Intravascular lymphoma presenting as a specific pulmonary embolism and acute respiratory failure: a case report

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Fonction endothéliale et rigidité artérielle, deux intégrateurs du risque cardiovasculaire : Etude à jeun et pendant la période post prandiale chez le sujet sain et le diabétique de type 2

Introduction : The primary objective of this thesis was to study, at fasting and during the postprandial period, cardiovascular risk integrators in subjects representing the continuum from normoglycemia to insulin treated type 2 diabetes. We studied the following parameters : endothelial function, arterial stiffness and autonomic nervous system. Methods We have (i) conducted a metabolic study in obese subjects with continuous glucose monitoring systems ; (ii) studied subjects with normal glycemia (NUTRIVASC: NCT01579409), impaired glucose tolerance (ACCESS : NCT01521312) and (iii) type 2 diabetes before and after insulin treatment (INSUVASC: 01022658) ; and finally (iv) we studied the association of arterial stiffness with hepatic fibrosis and with diabetic neuropathy. Results(i) Glucose variability was higher in the presence of dysglycemia and increased with HbA1c. The kinetics of oral glucose tolerance test compared to a standardized breakfast were well correlated. (ii) In elderly patients without cardiovascular risk factors, the post-prandial increase in cardiac output depended on the increase in heart rate which was not driven by cardiac vagal inhibition ; The French National Nutrition Program recommendations had favorable effects on heart rate and myocardial viability. (iii) A 4-week treatment with insulin in addition to metformin improved microvascular endothelial function at fasting. (iv) In normotensive patients with diabetes, those with peripheral neuropathy have a two-fold higher risk for increased arterial stiffness than those without neuropathy. Finally, liver fibrosis correlates with arterial stiffness independently of age and blood pressure in normotensive subjects. Conclusions : Our work underlines the importance of exploring cardiovascular integrators during post prandial period in healthy subjects and in diabetic patients, according to their diet and their hypoglycemic and anti-hypertensive treatments.Introduction : L’objectif de cette thèse était d'étudier les intégrateurs de risque cardiovasculaire chez des sujets qui représentent le continuum glycémique de la normo-glycémie jusqu'à la découverte du diabète, avant et après un petit déjeuner standardisé. Les paramètres que nous étudions étaient les suivants : l’endothélium, la rigidité artérielle et le système nerveux végétatif ou autonome (SNA). Méthodes : Dans un premier temps, nous avons mené une étude métabolique en utilisant des holters glycémiques. Ensuite nous avons étudié des sujets normo-glycémiques (NUTRIVASC: NCT01579409) intolérants au glucose (ACCES: NCT01521312) et diabétiques de type 2 avant et après un traitement par insuline (INSUVASC: 01022658). Nous avons étudié aussi le rôle des facteurs dit non classiques avec deux études sur l’association de la rigidité artérielle à la fibrose hépatique et la neuropathie diabétique. Conclusions : Nos résultats ont montré que la variabilité glycémique est plus forte en présence d’une dysglycémie et augmente avec l'HbA1c. Nous avons retrouvé une bonne corrélation entre la cinétique de la charge orale en glucose et celle d’un petit déjeuner standardisé. Chez les personnes âgées saines, l'augmentation du débit cardiaque après l'ingestion d'un repas dépend de l'augmentation de la FC sans que cet effet passe par l'inhibition vagale. Quatre semaines de traitement par insuline améliorait la fonction endothéliale microvasculaire à jeun. Parmi les patients diabétiques normotendus, ceux avec une neuropathie périphérique étaient deux fois plus susceptibles d'avoir une valeur de VOP > 90ème percentile des valeurs de référence que ceux sans neuropathie.La fibrose hépatique était corrélée à la rigidité artérielle indépendamment de l’âge et de la PA chez des sujets normotendus. Notre travail montre l’intérêt des explorations de la phase post-prandiale et l’étude des plusieurs cibles cardiovasculaires pour comprendre les différences de la PA et de la FC

Endothelial function and arterial stiffness, two integrators of cardiovascular risk : Study during fasting and during postprandial period in healthy subjects and in patients with type 2 diabetes

