Recent Advances in the Management of Diabetes Mellitus

peer reviewedThe recent epidemic of type 2 diabetes and the recognition that achieving specific glycemic goals can reduce morbidity have made the effective treatment of hyperglycemia a priority. The new therapeutic agents and the development of algorithms for the adjustment of therapy might contribute to an improved management of the disease. Moreover, type 2 diabetes is frequently associated with other co-morbidities (obesity, hypertension, dyslipidaemia, prothrombotic state). The appropriate management of patients with type 2 diabetes requires a global approach targeting each risk factor in order to reduce cardiovascular morbidity and mortality. This challenge represents a major public health issue. In type 1 diabetes patients, intensive therapy such as in the Diabetes Control and Complications Trial (DCCT) has been shown to obtain long-term beneficial effects on the reduction of the risk of progressive retinopathy, neuropathy and nephropathy and of the risk of cardiovascular disease. This benefit reinforces the original DCCT message that intensive therapy should be implemented as early as possible in people with type 1 diabetes. The recent development of new insulin analogues and the technical improvements of portable insulin pumps might contribute to obtain such a better metabolic control.RÉSUMÉ : L’augmentation d’incidence, quasi épidémique, du diabète de type 2 et la démonstration que l’obtention de bons taux glycémiques permettait de réduire la morbidité ont fait du traitement de l’hyperglycémie une priorité. Le développement de nouvelles classes thérapeutiques et la mise au point d’algorithmes de traitement contribuent à améliorer cette prise en charge. De plus, le diabète de type 2 est souvent associé à d’autres comorbidités (obésité, hypertension artérielle, dyslipidémies, état pro-thrombotique). La prise en charge du patient diabétique de type 2 requiert une approche globale visant à corriger chaque facteur de risque, ce qui permet de réduire substantiellement la mortalité cardio-vasculaire. Cette stratégie doit être considérée comme un objectif majeur de santé publique. Chez le sujet diabétique de type 1, un traitement intensif, comme celui imposé dans l’étude DCCT, permet d’obtenir une réduction prolongée du risque de survenue et de progression de la rétinopathie, de la neuropathie, de la néphropathie ainsi que du risque de maladie cardio-vasculaire. Ce bénéfice persistant renforce le message initial de l’étude DCCT qui avait démontré que le traitement intensif du diabète de type 1 devait être instauré dès le début de la maladie. Le développement récent des analogues de l’insuline et les améliorations techniques des pompes à insuline portables pourraient contribuer à atteindre un meilleur contrôle métabolique

ANALYSE DE TRACES ET ERGONOMIE, Étude du MOOC COURLIS

Depuis les années 2000, les domaines de l’éducation et du web co-évoluent au sein de la e-éducation. Les MOOC (Massive Online Open Courses) sont des cours de diverses natures et provenances qui sont dispensés de manière ouverte et souvent gratuite, à distance, via internet et pouvant donc accueillir un très grand nombre de participants. Ce mémoire propose des indicateurs permettant d’analyser l’activité des usagers de ces cours afin d’obtenir des informations utiles à leur responsables pour faire le bilan des cours ou encore créer ou modifier un MOOC. Ces indicateurs sont de nature statistique, provenant du data mining, applicables aux traces laissées par les utilisateurs des MOOCs sur les sites internet leur servant de support. D’autres indicateurs, de nature ergonomique cette fois, seront également proposés, applicables aux sites support du MOOC, tout comme aux médias utilisés par le MOOC lui-même et notamment aux vidéos qui constituent un média clef. Enfin, le MOOC COURLIS (COURs en LIgne de Statistique appliquée) de l’Université de Lorraine ouvert en septembre 2013 sera analysé grâce à ces indicateurs dans le but d’apporter à ses créateurs un bilan de l’activité et des observations qualitatives

Crowdsourcing Complex Language Resources: Playing to Annotate Dependency Syntax

International audienceThis article presents the results we obtained on a complex annotation task (that of dependency syntax) using a specifically designed Game with a Purpose, ZombiLingo. We show that with suitable mechanisms (decomposition of the task, training of the players and regular control of the annotation quality during the game), it is possible to obtain annotations whose quality is significantly higher than that obtainable with a parser, provided that enough players participate. The source code of the game and the resulting annotated corpora (for French) are freely available

Rigor Mortis: Annotating MWEs with a Gamified Platform

International audienceWe present here Rigor Mortis, a gamified crowdsourcing platform designed to evaluate the intuition of the speakers, then train them to annotate multi-word expressions (MWEs) in French corpora. We previously showed (Fort et al., 2018) that the speakers' intuition is reasonably good (65% in recall on non-fixed MWE). After a training phase using some of the tests developed in the PARSEME-FR project, we obtain 0.685 in F-measure at an experimentally determined 25% threshold (number of players who annotated the same segment)

