Day and night closed-loop control in adults with type 1 diabetes: a comparison of two closed-loop algorithms driving continuous subcutaneous insulin infusion versus patient self-management.

OBJECTIVE: To compare two validated closed-loop (CL) algorithms versus patient self-control with CSII in terms of glycemic control. RESEARCH DESIGN AND METHODS: This study was a multicenter, randomized, three-way crossover, open-label trial in 48 patients with type 1 diabetes mellitus for at least 6 months, treated with continuous subcutaneous insulin infusion. Blood glucose was controlled for 23 h by the algorithm of the Universities of Pavia and Padova with a Safety Supervision Module developed at the Universities of Virginia and California at Santa Barbara (international artificial pancreas [iAP]), by the algorithm of University of Cambridge (CAM), or by patients themselves in open loop (OL) during three hospital admissions including meals and exercise. The main analysis was on an intention-to-treat basis. Main outcome measures included time spent in target (glucose levels between 3.9 and 8.0 mmol/L or between 3.9 and 10.0 mmol/L after meals). RESULTS: Time spent in the target range was similar in CL and OL: 62.6% for OL, 59.2% for iAP, and 58.3% for CAM. While mean glucose level was significantly lower in OL (7.19, 8.15, and 8.26 mmol/L, respectively) (overall P = 0.001), percentage of time spent in hypoglycemia (<3.9 mmol/L) was almost threefold reduced during CL (6.4%, 2.1%, and 2.0%) (overall P = 0.001) with less time ≤2.8 mmol/L (overall P = 0.038). There were no significant differences in outcomes between algorithms. CONCLUSIONS: Both CAM and iAP algorithms provide safe glycemic control

The P2Y1 receptor is involved in the maintenance of glucose homeostasis and in insulin secretion in mice

Pancreatic β cells express several P2 receptors including P2Y1 and the modulation of insulin secretion by extracellular nucleotides has suggested that these receptors may contribute to the regulation of glucose homeostasis. To determine whether the P2Y1 receptor is involved in this process, we performed studies in P2Y1 mice. In baseline conditions, P2Y1-mice exhibited a 15% increase in glycemia and a 40% increase in insulinemia, associated with a 10% increase in body weight, pointing to a role of the P2Y1 receptor in the control of glucose metabolism. Dynamic experiments further showed that P2Y1-mice exhibited a tendency to glucose intolerance. These features were associated with a decrease in the plasma levels of free fatty acid and triglycerides. When fed a lipids and sucrose enriched diet for 15 weeks, the two genotypes no longer displayed any significant differences. To determine whether the P2Y1 receptor was directly involved in the control of insulin secretion, experiments were carried out in isolated Langerhans islets. In the presence of high concentrations of glucose, insulin secretion was significantly greater in islets from P2Y1-mice. Altogether, these results show that the P2Y1 receptor plays a physiological role in the maintenance of glucose homeostasis at least in part by regulating insulin secretion

Effects and mechanisms of activation of P2Y purinergic receptors of the pancreatic beta cell

