NuSTAR + XMM-Newton monitoring of the neutron star transient AX J1745.6-2901

AX J1745.6-2901 is a high-inclination (eclipsing) transient neutron star (NS) Low Mass X-ray Binary (LMXB) showcasing intense ionised Fe K absorption. We present here the analysis of 11 XMM-Newton and 15 NuSTAR new data-sets (obtained between 2013-2016), therefore tripling the number of observations of AX J1745.6-2901 in outburst. Thanks to simultaneous XMM-Newton and NuSTAR spectra, we greatly improve on the fitting of the X-ray continuum. During the soft state the emission can be described by a disk black body ($kT\sim1.1-1.2$ keV and inner disc radius $r_{DBB}\sim14$ km), plus hot ($kT\sim2.2-3.0$ keV) black body radiation with a small emitting radius ($r_{BB}\sim0.5-0.8$ km) likely associated with the boundary layer or NS surface, plus a faint Comptonisation component. Imprinted on the spectra are clear absorption features created by both neutral and ionised matter. Additionally, positive residuals suggestive of an emission Fe K$\alpha$ disc line and consistent with relativistic ionised reflection are present during the soft state, while such residuals are not significant during the hard state. The hard state spectra are characterised by a hard ($\Gamma\sim1.9-2.1$) power law, showing no evidence for a high energy cut off ($kT_e>60-140$ keV) and implying a small optical depth ($\tau<1.6$). The new observations confirm the previously witnessed trend of exhibiting strong Fe K absorption in the soft state, that significantly weakens during the hard state. Optical (GROND) and radio (GMRT) observations suggest for AX J1745.6-2901 a standard broad band SED as typically observed in accreting neutron stars.Comment: Accepted for publication in MNRA

Design and baseline characteristics of the finerenone in reducing cardiovascular mortality and morbidity in diabetic kidney disease trial

Background: Among people with diabetes, those with kidney disease have exceptionally high rates of cardiovascular (CV) morbidity and mortality and progression of their underlying kidney disease. Finerenone is a novel, nonsteroidal, selective mineralocorticoid receptor antagonist that has shown to reduce albuminuria in type 2 diabetes (T2D) patients with chronic kidney disease (CKD) while revealing only a low risk of hyperkalemia. However, the effect of finerenone on CV and renal outcomes has not yet been investigated in long-term trials. Patients and Methods: The Finerenone in Reducing CV Mortality and Morbidity in Diabetic Kidney Disease (FIGARO-DKD) trial aims to assess the efficacy and safety of finerenone compared to placebo at reducing clinically important CV and renal outcomes in T2D patients with CKD. FIGARO-DKD is a randomized, double-blind, placebo-controlled, parallel-group, event-driven trial running in 47 countries with an expected duration of approximately 6 years. FIGARO-DKD randomized 7,437 patients with an estimated glomerular filtration rate >= 25 mL/min/1.73 m(2) and albuminuria (urinary albumin-to-creatinine ratio >= 30 to <= 5,000 mg/g). The study has at least 90% power to detect a 20% reduction in the risk of the primary outcome (overall two-sided significance level alpha = 0.05), the composite of time to first occurrence of CV death, nonfatal myocardial infarction, nonfatal stroke, or hospitalization for heart failure. Conclusions: FIGARO-DKD will determine whether an optimally treated cohort of T2D patients with CKD at high risk of CV and renal events will experience cardiorenal benefits with the addition of finerenone to their treatment regimen. Trial Registration: EudraCT number: 2015-000950-39; ClinicalTrials.gov identifier: NCT02545049

Médecins généralistes (quels intérêts d'être dans un réseau diabète ?)

DIJON-BU Médecine Pharmacie (212312103) / SudocSudocFranceF

Comment promouvoir l activité physique chez les patients diabétiques de type 2 en médecine générale ?

