Education thérapeutique en groupe dans le diabète gestationnel (évaluation du projet régional multicentrique DIAMAT)

Le diabète gestationnel est une complication très fréquente de la grossesse, environ 6 % des femmes enceintes. Sa physiopathologie est proche de celle du diabète de type 2. Il n'existe pas actuellement de consensus concernant son dépistage et son diagnostic. Il est responsable d'une morbidité foeto-maternelle accrue, qui peut être réduite, voire prévenue, par une prise en charge précoce et multidisciplinaire. Un programme d'éducation thérapeutique en groupe a été mis en place en 2004 en Midi-Pyrénées (programme DIAMAT). Notre travail évalue ce programme chez 381 patientes éduquées ayant accouchées entre avril 2005 et janvier 2006. Notre étude observationnelle retrouve significativement moins de prématurité et de complications des suites de couches, ainsi qu'une tendance à moins d'HTA gravidique, d'interventions obstétricales en début de travail, de dystocie des épaules et d'hospitalisation du nouveau-né. Ces résultats demandent à être confirmés par une étude prospective et randomisée.TOULOUSE3-BU Santé-Centrale (315552105) / SudocPARIS-BIUM (751062103) / SudocSudocFranceF

Post-prandial hypoglycemia results from a non-glucose-dependent inappropriate insulin secretion in Roux-en-Y gastric bypassed patients

International audienceBACKGROUND : After Roux-en-Y gastric bypass (RYGB), hypoglycemia can occur and be associated with adverse events such as intense malaise and impaired quality of life.OBJECTIVE : To compare insulin secretion, sensitivity, and clearance between two groups of patients, with or without hypoglycemia, after an oral glucose tolerance test (OGTT 75-g), and also to compare real-life glucose profiles within these two groups.SETTING : Bariatric surgery referral center.METHODS : This study involves a prospective cohort of 46 consecutive patients who complained of malaise compatible with hypoglycemia after RYGB, in whom an OGTT 75-g was performed. A plasma glucose value of lower than 2.8 mmol/L (50 mg/dl) between 90 and 120 min after the load was considered to be a significant hypoglycemia. The main outcome measures were insulin sensitivity, beta-cell function, and glycemic profiles during the test. Glucose parameters were also evaluated by continuous glucose monitoring (CGM) in a real-life setting in 43 patients.RESULTS : Twenty-five patients had plasma glucose that was lower than 2.8 mmol/L between 90 and 120 from the load (HYPO group). Twenty-one had plasma glucose that was higher than 2.8 mmol/L (NONHYPO group). The HYPO patients were younger, had lost more weight after RYGB, were less frequently diabetic before surgery, and displayed higher early insulin secretion rates compared with the NONHYPO patients after the 75-g OGTT, and they had lower late insulin secretion rates. The HYPO patients had lower interstitial glucose values in real life, which suggests that a continuum exists between observations with an oral glucose load and real-life interstitial glucose concentrations.CONCLUSIONS : This study suggests that HYPO patients after RYGB display an early increased insulin secretion rate when tested with an OGTT. CGM shows that HYPO patients spend more time below 3.3 mmol/L when compared with NONHYPO patients. This phenotype of patients should be monitored carefully after RYGB