Recommandations 2012 en diabetologie Prise en charge de l’hyperglycémie dans le diabète de type 2 : une approche centrée sur le patient

in Revue Médicale de Liège (2012), 67(12), 623-631

The pharmacological therapy of type 2 diabetes has become increasingly complex and the goals are now more diverse and, in general, more stringent. The glycaemic target (glycated haemoglobin or HbA1c ) and ... [more ▼]

The pharmacological therapy of type 2 diabetes has become increasingly complex and the goals are now more diverse and, in general, more stringent. The glycaemic target (glycated haemoglobin or HbA1c ) and the medications to be prescribed to reach it should be selected according to the individual characteristics of the patient and, if possible, in agreement with him/her. The most relevant criteria to be taken into account are the glucose-lowering efficacy, the risk of hypoglycaemia, the effect on body weight, the side effects and the costs. We summarize here the strategy proposed in the joint «position statement» published in 2012 by the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD). We will more particularly focus our attention on the practical aspects useful for the clinician [less ▲]

Relation between disease phenotype and HLA-DQ genotype in diabetic patients diagnosed in early adulthood.

in Journal of Clinical Endocrinology and Metabolism (2002), 87(6), 2597-605

We investigated inaugural disease phenotype in relation to the presence or absence of diabetes-associated autoantibodies and human leukocyte antigen (HLA) DQ risk genotypes in adult-onset diabetic ... [more ▼]

We investigated inaugural disease phenotype in relation to the presence or absence of diabetes-associated autoantibodies and human leukocyte antigen (HLA) DQ risk genotypes in adult-onset diabetic patients. Blood samples and questionnaires were obtained from 1584 recent-onset Belgian Caucasian patients (age 15-39 yr at diagnosis of primary diabetes) who were recruited by the Belgian Diabetes Registry over an 11-yr period. At clinical diagnosis, antibody-positive patients (n = 1198) were on average younger and had more symptoms, a more acute disease onset, lower body mass index, and random C-peptide levels, but higher insulin needs, glycemia, and prevalence of ketonuria, HLA-DQ, and 5' insulin gene susceptibility genotypes (P < 0.001 vs. antibody-negative patients; n = 386). In antibody-positive patients, these characteristics did not differ according to HLA-DQ genotype. However, in antibody-negative subjects, we found that patients were younger (P = 0.001); had a lower body mass index (P < 0.001), higher insulin needs (P = 0.014), and amylasemia (P = 0.001); and tended to have a higher glycemia and lower C-peptide in the presence of susceptible HLA-DQ genotypes. Differences according to HLA-DQ genotype subsisted after careful age-matching. In conclusion, we found no relation between initial disease phenotype and HLA-DQ genotype in antibody-positive diabetic young adults. In contrast, antibody-negative patients displayed more type 1-like features when carrying susceptible HLA-DQ genotypes known to promote the development of antibody-positive diabetes. The overrepresentation of these susceptibility genotypes in antibody-negative patients suggests the existence of an immune-mediated disease process with as yet unidentified immune markers in a subgroup of seronegative patients. [less ▲]