Vitamin D and type 2 diabetes mellitus: Where do we stand?
CAVALIER, Etienne ; DELANAYE, Pierre ; et al
in Diabètes & Métabolism (2011), 37(4), 265-72
AIMS: In-vitro and observational studies have established a link between vitamin D deficiency and different type 2 diabetes outcomes (insulin resistance, insulin secretion, glucose intolerance). Although ... [more ▼]
AIMS: In-vitro and observational studies have established a link between vitamin D deficiency and different type 2 diabetes outcomes (insulin resistance, insulin secretion, glucose intolerance). Although the number of randomized controlled trials vs placebo is small, vitamin D (VTD) has been shown to prevent increases in glucose concentration and insulin resistance, enhance insulin sensitivity and reduce systolic blood pressure in type 2 diabetic patients. METHODS: In this review, we have focused on the potential mechanisms that might explain the association between VTD and type 2 diabetes mellitus (T2DM). We have also evaluated the different epidemiological and observational studies on the topic, as well as the various interventional studies. RESULTS: Although the in vitro studies appear to be promising in explaining the link between VTD metabolism and T2DM, the results of in vivo studies are conflicting. This could be related to differences in their methodological approaches. CONCLUSION: Although more studies are needed to confirm the role of VTD in the treatment of T2DM, there is nevertheless enough evidence at this time to suggest a need to maintain 25-OH vitamin D levels in T2DM patients around 30ng/mL over the course of a year. [less ▲]Detailed reference viewed: 53 (7 ULg)
Inhibiteurs du cotransporteur du glucose SGLT rénal pour traiter le diabète de type 2
SCHEEN, André ; RADERMECKER, Régis ; ERNEST, Philippe et al
in Revue Médicale Suisse (2011), 7(306), 1621-1629Detailed reference viewed: 17 (5 ULg)
Tight Glycaemic control and nutrition: A comparison of two protocols
; ; et al
in Proceedings of the Centre for Bio-Engineering One Day Conference 2010 (2010)Detailed reference viewed: 6 (0 ULg)
What makes tight glycemic control tight? The impact of variability and nutrition in two clinical studies.
; ; Preiser, Jean-Charles et al
in Journal of Diabetes Science and Technology (2010), 4(2), 284-98
INTRODUCTION: Tight glycemic control (TGC) remains controversial while successful, consistent, and effective protocols remain elusive. This research analyzes data from two TGC trials for root causes of ... [more ▼]
INTRODUCTION: Tight glycemic control (TGC) remains controversial while successful, consistent, and effective protocols remain elusive. This research analyzes data from two TGC trials for root causes of the differences achieved in control and thus potentially in glycemic and other outcomes. The goal is to uncover aspects of successful TGC and delineate the impact of differences in cohorts. METHODS: A retrospective analysis was conducted using records from a 211-patient subset of the GluControl trial taken in Liege, Belgium, and 393 patients from Specialized Relative Insulin Nutrition Titration (SPRINT) in New Zealand. Specialized Relative Insulin Nutrition Titration targeted 4.0-6.0 mmol/liter, similar to the GluControl A (N = 142) target of 4.4-6.1 mmol/liter. The GluControl B (N = 69) target was 7.8-10.0 mmol/liter. Cohorts were matched by Acute Physiology and Chronic Health Evaluation II score and percentage males (p > .35); however, the GluControl cohort was slightly older (p = .011). Overall cohort and per-patient comparisons (median, interquartile range) are shown for (a) glycemic levels achieved, (b) nutrition from carbohydrate (all sources), and (c) insulin dosing for this analysis. Intra- and interpatient variability were examined using clinically validated model-based insulin sensitivity metric and its hour-to-hour variation. RESULTS: Cohort blood glucose were as follows: SPRINT, 5.7 (5.0-6.6) mmol/liter; GluControl A, 6.3 (5.3-7.6) mmol/liter; and GluControl B, 8.2 (6.9-9.4) mmol/liter. Insulin dosing was 3.0 (1.0-3.0), 