Diabète gestationnel : et après ?

peer reviewe

SETHI / RAMSES-NG: New performances of the flexible multi-spectral airborne remote sensing research platform

International audienceSETHI is an airborne SAR/GMTI system developed by the French Aerospace Lab. ONERA, and integrating various sensors. In 2016 ONERA invested in upgrade and improvement of all SETHI components. The microwave ones cover from VHF-UHF to X Band, full polarimetric and very high resolution, along track and cross track interferometry and very high precision multi-baseline capacity for interferometry and tomography applications. The optronic sensors offer very high spatial resolution visible images and fine spectral scene analysis in VNIR and SWIR bands. This paper presents the upgrade and new performances of this flexible platform and the qualification campaign results with various sensor configurations

Euglycemic diabetic ketoacidosis in a patient with type 1 diabetes and SARS-CoV-2 pneumonia: case report and review of the literature.

OBJECTIVE: Recent publications on Coronavirus Disease-2019 (COVID-19) report that diabetic people with or without co-morbidities are at higher risk of developing severe and/or fatal illnesses. METHOD AND RESULT: We report the first case of a 60-year-old man with a 27-year history of type 1 diabetes mellitus, infected by SARS-CoV-2 presenting with an euglycaemic ketoacidosis and an acute respiratory distress syndrome. CONCLUSION: This case report reminds us of the importance of adjusting more recent glucose-lowering drugs, including sodium-glucose cotransporter 2 inhibitors, in the overall management of type 1 diabetic individuals during the ongoing COVID-19 outbreak

“Mind the gap please…”: estimated vs. measured A1c from continuous measurement of interstitial glucose over a 3-month period in patients with type 1 diabetes

INTRODUCTION: Glycated hemoglobin (A1c) is the measurement of choice to estimate the glycemic exposure over the last 3 months prior to sampling. The Free Style Libre® is a continuous glucose monitoring device which provides an estimated A1c (eA1c) from average interstitial glucose using Nathan's ADAG equation. The objective of this study was to compare eA1c and A1c in type 1 diabetes patients (T1D) over a period of 3 months. MATERIALS AND METHODS: Data were collected from patient charts between July 2016 and October 2017. 3-months recordings with >70% of data available were analyzed. eA1c was recorded at each visit and the corresponding A1c value measured by high performance liquid chromatography in a single reference lab. RESULTS: A total of 344 reports from 170 T1D were studied, 3 categories were identified: eA1c = A1c: 13% of reports. eA1c > A1c: 57% of reports, positive difference (eA1c - A1c) of +0.74 ± 0.5% (P < 0.0001). eA1c < A1c: 30% of reports, negative difference (eA1c - A1c) of -0.5 ± 0.3% (P < 0.0001). CONCLUSION: eA1c value was generally overestimated compared to measured A1c in this T1D cohort. This lesser concordance may result from differences in measured glucose source and/or frequency to calculate eA1c compared to ADAG, but also from using the reverse equation which is a source of potential bias. Another explanation could be a different rate of hypoglycemia between groups, or an asymmetric distribution of A1c patients' phenotypes with differential hyper- or hypoglycation intrinsic propensity

Lipohypertrophy Effect on Glycemic Profile in an Adult With Type 1 Diabetes Using Scanned Continuous Glucose Monitoring.

For people with diabetes, managing decisions to minimize hypoglycemia and hyperglycemia is stressful. To improve glycemic control, there is a growing shift toward continuous glucose monitoring (CGM). [...

Outcomes of glycemic control in type 1 diabetic patients switched from basal insulin glargine 100 U/ml to glargine 300 U/ml in real life

