Morning hyperglycemic excursions. A constant failure in the metabolic control of non-insulin-using patients with type 2 diabetes

WSTĘP. Celem pracy było ustalenie występowania w ciągu dnia epizodów hiperglikemii prowadzących do złej kontroli metabolicznej u chorych na cukrzycę typu 2. MATERIAŁ I METODY. Badana grupa liczyła 200 chorych na cukrzycę typu 2 leczonych lekami doustnymi i/lub dietą. W populacji tej badano profile dobowe glikemii i insulinemii. Pomiarów stężenia glukozy dokonywano na czczo bezpośrednio przed śniadaniem o 8.00 rano, następnie w okresie poposiłkowym o godz. 11.00 i 14.00) oraz w okresie poabsorpcyjnym o 17.00. WYNIKI. W całej populacji wartości glikemii przed obiadem (12,0 mmol/l) były znamiennie podwyższone (p < 0,0001) w porównaniu z glikemią mierzoną o godzinie 8.00 (8,8 mmol/l), 14.00 (10,5 mmol/l) i 17.00 (8,6 mmol/l). Podobny wzrost glikemii przedobiedniej (p < 0,0001) obserwowano w grupach chorych dobranych według kryteriów: 1) masy ciała; 2) wieku; 3) HbA1c; 4) sposobu leczenia; 5) rezydualnej funkcji komórek b. Z obliczeń pól pod krzywą dziennego przebiegu glikemii wynika, że w całkowitym podwyższeniu stężenia glukozy w surowicy względny udział glikemii na czczo i poposiłkowej jest zbliżony. WNIOSKI. Wysokie stężenia glukozy w surowicy w okresie przedpołudniowym są dość charakterystycznym wykładnikiem niepowodzenia leczenia cukrzycy typu 2 z zastosowaniem diety i leków doustnych. Hiperglikemie przedobiednie występują niezależnie od cech klinicznych (wskaźnik masy ciała [BMI, body mass index]), biologicznych (hemoglobina glikowana[HbA1c]), terapeutycznych i patofizjologicznych (rezydualna funkcja komórek b). W celu wykrycia takich zaburzeń powinno się zalecać dodatkowe pomiary glikemii przed obiadem. Przedpołudniowe hiperglikemie wymagają zmiany w leczeniu chorego.INTRODUCTION. To determine whether, over daytime, one or several hyperglycemic excursions exist that can be general failures in the glycemic control of patients with type 2 diabetes. MATERIAL AND METHODS. In 200 non-insulin-using patients with type 2 diabetes, diurnal plasma glucose and insulin profiles were studied. Plasma glucose concentrations were measured after an overnight fast (at 8:00 A.M. immediately before breakfast), during the postprandial period (at 11:00 A.M. and 2:00 P.M.), and during the postabsorptive period (at 5:00 P.M., extended postlunch time). RESULTS. In the population considered as a whole, prelunch glucose concentrations (12.0 mmol/l) were found to be significantly increased (P < 0.0001) when compared with those observed at 8:00 A.M. (8.8 mmol/l), at 2:00 P.M. (10.5 mmol/l), and at 5:00 P.M. (8.6 mmol/l). Similar significant excursions (P < < 0.0001) in prelunch glucose were observed within subsets of patients selected from the following criteria: 1) body weight; 2) HbA1c; 3) categories of treatment and 4) residual &#946;-cell function. From the calculation of areas under the daytime glucose curves, the relative contributions of postprandial and fasting glucose to the total glucose increment were found to be similar. CONCLUSIONS. High plasma glucose excursions over morning periods seem to be a permanent failure in non&#8211;insulin-using patients with type 2 diabetes, whatever the clinical (BMI), biological (HbA1c), therapeutic, and pathophysiological (residual &#946;-cell function) status. Midmorning glucose testing should be recommended for detecting such abnormalities and for correcting them with appropriate therapies

Triglycerides and glycated hemoglobin for screening insulin resistance in obese patients