1.5 (0.5-3), and 0.7 (0.0-1.7) U/h, respectively. Nutrition from carbohydrate (all sources) was 435.5 (259.2-539.1), 311.0 (0.0-933.1), and 622.1 (103.7-1036.8) kcal/day, respectively. Median per-patient results for blood glucose were 5.8 (5.3-6.4), 6.4 (5.9-6.9), and 8.3 (7.6-8.8) mmol/liter. Insulin doses were 3.0 (2.0-3.0), 1.5 (0.8-2.0), and 0.5 (0.0-1.0) U/h. Carbohydrate administration was 383.6 (207.4-497.7), 103.7 (0.0-829.4), and 207.4 (0.0-725.8) kcal/day. Overall, SPRINT gave approximately 2x more insulin with a 3-4x narrower, but generally non-zero, range of nutritional input to achieve equally TGC with less hypoglycemia. Specialized Relative Insulin Nutrition Titration had much less hypoglycemia (<2.2 mmol/liter), with 2% of patients, compared to GluControl A (7.7%) and GluControl B (2.9%), indicating much lower variability, with similar results for glucose levels <3.0 mmol/liter. Specialized Relative Insulin Nutrition Titration also had less hyperglycemia (>8.0 mmol/liter) than groups A and B. GluControl patients (A+B) had a approximately 2x wider range of insulin sensitivity than SPRINT. Hour-to-hour variation was similar. Hence GluControl had greater interpatient variability but similar intrapatient variability. CONCLUSION: Protocols that dose insulin blind to carbohydrate administration can suffer greater outcome glycemic variability, even if average cohort glycemic targets are met. While the cohorts varied significantly in model-assessed insulin resistance, their variability was similar. Such significant intra- and interpatient variability is a further significant cause and marker of glycemic variability in TGC. The results strongly recommended that TGC protocols be explicitly designed to account for significant intra- and interpatient variability in insulin resistance, as well as specifying or having knowledge of carbohydrate administration to minimize variability in glycemic outcomes across diverse cohorts and/or centers. [less ▲]Detailed reference viewed: 32 (5 ULg)
Management of blood glucose in patients with stroke.
Radermecker, Régis ; Scheen, André
in Diabètes & Métabolism (2010), 36S3
Stroke is a leading cause of death worldwide and the most common cause of long-term disability amongst adults, more particularly in patients with diabetes mellitus and arterial hypertension. Increasing ... [more ▼]
Stroke is a leading cause of death worldwide and the most common cause of long-term disability amongst adults, more particularly in patients with diabetes mellitus and arterial hypertension. Increasing evidence suggests that disordered physiological variables following acute ischaemic stroke, especially hyperglycaemia, adversely affect outcomes. Post-stroke hyperglycaemia is common (up to 50% of patients) and may be rather prolonged, regardless of diabetes status. A substantial body of evidence has demonstrated that hyperglycaemia has a deleterious effect upon clinical and morphological stroke outcomes. Therefore, hyperglycaemia represents an attractive physiological target for acute stroke therapies. However, whether intensive glycaemic manipulation positively influences the fate of ischaemic tissue remains unknown. One major adverse event of management of hyperglycaemia with insulin (either glucose-potassium-insulin infusions or intensive insulin therapy) is the occurrence of hypoglycaemia, which can also induce cerebral damage. Novel insights into post-stroke hyperglycaemia management have been derived from continuous glucose monitoring systems (CGMS). This article aims: 1) to describe the adverse effects of hyperglycaemia following acute ischaemic stroke and the risk associated with iatrogenic hypoglycaemia; 2) to summarise the evidence from current glucose-lowering treatment trials; and 3) to show the usefulness of CGMS in both non-diabetic and diabetic patients with acute stroke. [less ▲]Detailed reference viewed: 30 (5 ULg)
Continuous glucose monitoring reduces both hypoglycaemia and HbA1c in hypoglycaemia-prone type 1 diabetic patients treated with a portable pump.