Dans la prise en charge du diabète de type 2, l efficacité de l activité physique ne fait aucun doute, mais son application reste difficile à promouvoir. Cette étude a pour but d étudier les pratiques des médecins généralistes pour inciter à l activité physique et d appréhender les difficultés qu ils rencontrent. Pour cela, un questionnaire a été envoyé aux médecins généralistes de Saône et Loire avec différents items : leur pratique clinique, les freins de leurs patients et les aides potentielles. Les résultats mettent en évidence que pour les médecins généralistes, la thérapeutique médicamenteuse et les mesures diététiques sont plus efficaces que l activité physique. Leurs pratiques d incitation à l activité physique sont ressenties comme peu efficace et sont souvent basées sur l information et le conseil du patient avec peu d orientation pour déléguer l éducation. L absence d envie des patients, leur état de santé et leur manque de temps sont des barrières à l activité physique fréquemment identifiées par les médecins. Les propositions d aides qu ils retiennent sont le soutien des campagnes grand public, la possibilité d avoir plus de temps et la possibilité de déléguer ces tâches d éducation, en premier lieu aux réseaux puis aux paramédicaux. Malgré leur difficulté dans cette mission éducative, peu de médecins sont formés. L adhérence à un réseau change les attitudes et les besoins des soignants : ils sont plus formés et demandent plus à être formés, ils orientent plus leurs patients dans des structures relais et ils délèguent plus. Ces résultats permettent de s interroger sur les pistes d amélioration possibles : La poursuite du développement des relais d éducation à travers les réseaux ? L acquisition de compétence par les paramédicaux pour leur déléguer des tâches d éducation ? La création d offres accessibles d activité physique adaptée ? L amélioration de la formation des étudiants et une offre de formation plus adaptée aux médecins en exercice ?DIJON-BU Médecine Pharmacie (212312103) / SudocSudocFranceF

Performance and patients’ satisfaction with the A7+TouchCare insulin patch pump system: A randomized controlled non-inferiority study

Background We assessed the performance and patient satisfaction of a new insulin patch pump, the A7+TouchCare (Medtrum), compared with the Omnipod system. Methods This multicenter, randomized, open-label, controlled study enrolled 100 adult patients with type 1 or type 2 diabetes mellitus (A1C ≥ 6.5% and ≤ 9.5%, i.e., 48 to 80 mmol/mol) who were assigned with the Omnipod or with the A7+TouchCare pump for 3 months. The primary study outcome was the glucose management indicator (GMI) calculated with continuous glucose monitoring (CGM). Results Premature withdrawals occurs respectively in 2 and 9 participants in the Omnipod and TouchCare groups. In the Per Protocol analysis, the difference in GMI between groups was 0.002% (95% confidence interval -0.251; 0.255). The non-inferiority was demonstrated since the difference between treatments did not overlap the pre-defined non-inferiority margin (0.4%). There was no significant difference in CGM parameters between groups. On average, patients in both groups were satisfied/very satisfied with the insulin pump system. Patients preferred Omnipod as an insulin management system and especially the patch delivery system but preferred the A7+TouchCare personal diabetes manager to control the system. Conclusions This study showed that the A7+TouchCare insulin pump was as efficient as the Omnipod pump in terms of performance and satisfaction. Clinical trail registration The study was registered in the ClinicalTrials.gov protocol register (NCT04223973)

Performance and patients' satisfaction with the A7+TouchCare insulin patch pump system: A randomized controlled non-inferiority study.

BackgroundWe assessed the performance and patient satisfaction of a new insulin patch pump, the A7+TouchCare (Medtrum), compared with the Omnipod system.MethodsThis multicenter, randomized, open-label, controlled study enrolled 100 adult patients with type 1 or type 2 diabetes mellitus (A1C ≥ 6.5% and ≤ 9.5%, i.e., 48 to 80 mmol/mol) who were assigned with the Omnipod or with the A7+TouchCare pump for 3 months. The primary study outcome was the glucose management indicator (GMI) calculated with continuous glucose monitoring (CGM).ResultsPremature withdrawals occurs respectively in 2 and 9 participants in the Omnipod and TouchCare groups. In the Per Protocol analysis, the difference in GMI between groups was 0.002% (95% confidence interval -0.251; 0.255). The non-inferiority was demonstrated since the difference between treatments did not overlap the pre-defined non-inferiority margin (0.4%). There was no significant difference in CGM parameters between groups. On average, patients in both groups were satisfied/very satisfied with the insulin pump system. Patients preferred Omnipod as an insulin management system and especially the patch delivery system but preferred the A7+TouchCare personal diabetes manager to control the system.ConclusionsThis study showed that the A7+TouchCare insulin pump was as efficient as the Omnipod pump in terms of performance and satisfaction.Clinical trail registrationThe study was registered in the ClinicalTrials.gov protocol register (NCT04223973)