AIMS: The objective of this study was to evaluate glycemic control in type 1 diabetic mellitus patients who were switched from glargine 100 U/ml (Gla-100) to glargine 300 U/ml (Gla-300) in real life practice. METHODS: Glycemia based on self-monitoring capillary blood glucose, hypoglycemic events and insulin doses were considered during a two-week period before and after transition from Gla-100 to Gla-300 (period 1). Glycated hemoglobin A1c (HbA1c) levels, basal insulin doses and weight were also determined at 12 and 24 weeks after switching (period 2). RESULTS: 116 patients treated with a basal prandial insulin scheme were included. 72% received one injection and 28% two daily injections of Gla-100 before transition to Gla-300. Glycemic control was similar during period 1 . In contrast, the number of nocturnal hypoglycemic events were significantly reduced [22.2% vs 12.2%; relative risk 0.46 (95% CI 0.30 - 0.68); p < 0.0001], as well as the number of patients with nocturnal hypoglycemia per period [30% vs 16%; relative risk 0.53 (95% CI 0.31-0.86); p < 0.01]. At the end of period 2, HbA1c decreased from 8.0 ± 1.0% (65.5 ± 10.5 mmol/mol) to 7.9 ± 1.0% (62.8 ± 10 mmol/mol) (p = 0.03). Insulin doses of Gla-300 were increased in patients treated previously with Gla-100 (+6.5%), but no weight gain was observed. CONCLUSION: Short term glycemic control was comparable in patients treated with basal insulin Gla-100 or Gla-300 injection. Nocturnal hypoglycemic rate declined quickly after the switch. HbA1c was reduced after six months of Gla-300 treatment versus baseline. Gla-300 doses were moderately higher (vs Gla-100), in particular, in patients treated with one Gla-100 dose before switching. Gla-300 is an alternative therapeutic option of interest

Glycemic control and weight changes in patients with type 2 diabetes intensified to three insulin regimens after therapeutic failure to exenatide

The aim of this multicentre and observational study was to evaluate in a real life setting glycated haemoglobin A1(c), (HbA1c) as well as body weight outcomes in patients with type 2 diabetes in whom insulin was initiated after unsatisfactory response to exenatide, combined with maximal dosages of metformin and a sulfonylurea. We included 81 patients. In 56 patients, data were available after 6-8 and in 42 after 9-12 month's follow-up. Age and duration of diabetes were 57 +/- 11 and 11 +/- 6 years, respectively. Body mass index (BMI) was 32.4 +/- 6.9 kg/m2. Insulin was initiated with a basal insulin injection (22%), premixed insulin injections (48%) or a basal prandial scheme (30%). In the 6-8 and 9-12 month's cohorts, HbA(1c) decreased from 9.3 +/- 1.4 to 8.2 +/- 1.2% and from 9.3 +/- 1.3 to 8 +/- 1.1%, respectively (p < 0.0001). However, only 9 and 12% of subjects reached a target HbA(1c) of less than 7.0%, respectively. About half of the patients had HbA(1c) levels equal or higher than 8.0%. Insulin doses were progressively increased during the follow-up period. Insulin treatment was associated with a significant body weight increase (5-7 kg) (p < 0.0001). In conclusion, a high proportion of patients remained above the HbA(1c) targets after 6-12 month's treatment, despite a progressive increase in insulin dosages. Insulin treatment was associated with a marked weight gain

TSH élevée : N'est-ce toujours qu'une hypothyroïdie autoimmune ou chirurgicale?

Au travers de cas cliniques, nous revoyons les pièges classiques dans l’interprétation d’une augmentation de la TSH, une anomalie hormonale très fréquemment constatée: la non compliance au traitement, la malabsorption des hormones thyroïdiennes ou l’interaction médicamenteuse avec leur absorption, l’induction microsomiale, les pertes urinaires, la résistance génétique aux hormones thyroïdiennes et l’adénome hypophysaire à TSH. L’interprétation du dosage de TSH doit toujours être attentive et prudent

Exenatide improves weight loss insulin sensitivity and β-cell function following administration to a type 2 diabetic HIV patient on antiretroviral therapy

The use of retroviral drugs in the treatment of infection by human immunodeficiency virus (HIV) is associated, especially for first generations, with side effects such as lipodystrophy, fatty liver and insulin resistance, which may trigger secondary diabetes or worsen existing diabetes. The use of Glucagon-Like Peptide-1 in obese patients with type 2 diabetes on HIV retroviral as an alternative to insulin therapy is not documented; we report the case of a 47-year-old treated with exenatide when insulin was discontinued. During the first year of treatment, exenatide, in combination with metformin and repaglinide, led to a weight loss of 14 kg and fat mass and waist circumference were respectively reduced from 31 to 25.5% and from 114 to 103 cm. Homeostatic model assessment (HOMA) was used to calculate β-cell secretion which increased from 50 to 78% and insulin sensitivity which increased from 28 to 51%, reflecting a decrease in HbA(1c) by 1.9%. Exenatide may be a new therapeutic option for HIV-infected type 2 diabetes patients undergoing retroviral therapy