International audienceOBJECTIVE: Assessment of insulin resistance (IR) is essential in non-diabetic patients with obesity. Thus study aims to identify the best determinants of IR and to propose an original approach for routine assessment of IR in obesity. DESIGN AND PATIENTS: All adult with obesity defined by a body mass index >=30kg/m2, evaluated in the Nutrition Department between January 2010 and January 2015 were included in this cross-sectional study. Patients with diabetes were excluded. IR was diagnosed according to the HOMA-IR. Based on a logistic regression, we determined a composite score of IR. We then tested the variables with a principal component analysis and a hierarchical clustering analysis. RESULTS: A total of 498 patients with obesity were included. IR was associated with grade III obesity (OR=2.6[1.6-4.4], p\textless0.001), HbA1c>=5.7% (OR=2.6[1.7-4.0], p\textless0.001), hypertriglyceridemia \textgreater1.7mmol/l (OR=3.0[2.0-4.5], p\textless0.001) and age (OR=0.98[0.96-0.99], p=0.002). Exploratory visual analysis using factor map and clustering analysis revealed that lipid and carbohydrates metabolism abnormalities were correlated with insulin resistance but not with excessive fat accumulation and low-grade inflammation. CONCLUSIONS: Our results highlight the interest of simple blood tests such as HbA1c and triglyceride determination, which associated with BMI, may be widely available tools for screening IR in obese patients

Systems medicine and integrated care to combat chronic noncommunicable diseases

We propose an innovative, integrated, cost-effective health system to combat major non-communicable diseases (NCDs), including cardiovascular, chronic respiratory, metabolic, rheumatologic and neurologic disorders and cancers, which together are the predominant health problem of the 21st century. This proposed holistic strategy involves comprehensive patient-centered integrated care and multi-scale, multi-modal and multi-level systems approaches to tackle NCDs as a common group of diseases. Rather than studying each disease individually, it will take into account their intertwined gene-environment, socio-economic interactions and co-morbidities that lead to individual-specific complex phenotypes. It will implement a road map for predictive, preventive, personalized and participatory (P4) medicine based on a robust and extensive knowledge management infrastructure that contains individual patient information. It will be supported by strategic partnerships involving all stakeholders, including general practitioners associated with patient-centered care. This systems medicine strategy, which will take a holistic approach to disease, is designed to allow the results to be used globally, taking into account the needs and specificities of local economies and health systems

Protecting the Liver: Should We Substitute Fruit Juices for Sugar-Sweetened Beverages?

International audienc

Les comportements des parents vis-à-vis de l'alimentation de leurs enfants (influence du statut pondéral)

Le surpoids et l'obésité infantile représentent un problème majeur de santé publique, avec une prévalence d'environ 150/0, malgré une stabilisation récemment observée. Les facteurs· environnementaux et l'éducation à l'alimentation, s'associent à la part génétique du risque d'obésité chez l'enfant. Notre étude s'intéresse aux déterminants des pratiques éducatives des parents en termes d'alimentation, avec l'évaluation de l'influence du poids des parents sur ces comportements, et l'influence de leur de statut de restriction cognitive. Méthode : une étude transversale a évalué les comportements alimentaires des parents vis-à-vis de leurs enfants par un questionnaire issu du Comprehensive Feeding Practices Questionnaire (CFPQ). Puis la population a été séparée en tertiles en fonction des variables étudiées et une Analyse de Variance (ANOVA) a été réalisée pour les comparer. Résultats : nous avons retrouvé une utilisation de la nourriture comme récompense plus importante chez les parents ayant es IMC les plus élevés, ainsi qu'une tendance à moins de restriction pour le poids. Les parents ayant les IMC les plus bas ont tendance à proposer une alimentation plus variée et plus équilibrée à leurs enfants. D'autre part, les parents les plus restrictifs sont ceux qui restreignent le plus leurs enfants, mais également ceux qui leur offrent l'environnement alimentaire le plus sain. Conclusion: ces résultats suggèrent que le statut pondéral des parents influence certains de leurs / comportements vis-à-vis de l'alimentation de leurs enfants, notamment l'utilisation de la nourriture comme récompense, qui peut favoriser le déséquilibre de la balance énergétique chez l'enfant. Des mesures de prévention ont été mises en place, au travers du PNNS et du Plan Obésité, une prévention plus ciblée sur certains comportements pourrait être une des pistes pour l'optimisation de cette prévention. D'autres études avec une population plus représentative doivent être menées.MONTPELLIER-BU Médecine UPM (341722108) / SudocMONTPELLIER-BU Médecine (341722104) / SudocSudocFranceF

Effets sur la santé des alimentations végétariennes (données bibliographiques)

MONTPELLIER-BU Médecine UPM (341722108) / SudocMONTPELLIER-BU Médecine (341722104) / SudocPARIS-BIUM (751062103) / SudocSudocFranceF