Radermecker, Régis ; Saint-Remy, Annie ; Scheen, André et al
in Diabètes & Métabolism (2010), 36(5), 409-13
AIM: This study aimed to assess the effectiveness of continuous glucose monitoring (CGM) for glucose control in type 1 diabetic patients treated by continuous subcutaneous insulin infusion (CSII) and ... [more ▼]
AIM: This study aimed to assess the effectiveness of continuous glucose monitoring (CGM) for glucose control in type 1 diabetic patients treated by continuous subcutaneous insulin infusion (CSII) and presenting with frequent hypoglycaemic episodes. METHODS: Thirteen patients with type 1 diabetes (diabetes duration: 25+/-15 years; CSII duration: 5.5+/-7.0 years), with more than six recorded capillary blood glucose (CBG) values <60 mg/dL, according to their metres for the past 14 days, were offered the permanent use of a CGM device (Guardian RT((R)), Medtronic) plus ongoing self-monitoring of blood glucose (SMBG) for 12 weeks, followed by a 12-week crossover period of SMBG only, or vice versa. Glucose control, determined by recorded 14-day CBG values <60 mg/dL and HbA(1c) levels, and quality of life according to the Diabetes Quality of Life (DQOL) questionnaire, were assessed at baseline, and after 12- and 24-week follow-ups. RESULTS: Four patients withdrew from the study during the first period (of whom three were using CGM). In the nine study completers, the number of low CBG values decreased significantly from 13.9+/-9.2 to 7.6+/-6.8 (P=0.011) when patients used CGM, in either the initial or final trial period, while a decrease in HbA(1c) from 8.3+/-0.7 to 7.7+/-0.6% (P=0.049) was also observed, in contrast to the absence of any significant differences during the SMBG-only period. DQOL scores were also essentially unaffected. CONCLUSION: This pilot observational study supports the hypothesis that CGM use can significantly improve overall glucose control while reducing hypoglycaemic episodes in hypoglycaemia-prone type 1 diabetic patients treated by CSII. [less ▲]Detailed reference viewed: 33 (3 ULg)
Addition of incretin therapy to metformin in type 2 diabetes.
Scheen, André ; Radermecker, Régis
in Lancet (2010), 375(9724), 1410-2Detailed reference viewed: 25 (4 ULg)
Education therapeutique et mesure continue de la glycemie chez le patient diabetique insulino-traite.
Thielen, Vinciane ; Radermecker, Régis ; et al
in Revue Médicale Suisse (2010), 6(260), 1596-600
L’efficacité d’un programme éducationnel fondé sur l’utilisation d’une mesure continue du glucose avec un affichage en temps réel a été évaluée chez des patients diabétiques de type 1 (système couplé à ... [more ▼]
L’efficacité d’un programme éducationnel fondé sur l’utilisation d’une mesure continue du glucose avec un affichage en temps réel a été évaluée chez des patients diabétiques de type 1 (système couplé à une pompe à insuline externe - Paradigm Real Time®) et chez des patients diabétiques de type 2 mal contrôlés sous insuline (système Guardian RT® une semaine par mois pendant 3 mois versus automesure classique). Ces deux essais pilote montrent une diminution du taux d’hémoglobine glyquée (HbA1c) avec le « glucose sensor », avec moins d’hypoglycémies symptomatiques. Malgré certaines difficultés techniques (surtout chez les diabétiques de type 2), l’approche représente un outil intéressant d’éducation thérapeutique. Ces résultats prometteurs plaident pour des études de plus grande envergure chez des patients diabétiques bien sélectionnés. [less ▲]Detailed reference viewed: 45 (2 ULg)
Strategies pour eviter l'inertie et la non-observance dans les essais cliniques.
Jandrain, Bernard ; Ernest, Philippe ; Radermecker, Régis et al
in Revue Médicale de Liège (2010), 65(5-6), 246-9
Randomised controlled trials play a key role in evidence-based medicine as far as the assessment of both efficacy and safety of drugs is concerned. Various strategies are used to avoid physician's inertia ... [more ▼]
Randomised controlled trials play a key role in evidence-based medicine as far as the assessment of both efficacy and safety of drugs is concerned. Various strategies are used to avoid physician's inertia and to combat patient's non compliance, two pitfalls that may hinder the demonstration of the therapeutic efficacy of the drug. Clinical inertia may be limited by titration, forced or optional, driven by therapeutic targets, or by the use, if necessary, of rescue medications. Compliance may be verified by "pill count". This simple technique allows to exclude non compliant patients when they are detected during the placebo run-in period before randomisation or not to take into account patients with poor compliance in the final evaluation by using a statistical analysis restricted to individuals who have strictly adhered to the study protocol ("per protocol analysis"). Self-monitoring and patient's empowerment in the treatment also contribute to improve drug compliance. Clinicians may take advantage of these approaches derived from clinical trials to improve their daily practice. [less ▲]Detailed reference viewed: 87 (6 ULg)
Comment optimaliser le traitement hypolipidemiant: ne pas oublier la problematique du defaut d'observance.
