Preclinical carotid atherosclerosis in patients with latent autoimmune diabetes in adults (LADA), type 2 diabetes and classical type 1 diabetes

This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.This project was funded by Grants Nos. PI12/00183 and PI15/00625, both included in Plan Nacional de I + D + I, and co-financed by Instituto de Salud Carlos III, Subdireccion General de Evaluacion, Ministry of Economy and Competitiveness, and Fondo Europeo de Desarrollo Regional (FEDER). CIBER of Diabetes and Associated Metabolic Diseases (CIBERDEM) is an initiative from Instituto de Salud Carlos III, Spain

A Case of Familial Partial Lipodystrophy: From Clinical Phenotype to Genetics

International audienceWe discuss the case of a 56-year-old woman who presented with diabetes from the age of 24. The diagnosis of familial partial lipodystrophy was made after the discovery of the lamin A/C gene 20 years later. The diagnosis enabled the detection of a severe cardiac rhythm disorder with the need for an implantable defibrillator. This disease is a rare disorder characterized by an altered body fat repartition, cardiac rhythm anomalies and muscular dystrophy

Assessing diabetic foot osteomyelitis remission with white blood cell SPECT/CT imaging

International audienceAIMS: Diabetic foot osteomyelitis is an important risk factor of lower limb amputation. Antibiotic therapy is often effective in preventing surgery. However, the duration of antibiotic therapy is difficult to define in the absence of a marker to diagnose osteomyelitis remission at the end of the treatment. In this study, we assessed the diagnostic performance of white blood cell SPECT/CT imaging for evaluating osteomyelitis remission. PATIENTS AND METHODS: Twenty-nine out of 42 episodes of diabetic foot osteomyelitis seen between December 2009 and April 2012 had radiographs, a three-phase bone scintigraphy and a white blood cell SPECT/CT at the end of antibiotic therapy. They were treated with antibiotics alone and considered in clinical remission. White blood cell SPECT/CT results were considered positive when abnormal uptake in the osteomyelitis location was identified. Osteomyelitis remission was defined by the absence of an osteomyelitis relapse after 12 months' follow-up. RESULTS: A negative white blood cell SPECT/CT was seen for 22 episodes of osteomyelitis. All of them were in remission. A positive white blood cell SPECT/CT was observed for seven episodes. A relapse occurred in five episodes (71.5%) after a median duration of 4 months (2-7 months). Sensitivity, specificity, positive predictive value and predictive negative value in predicting osteomyelitis relapse after the discontinuation of antibiotic treatment were, respectively, for radiographs 80%, 33%, 20% and 89%; for three-phase bone scintigraphy 100%, 12.5%, 15.5% and 100%; and for the white blood cell SPECT/CT 100%, 91.5%, 71.5% and 100%. CONCLUSION: Negative uptake on white blood cell SPECT/CT is a good marker for diagnosis of diabetic foot osteomyelitis remission and might be very useful in guiding antibiotic therapy

Antibody-Mediated Insulin Resistance: When Insulin and Insulin Receptor Act as Autoantigens in Humans

International audienceWe report the case of a patient with diabetes presenting a severe insulin-resistance syndrome due to the production of insulin autoantibodies by a lymphocytic lymphoma. We describe the various mechanisms leading to the production of insulin autoantibodies and insulin receptor autoantibodies and review the therapeutic possibilities

Advanced glycation end products assessed by skin autofluorescence: a new marker of diabetic foot ulceration

International audienceBackground: Accumulation of advanced glycation end products (AGEs) may contribute to diabetic foot ulceration (DFU). Our goal was to determine whether AGEs measurement by skin autofluorescence (SAF) would be an additional marker for DFU management. Patients and Methods: We performed SAF analysis in 66 patients with a history of DFU prospectively included and compared the results with those of 84 control patients with diabetic peripheral neuropathy without DFU. We then assessed the prognostic value of SAF levels on the healing rate in the DFU group. Results: Mean SAF value was significantly higher in the DFU group in comparison with the control group, even after adjustment for other diabetes complications (3.2-0.6 arbitrary units vs. 2.9-0.6 arbitrary units; P = 0.001). In the DFU group, 58 (88%) patients had an active wound at inclusion. The mean DFU duration was 14-13 weeks. The healing rate was 47% after 2 months of appropriate foot care. A trend for a correlation between SAF levels and healing time in DFU subjects was observed but was not statistically significant (P = 0.06). Conclusions: Increased SAF levels are associated with neuropathic foot complications in diabetes. Use of SAF measurement to assess foot vulnerability and to predict DFU events in high-risk patients appears to be promising

Carotid atherosclerosis progression and cerebrovascular events in patients with diabetes

International audienceAIM: Carotid atherosclerosis progression is associated with a higher risk of cerebrovascular events but there is no specific data for diabetes. We assessed in a cohort of patients with diabetes the rate of atherosclerosis progression by Doppler ultrasonography and the association with cerebrovascular events. METHODS: We analyzed a retrospective cohort of 342 patients with a mean duration of diabetes of 13.6+/-10.6years. The mean delay between the first and last Doppler ultrasonography was 6.4+/-4.6years, with a mean of 3.4 examinations per person. Cerebrovascular events were noted. RESULTS: A progression of carotid atherosclerosis was observed in 20.1% of cases. No factor was significantly associated with progression. A prophylactic carotid endarterectomy was performed on 6 of the 27 patients with a stenosis \textgreater/=50%. A cerebrovascular event occurred in 1.2% of patients; none of them had carotid atherosclerosis progression. CONCLUSIONS: Carotid atherosclerosis progression in patients with diabetes is frequent but surgical treatment and cerebrovascular events are low. The benefit of a systematic follow-up of carotid atherosclerosis seems limited

Usefulness of a systematic screening of carotid atherosclerosis in asymptomatic people with type 2 diabetes for cardiovascular risk reclassification

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Autoimmune Recurrence as a Cause of Adrenal Gland Graft Loss?

International audienceTwo years ago we reported the outcome at one year of the first simultaneous kidney-adrenal gland-pancreas transplantation in a type 1 diabetic patient with chronic kidney disease and concomitant autoimmune adrenal insufficiency (1). The transplantation of the adrenal gland was proposed to the patient given the considerable risk of recurrent adrenal crises in this patient, who had already experienced two episodes on substitutive treatment with hydrocortisone and fludrocortisone. This therapeutic option was considered surgically feasible by transplanting the left adrenal gland en-bloc with the left kidney without additional vascular anastomosis. This article is protected by copyright. All rights reserved