Les récepteurs purinergiques P2Y ont un rôle modulateur de la sécrétion d'insuline et constituent une cible potentielle pour la recherche de nouveaux antidiabétiques. Dans le modèle du pancréas isolé perfusé de Rat, dans des conditions fonctionnelles proches de la physiologie, nous avons montré que l'activation de ces récepteurs potentialise l'effet insulino-sécrétoire d'une stimulation glucosée. Cet effet requiert le métabolisme du glucose ; il est probablement lié à une augmentation de la concentration intracellulaire de Ca2+, et est indépendant d'un effet direct sur les canaux potassiques ATP dépendants. Nous avons également étudié les effets pancréatiques de nouveaux agonistes des récepteurs P2Y, synthétisés par l'équipe du Pr B. Fischer : parmi ces dérivés, le 2-méthylthio-ATP-a-S (isomère A) est un insulino-sécrétagogue gluco-dépendant, hautement efficace et puissant (CE50 de 28,1 nmol/l), avec une très bonne sélectivité tissulaire. Par ailleurs, nous avons exploré l'implication des récepteurs P2Y dans la prolifération cellulaire en utilisant un modèle de lignée cellulaire insulino-sécrétrice issue d'insulinome de Rat (lignée INS-1E) : aux doses utilisées, l'ATP-a-S (agoniste du récepteur P2Y) et le GLP-1 entraînent une réponse insulinique comparable, mais une augmentation de l'AMPc intracellulaire d'amplitude différente ; de plus, contrairement au GLP-1, l'ATP-a-S est sans effet sur la prolifération des cellules. Enfin, en collaboration avec l'équipe du Pr C. Gachet, nous avons montré l'implication des récepteurs de sous-type P2Y1 dans la réponse insulinique d'îlots pancréatiques de Souris. Nos travaux ont donc permis d'améliorer les connaissances sur les récepteurs purinergiques P2Y des cellules ß pancréatiques en ce qui concerne leurs mécanismes d'action, leurs effets sur l'insulino-sécrétion et sur la prolifération cellulaire ; nous avons également contribué au développement d'agonistes spécifiques, potentiellement intéressants pour le traitement du diabète de type 2.P2Y purinergic receptors play a role in the modulation of insulin secretion and represent a potential therapeutic target for new antidiabetic drugs. In the model of isolated perfused rat pancreas, in functional conditions close to physiology, we have shown that the activation of these receptors amplify the glucose-induced insulin secretion. This effect requires the metabolism of glucose; it is probably related to a rise in intracellular Ca2+ concentration, and is independent from a direct effect on ATP-dependent potassium channels. We have also studied the pancreatic effects of new P2Y receptor agonists, synthesized by the group of Prof. B. Fischer: among these compounds, 2-methylthio-ATP-a-S (A isomer) is a glucose-dependent insulin secretagogue, with high efficacy and potency (EC50 at 28.1 nmol/l), and with very good tissue selectivity. On the other hand, we have investigated the implication of P2Y receptors in cell proliferation, using a model of insulin secreting cell line from rat insulinoma (INS-1E cell line): at the doses used, ATP-a-S (a P2Y receptor agonist) and GLP-1 induce a similar insulin response, but an increase in intracellular cAMP of different magnitude; moreover, in contrast to GLP-1, ATP-a-S is ineffective on cell proliferation. Finally, in collaboration with the group of Prof. C. Gachet, we have shown that the P2Y1 receptor subtype was involved in the insulin response of mice pancreatic islets. Thus, our studies contributed to the improvement of knowledge on P2Y purinergic receptors of pancreatic ß-cells, as regards their mechanisms of action, their effects on insulin secretion and on cell proliferation; we also contributed to the development of specific agonists, potentially interesting for the treatment of type 2 diabetes

Traitement de l'obésité morbide par cerclage gastrique ajustable (évaluation clinique et métabolique post-opératoire)

MONTPELLIER-BU Médecine UPM (341722108) / SudocPARIS-BIUM (751062103) / SudocMONTPELLIER-BU Médecine (341722104) / SudocSudocFranceF

Le pancréas artificiel, un rêve sur le point de devenir réalité

International audienceAlmost 45 000 patients with type 1 diabetes are concerned in France by outpatient insulin pump therapy. The first systems of insulin pump therapy guided by glycaemia have evolved driven by the work carried out by multi-disciplinary research teams. Today, the outpatient treatment of type 1 diabetes by an artificial pancreas is on the point of becoming reality

Improvement of Glucose Control and Reduction of Hypoglycemia Following Intravenous Immune Globulins in a Child With Type 1 Diabetes and High Levels of Insulin Antibodies

International audienceNon

Psychological and physiological effects of bupropion compared to methylphenidate after prolonged administration in healthy volunteers (NCT00285155)

International audiencePURPOSE:Bupropion is largely used as an antidepressant and smoking cessation therapy. The aim of this work was to compare pharmacodynamic properties of bupropion and the amphetamine-like methylphenidate after sustained administration in humans.METHODS:Twelve male volunteers completed this randomized, double-blind, placebo controlled, cross-over study. Bupropion and methylphenidate were administered separately for initial half-dose 6-day periods (150 and 10 mg respectively) followed by full-dose 8-day periods (300 and 20 mg respectively). Outcomes were subjective feelings, cognitive performances, autonomic and physiological parameters.RESULTS:Data are expressed as mean(SEM). After repeated administration, bupropion, like methylphenidate, decreased asthenia-fatigue [44(3.2) and 42(3.7), respectively vs. 53(4.1) for placebo; p = 0.034], despite an impairment of sleep onset [-4.3(3.32) and -1.9(3.76), respectively vs. +7.5(3.69); p = 0.016]. Both drugs increased resting diastolic blood pressure [67.9(1.23) and 65.7(0.98), respectively vs. 62.5(1.42) mm Hg; p = 0.001], body temperature [36.5(0.12) and 36.5(0.14) vs. 36.3(0.10) °C; p = 0.037] and decreased body weight [-0.7(0.23) and -0.6(0.22), respectively vs. +0.2(0.27) kg; p = 0.038]. No significant change could be observed on cognitive functions, appetite and energy consumption.CONCLUSION:Although it may not share all the properties of stimulant drugs, the effect profile of bupropion presents a number of similarities with that of methylphenidate over a 2-week treatment period