excursions hypo/hyperglycémiques (et la variabilité glycémique) pendant et après les sessions d’AP déclarées par les participants (mesurées par capteurs de glucose en continu) avec les freins à l’AP (questionnaire BAPAD-1, variable dépendante), en tenant compte du niveau hebdomadaire d’AP (accélérométrie). Résultats – La peur de l’hypoglycémie est le frein principal à l’AP dans tous les sous-groupes. Chez les adultes, aucun lien entre excursions glycémiques et freins à l’AP n’apparaît. Les enfants/adolescents qui déclarent davantage l’hypoglycémie comme un frein à l’AP sont les plus actifs (ß=0,071;P=0,002). Les parents des enfants/adolescents les moins sédentaires jugent davantage le risque hypoglycémique comme un frein à l’AP (ß =–0,009;P=0,006). Plus les enfants/adolescents passent du temps en hypoglycémie (<70mg.dL-1) les nuits suivant l’AP, plus ils déclarent le risque hypoglycémique comme un frein (ß=0,183;P=0,034). De même, plus la proportion de sessions d’AP s’accompagnant d’une baisse de glycémie (vs. stagnation ou augmentation) est élevée, plus l’hypoglycémie est un frein pour leurs parents (ß=0,055;P=0,042). Conclusion – Plus les enfants/adolescents DT1 sont actifs (ou moins sédentaires), plus ils (ou leurs parents) s’aperçoivent du risque hypoglycémique à l’exercice et le craignent. Chez ces jeunes et leurs parents, et non chez les adultes DT1, la peur de l’hypoglycémie s’avère réellement associée à la baisse de glycémie à l’exercice et au risque d’hypoglycémies nocturnes s’ensuivant. Ceci montre l’importance de trouver des solutions pour limiter ces hypoglycémies. Références :1.Brazeau, A. S.; Rabasa-Lhoret, R.; Strychar, I.; Mircescu, H., Barriers to physical activity among patients with type 1 diabetes. Diabetes Care 2008, 31 (11), 2108-9.2.Jabbour, G.; Henderson, M.; Mathieu, M. E., Barriers to Active Lifestyles in Children with Type 1 Diabetes. Can J Diabetes 2016, 40 (2), 170-2