Mesure de l’AASI (Ambulatory Arterial Stiffness Index) calculé lors d’un test court avec mesure continue de la pression artérielle.

in Archives des Maladies du Coeur et des Vaisseaux (2007), 100(hors série), 28078

Effets de la duree du diabete de type 1 sur la pression arterielle pulse: etude transversale controlee.

in Archives des Maladies du Coeur et des Vaisseaux (2006), 99(7-8), 683-6

Diabetes mellitus and arterial pulse pressure (PP) are two independent cardiovascular risk factors. This cross-sectional study investigated the influence of diabetes duration on PP in type 1 diabetic ... [more ▼]

Diabetes mellitus and arterial pulse pressure (PP) are two independent cardiovascular risk factors. This cross-sectional study investigated the influence of diabetes duration on PP in type 1 diabetic patients without any cardiovascular disease. PP was measured continuously during 3 minutes (active orthostatic test: 1 min standing--1 min squatting--1 min standing) using a fingertip plethysmograph (Finapres) in 159 type 1 diabetic patients aged 20-60 yrs. They were divided into 4 groups according to diabetes duration: (1) G1 : <10 yrs (n=39); G2: 11-20 yrs (n=45); G3: 21-30 yrs (n=57); and G4: >30 yrs (n=18). In order to separate the effects of age from the effects of diabetes duration, diabetic patients were compared to age- and sex-matched non diabetic controls. PP (expressed in mmHg; mean +/- SD) was higher in men than in women in both diabetic (58 +/- 15 vs. 50 +/- 14; p = 0.001) and non diabetic subjects (55 +/- 14 vs. 47 +/- 12; p = 0.001). Overall PP was higher in diabetic than in non diabetic individuals (54 +/- 15 vs. 50 +/- 13; p = 0.025). PP progressively increased according to diabetes duration: 47 +/- 16 vs. 51 +/- 13 vs. 59 +/- 14 vs. 62 +/- 12, from G1 to G4 respectively; p < 0.0001. Such an increase was not observed in age-matched non diabetic subjects: 50 +/- 11 vs. 52 +/- 12 vs. 49 +/- 14 vs. 52 +/- 18, from G1 to G4, respectively; NS. PP was higher in squatting than in standing position in non diabetic subjects (52 +/- 16 vs. 47 +/- 13; p < 0.0001) and even more in diabetic patients (59 +/- 17 vs. 50 +/- 14; p < 0.0001). Overall, PP difference between diabetic and non diabetic individuals was not significant in standing position (50 +/- 14 vs. 47 +/- 13; NS) although it became highly significant in squatting position (59 +/- 17 vs. 52 +/- 16; p = 0.0005). The squatting-standing difference in PP markedly increased with diabetes duration: 69 +/- 14 during squatting vs. 50 +/- 18 during standing in G4 compared to respectively 50 +/- 17 vs. 44 +/- 15 in G1 diabetic patients. Finally, PP was similar (NS) in diabetic patients with HbA1c < 8% (54 +/- 14) or > or =8% (55 +/- 16), with (57 +/- 17) or without (54 +/- 14) microalbuminuria, treated (56 +/- 14) or not (54 +/- 15) by inhibitors of the renin-angiotensin system. In conclusion, PP progressively increased with the duration of type 1 diabetes, independently of age. Such increase was more marked in squatting than in standing position. The role of such PP rise in the increased cardiovascular risk of patients with type 1 diabetes, although suspected in the recent EURODIAB Prospective Complications Study, deserves further investigation. [less ▲]

Effets de la durée du diabète de type 1 sur la pression artérielle pulsée : résultats d’une étude transversale comparative à un groupe contrôle non diabétique.

in Archives des Maladies du Coeur et des Vaisseaux (2005), 98(suppl), 7010

Hemochromatose et diabete sucre: approche diagnostique et evolution clinique.

in Revue Médicale de Liège (2005), 60(5-6), 448-54

We report the characteristics of diabetes mellitus in 10 patients with a suspicion of hereditary hemochromatosis. The results of this personal series were compared to literature's data described in a ... [more ▼]

We report the characteristics of diabetes mellitus in 10 patients with a suspicion of hereditary hemochromatosis. The results of this personal series were compared to literature's data described in a recent article. Early diagnosis and treatment by phlebotomy can improve blood glucose control in the early stages of the disease. If diagnosis occurs later, when the patient already needs insulin therapy, diabetes will not be improved by phlebotomy anymore. [less ▲]

Le medicament du mois. L'insuline detemir (Levemir)

in Revue Médicale de Liège (2005), 60(10), 814-9

Insulin detemir (Levemir) is a soluble long acting human insulin analogue acylated with a 14-carbon fatty acid. The fatty acid modification allows insulin detemir to reversibly bind to albumin, thereby ... [more ▼]

Insulin detemir (Levemir) is a soluble long acting human insulin analogue acylated with a 14-carbon fatty acid. The fatty acid modification allows insulin detemir to reversibly bind to albumin, thereby providing slow absorption and a prolonged metabolic effect (up to 24 hours) with low variability. Indeed, in patients with type 1 or type 2 diabetes mellitus, insulin detemir has a more predictable, protracted and consistent effect, with less intrapatient variability in glycaemic control (particularly fasting plasma glucose levels), compared with NPH (Neutral Protamine Hagedorn) insulin. Insulin detemir, is at least as effective as NPH insulin in maintaining overall glycaemic control, with a lower risk of nocturnal hypoglycaemia. It also provides the additional benefit of less body weight gain as compared to other basal insulins. Levemir, presented in cartridges for the pen device NovoPen 3 and administered preferably at bedtime (if necessary morning and evening), is a promising new option for basal insulin therapy in diabetic patients, especially those on a basal-bolus scheme. [less ▲]