An Exact Solution to Support Vector Mixture

International audienceThis paper presents a new version of the SVM mixture algorithm initially proposed by Kwok for classification and regression problems. For both cases, a slight modification of the mixture model leads to a standard SVM training problem, to the existence of an exact solution and allows the direct use of well known decomposition and working set selection algorithms. Only the regression case is considered in this paper but classification has been addressed in a very similar way. This method has been successfully applied to engine pollutants emission modeling

Reactive hypoglycaemia, a frequently mentioned functional disorder, yet overestimated in clinical practice.

editorial reviewedMalaises are often attributed to hypoglycaemia in nondiabetic people who don't have any other serious medical problem. Reactive hypoglycaemia, the most frequent one, may be considered as a functional disorder. However, its diagnosis is often overused, because not really demonstrated in most instances. The diagnosis of hypoglycaemia should be structured, based upon the Whipple triad. First, the medical interrogatory must search for adrenergic and neuroglucopenic symptoms that suggest hypoglycaemia. Second, if the malaise is due to a hypoglycaemia, it should resume rapidly after the administration of sugar. Third, hypoglycaemia must be confirmed by a measurement of a low glucose level at the time of a malaise. The latter approach is facilitated by the use of home blood monitoring, a strategy that is now preferred to the use of an oral glucose tolerance test, a non-physiological test far from real-life conditions. When the diagnosis is made based upon this triad, the medical interview should precise the severity of the symptoms and focus on the chronology of the malaises, typically 2-3 hours after a sugar-enriched meal in case of a reactive hypoglycaemia. Therapeutic approach of this functional disorder mostly relies on dietary advices

Crowdsourcing Complex Language Resources: Playing to Annotate Dependency Syntax

International audienceThis article presents the results we obtained on a complex annotation task (that of dependency syntax) using a specifically designed Game with a Purpose, ZombiLingo. We show that with suitable mechanisms (decomposition of the task, training of the players and regular control of the annotation quality during the game), it is possible to obtain annotations whose quality is significantly higher than that obtainable with a parser, provided that enough players participate. The source code of the game and the resulting annotated corpora (for French) are freely available

Kernel Hierarchical Agglomerative Clustering - Comparison of Different Gap Statistics to Estimate the Number of Clusters

International audienceClustering algorithms, as unsupervised analysis tools, are useful for exploring data structure and have owned great success in many disciplines. For most of the clustering algorithms like k-means, determining the number of the clusters is a crucial step and is one of the most difficult problems. Hierarchical Agglomerative Clustering (HAC) has the advantage of giving a data representation by the dendrogram that allows clustering by cutting the dendrogram at some optimal level. In the past years and within the context of HAC, efficient statistics have been proposed to estimate the number of clusters and the Gap Statistic by Tibshirani has shown interesting performances. In this paper, we propose some new Gap Statistics to further improve the determination of the number of clusters. Our works focus on the kernelized version of the widely-used Hierarchical Clustering Algorithm

Investigational glucagon receptor antagonists in Phase I and II clinical trials for diabetes.

INTRODUCTION: Despite type 2 diabetes (T2D) being recognized as a bihormonal pancreatic disease, current therapies are mainly focusing on insulin, while targeting glucagon has been long dismissed. However, glucagon receptor (GCGr) antagonists are currently investigated in clinical trials. Area covered: Following a brief description of the rationale for antagonizing GCGr in T2D, lessons from GCGr knock-out mice and pharmacological means to antagonize GCGr, a detailed description of the main results obtained with GCGr antagonists in Phase I-II clinical trials is provided. The development of several small molecules has been discontinued, while new ones are currently considered as well as innovative approaches such as monoclonal antibodies or antisense oligonucleotides inhibiting GCGr gene expression. Their potential benefits but also limitations are discussed. Expert opinion: The proof-of-concept that antagonizing GCGr improves glucose control in T2D has been confirmed in humans. Nevertheless, some adverse events led to stopping the development of some of these GCGr antagonists. New approaches seem to have a better benefit/risk balance, although none has progressed to Phase III clinical trials so far. Pharmacotherapy of T2D is becoming a highly competitive field so that GCGr antagonists should provide clear advantages over numerous existing glucose-lowering medications before eventually reaching clinical practice

Who wants to play Zombie? A survey of the players on ZOMBILINGO

International audienceWe present here the results of two surveys we led on ZOMBILINGO's players, aiming at learning who they are and what are their motivations in playing the game, in order to improve the participation in the game