Showing papers by "Anne Wojtusciszyn published in 2017"

Toward Defining the Threshold Between Low and High Glucose Variability in Diabetes

Abstract: OBJECTIVE To define the threshold for excess glucose variability (GV), one of the main features of dysglycemia in diabetes. RESEARCH DESIGN AND METHODS A total of 376 persons with diabetes investigated at the University Hospital of Montpellier (Montpellier, France) underwent continuous glucose monitoring. Participants with type 2 diabetes were divided into several groups—groups 1, 2a, 2b, and 3 ( n = 82, 28, 65, and 79, respectively)—according to treatment: 1 ) diet and/or insulin sensitizers alone; 2 ) oral therapy including an insulinotropic agent, dipeptidyl peptidase 4 inhibitors (group 2a) or sulfonylureas (group 2b); or 3 ) insulin. Group 4 included 122 persons with type 1 diabetes. Percentage coefficient of variation for glucose (%CV = [(SD of glucose)/(mean glucose)] × 100) and frequencies of hypoglycemia (interstitial glucose RESULTS Percentages of CV (median [interquartile range]; %) increased significantly ( P P P 36% were compared with those with %CV ≤36%. CONCLUSIONS A %CV of 36% appears to be a suitable threshold to distinguish between stable and unstable glycemia in diabetes because beyond this limit, the frequency of hypoglycemia is significantly increased, especially in insulin-treated subjects.

Randomised, prospective, medico-economic nationwide French study of islet transplantation in patients with severely unstable type 1 diabetes: the STABILOT study protocol

Abstract: Introduction Islet transplantation may be an appropriate treatment option for patients with severely unstable type 1 diabetes experiencing major glucose variability with severe hypoglycaemia despite intensive insulin therapy. Few data are available on the costs associated with islet transplantation in relation to its benefits. The STABILOT study proposes to assess the economic impact of islet transplantation in comparison with the current best medical treatment defined as sensor-augmented pump (SAP) therapy. Methods The trial will adopt an open-label, randomised, multicentred design. The study will include 30 patients with severely unstable type 1 diabetes. Eligible participants will be 18–65 years old, with type 1 diabetes duration >5 years, a negative basal or stimulated C-peptide, and severe instability defined by persistent, recurrent and disabling severe hypoglycaemia, despite optimised medical treatment. Participants will be randomised into two groups: one group with immediate registration for islet transplantation, and one group with delayed registration for 1 year while patients receive SAP therapy. The primary endpoint will be the incremental cost-utility ratio at 1 year between islet transplantation and SAP therapy. Perspectives of both the French Health Insurance System and the hospitals will be retained. Ethics and dissemination Ethical approval has been obtained at all sites. The trial has been approved by ClinicalTrials.gov (Trial registration ID NCT02854696). All participants will sign a free and informed consent form before randomisation. Results of the study will be communicated during national and international meetings in the field of diabetes and transplantation. A publication will be sought in journals usually read by physicians involved in diabetes care, transplantation and internal medicine. Trial registration number NCT02854696; Pre-results.

Un col à risque : rapport d’un hypercortisolisme ACTH-dépendant très agressif induit par une tumeur neuro-endocrine du col utérin

Abstract: Introduction Le syndrome de Cushing ACTH-dependant peut etre lie a un adenome hypophysaire ou a une secretion ectopique d’ACTH. Observation Nous rapportons le cas d’une patiente de 32 ans ayant un carcinome neuro-endocrine a petites cellules de haut grade du col uterin diagnostique devant des metrorragies. Entre les deux premieres cures de chimiotherapie : apparition d’une obesite facio-tronculaire, erythrose faciale, faiblesse musculaire, hypertension arterielle et d’un hirsutisme. La biologie retrouvait un diabete (HbA1c 8, 3 %) et des hypokaliemies severes ( 63,4 μg/dL), et absence de freinage sous dexamethasone. L’ACTH etait elevee (384 pg/mL). Les tests dynamiques ont confirme l’origine paraneoplasique. Cet hypercortisolisme a engendre des poussees hypertensives necessitant l’augmentation de l’aldactone a 400 mg/j, des hyperglycemies necessitant une insulinotherapie, des hypokaliemies menacantes. Une surrenalectomie bilaterale a ete realisee devant l’echec du traitement medical par Lysodren et Nizoral. L’evolution par la suite a revele des metastases multiples. Discussion Les tumeurs du col neuro-endocrines sont rares et d’autant plus celles produisant de l’ACTH. Elles surviennent souvent avant 50 ans et des metastases sont frequentes. Les consequences peuvent etre tres severes [1] .