Radermecker, Régis ; Scheen, André
in Revue Médicale de Liège (2010), 65(5-6), 311-7
The pharmacological treatment of dyslipidaemia, essentially by statins, should take place in a global strategy of prevention of cardiovascular diseases. Treating a risk factor, asymptomatic by definition ... [more ▼]
The pharmacological treatment of dyslipidaemia, essentially by statins, should take place in a global strategy of prevention of cardiovascular diseases. Treating a risk factor, asymptomatic by definition, which imposes an early constraint for a potential late benefit, exposes to patient's noncompliance. Besides physician's clinical inertia to initiate and adjust the lipid-lowering therapy in at risk patients, such lack of patient's compliance is one of the key elements that may explain the failure to reach or maintain therapeutic targets, and represents a major pharmacoeconomical concern. This article analyses first the main reasons explaining the poor compliance to lipid-lowering therapy and, then, describes some approaches to improve patient's adherence to medications in order to better prevent cardiovascular diseases. [less ▲]Detailed reference viewed: 54 (1 ULg)
ézétimibe (Ezetrol®) chez le patient diabétique
Scheen, André ; Radermecker, Régis
in Revue Médicale de Liège (2009), 64(12), 606-611
L’ézétimibe (Ezetrol®) inhibe sélectivement l’absorption intestinale du cholestérol et des phytostérols apparentés. Son mécanisme d’action résulte en un effet hypocholestérolémiant synergique en ... [more ▼]
L’ézétimibe (Ezetrol®) inhibe sélectivement l’absorption intestinale du cholestérol et des phytostérols apparentés. Son mécanisme d’action résulte en un effet hypocholestérolémiant synergique en combinaison avec une statine, inhibant la synthèse hépatique de cholestérol, ce qui a conduit à la commercialisation d’une combinaison fixe ézétimibe-simvastatine (Inegy®). L’ézétimibe a été plus spécifiquement étudié chez les personnes avec un diabète de type 2 qui sont confrontées à un risque cardio-vasculaire particulièrement élevé. Le but de cet article est de présenter les avancées et les particularités en ce qui concerne l’utilisation de l’ézétimibe dans la population diabétique de type 2. [less ▲]Detailed reference viewed: 56 (0 ULg)
Continuous glucose monitoring as a tool to identify hyperglycaemia in non-diabetic patients with acute coronary syndromes
RADERMECKER, Régis ; ; et al
in Diabetic Medicine : A Journal of the British Diabetic Association (2009), 26
Aim To explore the occurrence and the distribution of glucose excursions > 7.8 mmol/l by continuous glucose monitoring (CGM) in non-diabetic patients admitted with acute coronary syndrome (ACS). Methods ... [more ▼]
Aim To explore the occurrence and the distribution of glucose excursions > 7.8 mmol/l by continuous glucose monitoring (CGM) in non-diabetic patients admitted with acute coronary syndrome (ACS). Methods Twenty-one non-diabetic patients without baseline hyperglycaemia admitted for ACS wore a continuous glucose monitoring system (CGMS) for a median period of 45.6 h. Occurrence and 24-h distribution of time spent with blood glucose > 7.8 mmol/l (TS > 7.8) were retrospectively investigated. Results CGMS data disclosed time spent > 7.8 in 17 patients, whereas only seven of them showed at least one capillary blood glucose test value above the threshold for the same time period. Glucose excursions were detectable earlier from CGMS data. Hyperglycaemia was detected most frequently in the morning, more than 2 h after breakfast. Conclusions CGM discloses early and frequent hyperglycaemia in non-diabetic patients with ACS. Intensive glucose monitoring during the morning time period is the most efficient in screening for hyperglycaemia and could be a valuable guide to initiating insulin therapy and to further investigate outcomes in ACS. [less ▲]Detailed reference viewed: 6 (1 ULg)
Circulating insulin antibodies: influence of continuous subcutaneous or intraperitoneal insulin infusion, and impact on glucose control.