Reduction of clinically important low glucose excursions with a long‐term implantable continuous glucose monitoring ( CGM ) system in adults with type 1 diabetes prone to hypoglycemia. France Adoption randomized clinical trial

International audienceAim: This trial assessed the outcomes on glucose control of the implantable Eversense real-time continuous glucose monitoring (CGM) system compared to self-monitoring of blood glucose or intermittently scanned CGM in patients with type 1 or type 2 diabetes (T1D or T2D).Patients and methods: This was a randomized (2:1), prospective, national, multicenter study. All participants, aged >18, on multiple daily insulin injections or insulin pump had a sensor inserted, activated only in the enabled group. Included patients had T1D or T2D with an HbA1c level >8% (cohort 1) or T1D with a time below range 1.5 hour/day during the previous 28 days (cohort 2). The primary outcomes were the HbA1c change at D180 (cohort 1) or the change in TBR180 ) was observed. In cohort 2, the mean adjusted difference in TBR<54 was -1.6% [-3.1; -0.1], p=0.039 during D90-D120 and remained at -2.6%, [-4.5; -0.6], p=0.011 during D150-D180 (pre-specified secondary outcome). There was no safety issue.Conclusion: This study shows that the Eversense CGM system can significantly decrease TBR<54 in patients with T1D prone to hypoglycemia

Trends in the relation between hyperglycemia correction and active Charcot neuroarthropathy: results from the EPICHAR study

International audienceIntroduction The pathophysiology of Charcot neuroarthropathy (CN) remains unclear. There are a number of hypotheses but these are not exclusive. In its clinical presentation, this complication intersects with the semiology of diabetic-induced neuropathy, such as peripheral hypervascularization and the appearance of arteriovenous shunt. The EPICHAR study is as yet an unpublished cohort of people living with diabetes complicated by CN (in active or chronic phase). Based on the findings of the EPICHAR study, this study aimed to investigate whether a reduction in the rate of hyperglycemia accompanies the onset of an active phase of CN.Research design and methods Hemoglobin A1c (HbA1c) levels were assessed 3 months (M3) and 6 months (M6) before the diagnosis of active CN (M0).Results 103 patients living with diabetes and presenting active CN were included between January and December 2019 from the 31 centers participating in this study (30 in France and 1 in Belgium). The mean age of the participants was 60.2±12.2 years; the vast majority were men (71.8%) living with type 2 diabetes (75.5%). Mean HbA1c levels significantly declined between M6 (median 7.70; Q1, Q3: 7.00, 8.55) and M3 (median 7.65; Q1, Q3: 6.90, 8.50) (p=0.012), as well as between M6 and M0 (median 7.40; Q1, Q3: 6.50, 8.50) (p=0.014). No significant difference was found between M3 and M0 (p=0.072).Conclusions A significant reduction in HbA1c levels seems to accompany the onset of the active phase of CN. Trial registration number NCM03744039

Dissertatio historica de initiis monarchiae Babyloniorum, quam, cum cons. ampliss. Colleg. Philos. in Reg. Acad. Upsal. sub praesidio ... Jacobi Arrhenii ... publico examini modeste subjicit Petrus Hagberg Gestr. In audit. Gustav. maj. ad d. 25. Maji. Anni MDCCV.

International audienceBackground : The incidence of childhood type 1 diabetes (T1D) incidence is rising in many countries, supposedlybecause of changing environmental factors, which are yet largely unknown. The purpose of the study was tounravel environmental markers associated with T1D. Methods : Cases were children with T1D from the French Isis-Diab cohort. Controls were schoolmates or friends ofthe patients. Parents were asked to fill a 845-item questionnaire investigating the child’s environment before diagnosis.The analysis took into account the matching between cases and controls. A second analysis used propensity scoremethods. Results : We found a negative association of several lifestyle variables, gastroenteritis episodes, dental hygiene, hazelnutcocoa spread consumption, wasp and bee stings with T1D, consumption of vegetables from a farm and death of a petby old age. Conclusions : The found statistical association of new environmental markers with T1D calls for replication in othercohorts and investigation of new environmental areas