Influence du contrôle glycémique sur l’évolution de la pression artérielle pulsée chez le patient diabétique de type 1 : premiers résultats d’une étude longitudinale.

in Archives des Maladies du Coeur et des Vaisseaux (2004), 97(suppl), 252

Info-congres. Optimalisation de la prise en charge du patient diabetique: une selection de quelques essais cliniques presentes au Congres 2004 de l'American Diabetes Association.

in Revue Médicale de Liège (2004), 59(6), 407-12

The 64th scientific congress of the American Diabetes Association had a special session devoted to the presentation of the results from three clinical trials: 1) the first multicentre international trial ... [more ▼]

The 64th scientific congress of the American Diabetes Association had a special session devoted to the presentation of the results from three clinical trials: 1) the first multicentre international trial of pancreatic islet transplantation according to the so-called Edmonton protocol with the primary endpoint of restoring insulin independence in type 1 diabetic patients; 2) three pivotal studies of 30 weeks testing both the efficacy and safety of exenatide (exendin-4), a new insulin secretagogue that is a long-acting analogue of glucagon-like peptide-1, in patients with type 2 diabetes treated with either metformin, or a sulfonylurea, or a metformin-sulfonylurea combination; and 3) the "Collaborative AtoRvastatin Diabetes Study" (CARDS), a placebo-controlled primary prevention trial of cardiovascular complications using atorvastatin 10 mg in 2 838 at risk patients with type 2 diabetes. The main results and conclusions of these trials are briefly presented as they open new perspectives in the management of patients with type 1 or type 2 diabetes mellitus. [less ▲]

La transplantation d'ilots de Langerhans ou de cellules B: un pas vers la guerison du diabete?

in Revue Médicale de Liège (2003), 58(2), 83-7

Diabetes mellitus places an enormous burden on patients, their relatives and the society. Current therapies do not provide sufficiently tight control of blood glucose to avoid diabetic complications. Some ... [more ▼]

Diabetes mellitus places an enormous burden on patients, their relatives and the society. Current therapies do not provide sufficiently tight control of blood glucose to avoid diabetic complications. Some recent developments try to restore normal glucose homeostasis. Research is islet and stem cell transplantation is developing rapidly and this article summarizes the new approaches that could cure and not simply treat diabetes in the future. [less ▲]

Strategies de prevention du diabete de type 1: le point en 2003.

in Revue Médicale de Liège (2003), 58(4), 211-9

Type 1 diabetes is caused by a progressive autoimmune destruction of insulin-producing B cells of the pancreatic islets of Langerhans. The autoimmune process begins years before the B-cell destruction ... [more ▼]

Type 1 diabetes is caused by a progressive autoimmune destruction of insulin-producing B cells of the pancreatic islets of Langerhans. The autoimmune process begins years before the B-cell destruction becomes complete, thereby providing an opportunity for early intervention. Genetic susceptibility markers have been identified and autoantibody assays make possible the identification of individuals at high risk of the disease. Prevention strategies could be implemented in first-degree relatives of type 1 diabetic patients at high risk of developing the disease because of the presence of several autoantibodies. Alternatively, they may also be considered at time of clinical diagnosis of type 1 diabetes mellitus in order to maintain residual endogenous insulin secretion that markedly contributes to long-term better glycaemic stability. Thus, the goals of prevention are to preserve B cells during the preclinical period and/or after early diagnosis by modifying immunological pathogenic processes. Several molecules have been administered or are currently investigated to achieve this protection. This article summarizes the hopes and deceptions of previous clinical trials and describes the rationale and protocols of ongoing trials dealing with the prevention of type 1 diabetes. [less ▲]

L'etude clinique du mois. Essais de preservation des cellules B a la phase initiale du diabete de type 1: resultats negatifs avec l'insuline retard, mais prometteurs avec un anticorps monoclonal anti-CD3.

in Revue Médicale de Liège (2002), 57(6), 413-7

Type 1 diabetes is an autoimmune disease leading to a progressive exhaustion of the insulin secretion and a destruction of the B-cells. Attempts of preservation of insulin-producing B-cells can be ... [more ▼]

Type 1 diabetes is an autoimmune disease leading to a progressive exhaustion of the insulin secretion and a destruction of the B-cells. Attempts of preservation of insulin-producing B-cells can be performed at an early, most often silent, stage of the disease in well-selected at high risk subjects or during the period immediately following the clinical diagnosis based upon classical signs of hyperglycaemia. In the "Diabetes Prevention Trial-Type 1", the prophylactic subcutaneous administration of low-dose ultralente insulin was not able to prevent the development of type 1 diabetes nor to preserve residual insulin secretion in young relatives at very high-risk of diabetes, selected upon genetic, immunological and metabolic criteria. In contrast, a pilot randomized trial shows that a treatment with a nonactivating humanized monoclonal antibody against CD3 mitigates the deterioration in insulin production and improves metabolic control, with lower dose of exogenous insulin, during the first year of type 1 diabetes mellitus in 9 out of 12 treated patients. Besides a better understanding of the natural history of the disease, these clinical trials open new perspectives for prevention of type 1 diabetes mellitus, currently assessed by the Belgian Diabetes Registry. [less ▲]