Preserving of postnatal leptin signaling in obesity-resistant lou/c rats following a perinatal high-fat diet

Physiological processes at adulthood, such as energy metabolism and insulin sensitivity may originate before or weeks after birth. These underlie the concept of fetal and/or neonatal programming of adult diseases, which is particularly relevant in the case of obesity and type 2 diabetes. The aim of this study was to determine the impact of a perinatal high fat diet on energy metabolism and on leptin as well as insulin sensitivity, early in life and at adulthood in two strains of rats presenting different susceptibilities to diet-induced obesity. The impact of a perinatal high fat diet on glucose tolerance and diet-induced obesity was also assessed. The development of glucose intolerance and of increased fat mass was confirmed in the obesity-prone Wistar rat, even after 28 days of age. By contrast, in obesity-resistant Lou/C rats, an improved early leptin signaling may be responsible for the lack of deleterious effect of the perinatal high fat diet on glucose tolerance and increased adiposity in response to high fat diet at adulthood. Altogether, this study shows that, even if during the perinatal period adaptation to the environment appears to be genetically determined, adaptive mechanisms to nutritional challenges occurring at adulthood can still be observed in rodents

Moderate to Severe Soft Tissue Diabetic Foot Infections: A Randomized, Controlled, Pilot Trial of Post-Debridement Antibiotic Treatment for 10 versus 20 days

Background: The optimal duration of antibiotic therapy for soft-tissue infections of the diabetic foot (ST-DFI) remains unknown. Objective: We determine if antibiotic therapy after debridement for a short (10 days), compared with a long (20 days), duration for ST-DFI results in similar rates of clinical remission and adverse events (AE). Summary Background Data: The optimal duration of systemic antibiotic therapy, after successful debridement, for soft tissue infections of diabetic patients is unknown. Because of the high recurrence risk, overuse is commonplace. Methods: This was a randomized, controlled, non-inferiority pilot trial of cases of diabetic foot infection (excluding osteomyelitis) with the primary outcome of “clinical remission at two-months follow-up”. Results: Among 66 enrolled episodes (17% females; median age 71 years), we randomized 35 to the 10-day arm and 31 to the 20-day arm. The median duration of the parenteral antibiotic therapy was 1 day, with the remainder given orally. In the intention-to-treat (ITT) population, we achieved clinical remission in 27 (77%) patients in the 10-day arm compared to 22 (71%) in the 20-days arm (p = 0.57). There were a similar proportion in each arm of AE (14/35 versus 11/31; p = 0.71), and remission in the per-protocol (PP) population (25/32 vs. 18/27; p = 0.32). Overall, eight soft tissue DFIs in the 10-day arm and five cases in the 20-day arm recurred as a new osteomyelitis (8/35 [23%] versus 5/31 [16%]; p = 0.53). Overall, the number of recurrences limited to the soft tissues was 4 (6%). By multivariate analysis, rates of remission (ITT population, hazard ratio 0.6, 95%CI 0.3-1.1; PP population 0.8, 95%CI 0.4-1.5) and AE were not significantly different with a 10-day compared to 20-day course. Conclusions: In this randomized, controlled pilot trial, post-debridement antibiotic therapy for soft tissue DFI for 10 days gave similar (and non-inferior) rates of remission and AEs to 20 days. A larger confirmatory trial is under way

NAFLD: From Mechanisms to Therapeutic Approaches

Nonalcoholic fatty liver disease (NAFLD) now represents the most frequent chronic liver disease worldwide [...

Thirteen-year trends in the prevalence of diabetes according to socioeconomic condition and cardiovascular risk factors in a Swiss population