Introduction : L’objectif de cette thèse était d'étudier les intégrateurs de risque cardiovasculaire chez des sujets qui représentent le continuum glycémique de la normo-glycémie jusqu'à la découverte du diabète, avant et après un petit déjeuner standardisé. Les paramètres que nous étudions étaient les suivants : l’endothélium, la rigidité artérielle et le système nerveux végétatif ou autonome (SNA). Méthodes : Dans un premier temps, nous avons mené une étude métabolique en utilisant des holters glycémiques. Ensuite nous avons étudié des sujets normo-glycémiques (NUTRIVASC: NCT01579409) intolérants au glucose (ACCES: NCT01521312) et diabétiques de type 2 avant et après un traitement par insuline (INSUVASC: 01022658). Nous avons étudié aussi le rôle des facteurs dit non classiques avec deux études sur l’association de la rigidité artérielle à la fibrose hépatique et la neuropathie diabétique. Conclusions : Nos résultats ont montré que la variabilité glycémique est plus forte en présence d’une dysglycémie et augmente avec l'HbA1c. Nous avons retrouvé une bonne corrélation entre la cinétique de la charge orale en glucose et celle d’un petit déjeuner standardisé. Chez les personnes âgées saines, l'augmentation du débit cardiaque après l'ingestion d'un repas dépend de l'augmentation de la FC sans que cet effet passe par l'inhibition vagale. Quatre semaines de traitement par insuline améliorait la fonction endothéliale microvasculaire à jeun. Parmi les patients diabétiques normotendus, ceux avec une neuropathie périphérique étaient deux fois plus susceptibles d'avoir une valeur de VOP > 90ème percentile des valeurs de référence que ceux sans neuropathie.La fibrose hépatique était corrélée à la rigidité artérielle indépendamment de l’âge et de la PA chez des sujets normotendus. Notre travail montre l’intérêt des explorations de la phase post-prandiale et l’étude des plusieurs cibles cardiovasculaires pour comprendre les différences de la PA et de la FC.Introduction : The primary objective of this thesis was to study, at fasting and during the postprandial period, cardiovascular risk integrators in subjects representing the continuum from normoglycemia to insulin treated type 2 diabetes. We studied the following parameters : endothelial function, arterial stiffness and autonomic nervous system. Methods We have (i) conducted a metabolic study in obese subjects with continuous glucose monitoring systems ; (ii) studied subjects with normal glycemia (NUTRIVASC: NCT01579409), impaired glucose tolerance (ACCESS : NCT01521312) and (iii) type 2 diabetes before and after insulin treatment (INSUVASC: 01022658) ; and finally (iv) we studied the association of arterial stiffness with hepatic fibrosis and with diabetic neuropathy. Results(i) Glucose variability was higher in the presence of dysglycemia and increased with HbA1c. The kinetics of oral glucose tolerance test compared to a standardized breakfast were well correlated. (ii) In elderly patients without cardiovascular risk factors, the post-prandial increase in cardiac output depended on the increase in heart rate which was not driven by cardiac vagal inhibition ; The French National Nutrition Program recommendations had favorable effects on heart rate and myocardial viability. (iii) A 4-week treatment with insulin in addition to metformin improved microvascular endothelial function at fasting. (iv) In normotensive patients with diabetes, those with peripheral neuropathy have a two-fold higher risk for increased arterial stiffness than those without neuropathy. Finally, liver fibrosis correlates with arterial stiffness independently of age and blood pressure in normotensive subjects. Conclusions : Our work underlines the importance of exploring cardiovascular integrators during post prandial period in healthy subjects and in diabetic patients, according to their diet and their hypoglycemic and anti-hypertensive treatments

More Studies are Needed on the Link between Metformin and Decreased Mortality in Diabetic COVID-19 Patients

International audienc

Letter to the Editor Concerning: Sharma, P.; McCarty, T. R.; Yadav, S.; Ngu, J. N.; and Njei, B. (2019). Impact of Bariatric Surgery on Outcomes of Patients with Sickle Cell Disease: a Nationwide Inpatient Sample Analysis, 2004-2014. Obesity Surgery, 1-8

International audienc

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

Ketosis prone diabetes presenting as fulminant type 1 diabetes

Patients with ketosis prone diabetes have been reported primarily in Africans and African Americans. At presentation, both insulin secretion and insulin action are impaired in ketosis prone diabetes patients. Fulminant diabetes is a subtype of type 1 diabetes reported mainly in the Asian populations characterized by diabetic ketosis or ketoacidosis occurring soon after the onset of hyperglycemic symptoms with inappropriately low HbA1c (&lt; 8.5%). We report here the first case of a ketosis prone diabetes presenting as fulminant diabetes

Acute and long-term effects of saxagliptin on a set of cardiovascular targets measured at fasting and post-prandially in obese patients with impaired glucose tolerance: A placebo-controlled study

International audienceBackground and aimsStudies of dipeptidyl peptidase inhibitors (DPP4is) report heterogeneous effects on cardiovascular targets in type 2 diabetes. This study aimed to investigate, in patients with impaired glucose tolerance (IGT), whether saxagliptin, a DPP4i, had beneficial cardiovascular effects at fasting and during the post-prandial state.Methods and resultsIn this randomized, placebo-controlled, double-blind, single-center pilot exploratory study, we included obese individuals with IGT. Twenty-four individuals (BMI 36.8 ± 4.8 kg/m2) were randomized to receive for 12 weeks either saxagliptin 5 mg a day or placebo. They were explored before and after a standardized breakfast for biological markers; microcirculatory blood flow at baseline and after transcutaneous administration of acetylcholine (Periflux System 5000® PERIMED); post-occlusive digital reactive hyperhemia (Endopat2000®); pulse wave velocity, augmentation index, central pulse pressure and subendocardial viability ratio (Sphygmocor®); cardiac hemodynamic parameters and cardiovascular autonomic nervous system activity (Task force monitor®).The results of all the investigations were similar after breakfast in the two groups at Visit 1 (acute post-prandial effects, after the first tablet) and Visit 2 (long-term post-prandial effects), and at fasting at Visit 1 and 2 (long-term effects, after 12 weeks of treatment). Only at Visit 2 the decrease in cardiac vagal activity occurring after breakfast was more sustained in the saxagliptin group than in the placebo group (interaction between treatment and time effect: p = 0.016).ConclusionIn obese patients with IGT, the effects of saxagliptin on the large set of cardiovascular parameters measured are neutral, except for a more marked post-prandial depression of vagal activity.Clinical trial registration numberNCT01521312