Cétose ou acidocétose diabétique euglycémique chez des patients diabétiques de type 2 traités par inhibiteurs du SGLT2 : une série de cas cliniques en Belgique

INTRODUCTION : Les inhibiteurs du cotransporteur sodium-glucose de type 2 (iSGLT2) est à une nouvelle classe médicamenteuse qui améliore la prise en charge du diabète de type 2. Les résultats des essais cliniques sur les iSGLT2 ont démontré une réduction des glycémies ainsi qu’une diminution significative de certaines complications cardiovasculaires et rénales liées au diabète. Cependant, des événements indésirables rares tels que l’acidocétose diabétique ont été rapportés au cours de ces essais cliniques et dans la « vraie vie ». Ces acidocétoses étaient atypiques car l’hyperglycémie était peu élevée par rapport aux hyperglycémies de la traditionnelle acidocétose diabétique, d’où leur nom d’acidocétose « euglycémique ». Nous détaillons une série de sept cas survenus dans notre centre associé à la prise d’iSGLT2 chez des diabétiques de type 2. MÉTHODE : Les cas ont été colligés de façon systématique rétrospectivement. Sept cas acidocétoses diabétiques « euglycémiques » associées à la prise d’un iSGLT2 ont été identifié au sein de notre institution entre 2016 et 2019. RÉSULTATS : Sept dossiers de diabétiques de type 2 (H/F : 5/2) âgés de 51 à 74 ans ont été observés. Tous présentaient des symptômes de l’hypercétonémie (haleine fruitée, nausée, inappétence) et un taux élevé d’acide β-hydroxybutyrique capillaire malgré un taux de glycémie compris entre 112 et 280 mg/dL. Les facteurs de risque de l’acidocétose identifiés étaient : le jeun prolongé, l’infection, la déshydratation et une fonction sécrétoire insulinique fortement diminuée (selon le modèle HOMA) révélant une insulinopénie endogène préexistante à l’acidocétose. CONCLUSION : L’utilisation croissante des iSGLT2 dans le traitement du diabète de type 2 risque d’entraîner une augmentation du nombre de cas d’acidocétose diabétique « euglycémique ». Il est donc essentiel de savoir reconnaître cette complication potentiellement morbide et de l’éviter si certains facteurs de risques sont présents.[Diabetic euglycemic ketosis or ketoacidosis in individuals with type 2 diabetes treated by SGLT2 inhibitors: A series of Belgian clinical cases] INTRODUCTION: Sodium-glucose cotransporter type 2 inhibitors (SGLT2i) are new therapeutic agents that improves the management of type 2 diabetes. Clinical trial results for SGLT2i have shown a reduction in blood glucose levels and a decrease in significant cardiovascular and renal complications related to diabetes. However, rare adverse events such as diabetic ketoacidosis have been reported in these clinical trials and in "real life". These ketoacidosis were atypical because the hyperglycemia was less severe than in traditional acute diabetes, hence the name of "euglycemic" ketoacidosis. We detail a series of local cases associated with the use of SGLT2i in type 2 diabetic patients. METHODS: This was a retrospective consecutive case study, with a review of medical records from 2016 to 2019. We identified 7 single episodes of "euglycemic" ketoacidosis associated with SGLT2i use in individuals with type 2 diabetes. RESULTS: Seven cases of type 2 diabetic individuals (M/F: 5/2) aged from 51 to 74years old were analysed. All had symptoms of hyperketonemia (fruity smelling breath, nausea or lack of appetite) and an increase level of capillary β-hydroxybutyric acid despite a glycaemia between 112 and 280mg/dL. The risk factors for ketoacidosis identified in these patients were: prolonged fasting, infection, dehydration and significantly decreased in insulin secretory function (according to the HOMA model), revealing endogenous insulinopenia before ketoacidosis. CONCLUSION: The increasing use of SGLT2i in individuals with type 2 diabetes is likely to increase the number of ketoacidosis cases. It is essential to recognise this complication and prevent it according to each patient's risk factors