Introduction To estimate the prevalence of and trends in diabetes according to sociodemographic indicators and cardiovascular risk factors in a Swiss population.Research design and methods Annual cross-sectional study of adults residing in the state of Geneva. We included 9886 participants (51% women; mean age (SD) of 48.9 (13.4) years). Diagnosed diabetes was self-reported; undiagnosed diabetes was defined as having fasting plasma glucose level of ≥7 mmol/L and no previous diagnosis; total diabetes as the sum of diagnosed and undiagnosed diabetes. To assess trends, we grouped survey years into three time periods: 2005–2010, 2011–2014, and 2015–2017. To assess inequalities, we constructed the relative index of inequality (RII) and the slope index of inequality (SII) for education, income, and health insurance subsidy (state program based on socioeconomic disadvantage).Results In total, 683 diabetes cases were identified. In 2015–2017, total diabetes prevalence was 11.8% (8.6%–14.9%) among lowest income participants, and 4.7% (3.4%–5.9%) among highest income participants (p<0.01). Similar findings were observed for education. Among participants with full health insurance subsidy, diabetes prevalence was 19.4% (12.1%–26.8%), and 6.1% (5.3%–7.0%) among those without (p<0.01). High diabetes prevalence was observed among participants who were men, older, overweight or obese, hypertensive, and hypercholesterolemic. Among participants with diabetes, 74.0% (63.5%–84.4%) in the lowest income group were diagnosed, compared with 90.2% (81.9%–98.4%) in the highest income group (p=0.04). Over the 13-year period, widening relative and absolute inequalities in total diabetes prevalence were observed for education and income. The education-RII (95% CI) increased from 1.51 (95% CI 1.01 to 2.32) in 2005–2010 to 2.54 (95% CI 1.58 to 4.07) in 2015–2017 (p=0.01), and the education-SII (95% CI) from 0.04 (95% CI 0.01 to 0.08) to 0.08 (95% CI 0.04 to 0.10; p<0.01). The income-RII increased from 2.35 (95% CI 1.44 to 3.84) to 3.91 (95% CI 2.24 to 6.85; p<0.01), and the income-SII from 0.08 (95% CI 0.04 to 0.12) to 0.011 (95% CI 0.07 to 0.14; p=0.01). Inequalities by health insurance subsidy were large (RII 3.56 (95% CI 1.90 to 6.66) and SII 0.10 (95% CI 0.05 to 0.15)) but stable across the study period.Conclusion Among adults living in Geneva, Switzerland, substantial differences were observed in diabetes prevalence across socioeconomic and cardiovascular risk groups over a 13-year period, and relative and absolute socioeconomic inequalities appeared to have increased

Tratamiento podológico del pie diabético

El podólogo desempeña un papel fundamental en el tratamiento del paciente diabético. La palabra clave en el tratamiento podológico es «descarga». El podólogo debe hacer todo lo posible para evitar presiones que puedan provocar complicaciones. En el marco del trabajo multidisciplinario, el podólogo debe proponer soluciones para preservar la integridad del pie. El análisis baropodométrico, la observación y el asesoramiento sobre el calzado son esenciales para el cuidado de los pies del paciente durante toda su vida. Los cuidados regulares, las plantillas ortopédicas hechas a medida y reevaluadas de forma periódica, así como los diversos dispositivos ortopédicos, son las herramientas del podólogo para llevar a cabo sus tratamientos con vistas a la prevención, pero también para permitir la curación cuando, por desgracia, se produce una herida. La relación de confianza entre los profesionales intervinientes es fundamental para ayudar al paciente a aceptar las complicaciones de una enfermedad crónica. Si el equipo médico consigue coordinar lo mejor posible las intervenciones de todos, la amputación ya no tiene por qué ser el destino de estos pacientes

Prise en charge podologique du pied diabétique

Le podologue joue un rôle important dans la prise en charge du patient diabétique. Le maître-mot du traitement podologique est la décharge. Le podologue doit tout mettre en œuvre pour éviter les contraintes qui pourraient entraîner des complications. Dans le cadre d'un travail pluridisciplinaire, le podologue doit proposer des solutions pour préserver l'intégrité du pied du patient. L'analyse baropodométrique, l'observation et les conseils de chaussage sont indispensables pour permettre le suivi des pieds du patient tout au long de sa vie. Le soin régulier, les semelles orthopédiques réalisées sur mesure et régulièrement réévaluées, ainsi que les différents appareillages sont les outils du podologue pour mener à bien sa prise en charge dans une optique de prévention, mais aussi pour permettre la guérison quand malheureusement une plaie survient. Les liens de confiance de l'ensemble des différents acteurs sont importants pour aider le patient à accepter de vivre avec les complications d'une maladie chronique. Si l'équipe médicale arrive à coordonner au mieux les interventions de chacun, l'amputation ne doit plus être une fatalité