Radermecker, Régis ; ; Scheen, André
in Diabetes/Metabolism Research & Reviews (2009)
The purification of animal insulin preparations and the use of human recombinant insulin have markedly reduced the incidence, but not completely suppressed, the development of anti-insulin antibodies (IAs ... [more ▼]
The purification of animal insulin preparations and the use of human recombinant insulin have markedly reduced the incidence, but not completely suppressed, the development of anti-insulin antibodies (IAs). Advances in technologies concerning the mode of delivery of insulin, i.e. continuous subcutaneous insulin infusion (CSII), continuous peritoneal insulin infusion (CPII) and more recently inhaled insulin administration, appear to significantly increase circulating levels of immunoglobulin G (IgG) anti-IAs in diabetic patients. However, the increase is usually moderate and mostly transient as compared to previous observations with poorly purified animal insulin preparations. The clinical impact of these circulating anti-IAs remains unclear. Nevertheless, several studies have suggested that antibodies could retard insulin action, leading to a worsening of postprandial hyperglycaemia and/or serve as a carrier, thus leading to unexpected hypoglycaemia. CPII may be associated with more marked and sustained increase in IAs levels, possibly related to the use of an unstable insulin and the formation of immunogenic aggregates of insulin. The possible clinical consequences of these high levels of IAs remain to be evaluated because a low-glucose morning syndrome or severe insulin resistance with ketone bodies production have been reported in some cases. In conclusion, even if CSII and CPII may promote the development of circulating IAs, this increase does not lead to immunological insulin resistance, compared to that previously described with animal non-purified insulin preparations, and seems to have only marginal influence on blood glucose control or complications in most diabetic patients. [less ▲]Detailed reference viewed: 29 (6 ULg)
Optimisation du traitement pharmacologique chez un patient avec un diabete de type 2 nouvellement diagnostique.
De Flines, Jenny ; Radermecker, Régis ; Jandrain, Bernard et al
in Revue Médicale de Liège (2009), 64(2), 109-14
The diabetic patient, when type 2 diabetes is newly diagnosed, raises a therapeutic problem commonly observed in clinical practice, which is more complex than expected at first glance. The physician has ... [more ▼]
The diabetic patient, when type 2 diabetes is newly diagnosed, raises a therapeutic problem commonly observed in clinical practice, which is more complex than expected at first glance. The physician has to select the most appropriate antidiabetic oral agent as first choice, to consider the potential of using combined glucose-lowering therapies, to fix glycaemic target taking into account the individual benefit/risk ratio, and to offer the best protection against cardiovascular complications. The present clinical case illustrates such therapeutic problem describing a patient with a high cardiovascular risk profile who experienced a hypoglycaemic episode after the prescription of glibenclamide following the discovery of a moderate hyperglycaemia. [less ▲]Detailed reference viewed: 108 (6 ULg)
Estimation of GFR by different creatinine- and cystatin-C-based equations in anorexia nervosa.
Delanaye, Pierre ; Cavalier, Etienne ; Radermecker, Régis et al
in Clinical Nephrology (2009), 71(5), 482-91
Background: Patients with anorexia nervosa (AN) are at high risk of renal failure. Glomerular filtration rate (GFR) is overestimated when estimated by the creatinine-based equations. We have studied the ... [more ▼]
Background: Patients with anorexia nervosa (AN) are at high risk of renal failure. Glomerular filtration rate (GFR) is overestimated when estimated by the creatinine-based equations. We have studied the accuracy and precision of cystatin C-based equations. Method: 27 AN patients were included. GFR was measured with the chromium-51-ethylenediaminetetraacetate (51Cr-EDTA) method. We have compared the accuracy and precision of creatinine-based equations (MDRD and Cockcroft) with those of different new cystatin C-based equations. Results: The creatinine-based equations overestimate measured GFR, especially the MDRD study equation. All the cystatin C-based equations also overestimate measured GFR. The Cockcroft and Gault formula and the cystatin C-based equation published by Rule have the best accuracy and precision, but these last performances remain unsatisfactory. Conclusion: Both creatinine and cystatin C-based equations strongly overestimate measured in patients with AN. [less ▲]Detailed reference viewed: 63 (17 ULg)
Estimation du debit de filtration glomérulaire chez le patient obese: performances des équations basées sur la créatinine et la cystatine C
Delanaye, Pierre ; Cavalier, Etienne ; Rorive, Marcelle et al
in Néphrologie & Thérapeutique (2009), 5(5), 003Detailed reference viewed: 51 (8 ULg)
What makes TGC protocols “T” (tight)? An analysis of data from 2 studies
; ; Preiser, Jean-Charles et al
in Proc 9th Annual Diabetes Technology Meeting (DTM2009) (2009)Detailed reference viewed: 19 (1 ULg)