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Biomedical subjects

A Avignon

Publications and source records attributed to A Avignon.

At least 19 recordsLinked to original sources
PubMed2006

PKC-B inhibition: a new therapeutic approach for diabetic complications?

PKC comprises a superfamily of isoenzymes that is activated in response to various stimuli. Hyperglycaemia induces the activation of different PKC isoforms. However, the PKC-B isoform appears to be preferentially activated by high glucose levels and has been shown to be associated with diabetic vascular complications. In vitro and in vivo animal studies have shown that ruboxistaurin mesylate, a novel selective inhibitor of PKC-B ameliorates the biochemical and functional consequences of PKC activation and may have the potential to reduce the burden of vascular complications associated with diabetes. Results of the first phase-II and phase-III trials evaluating the efficacy of this compound on diabetic microvascular complications have been published recently. They confirm that this compound may favorably influence the evolution of diabetic microvascular complications.

Diabetes Complications↗
PubMed2006

Myocardial perfusion imaging and cardiac events in a cohort of asymptomatic patients with diabetes living in southern France.

AIMS: To assess the association between abnormal stress myocardial perfusion imaging (MPI) and cardiac events (CE) in asymptomatic patients with diabetes and with > or = 1 additional risk factor. Predictors of abnormal stress MPI were also evaluated. METHODS: Four hundred and forty-seven consecutive patients who underwent stress MPI were prospectively followed for 2.1 [0.5-4.1] years for the subsequent occurrence of hard CE (myocardial infarction and sudden or coronary death) and soft CE (unstable angina and ischaemic heart failure requiring hospitalization). Re-vascularization procedures performed as a result of the screening protocol were not included in the analysis. RESULTS: Follow-up was successful in 419 of 447 patients (94%), of whom 71 had abnormal MPI at baseline. Medical therapy was intensified in all subjects and especially in those with abnormal MPI. Twenty-three patients with abnormal MPI underwent a re-vascularization procedure. CEs occurred in 14 patients, including six of 71 patients (8.5%) with abnormal MPI and eight of 348 patients (2.3%) with normal MPI (P < 0.005). Only two patients developed a hard CE and 12 a soft CE. In multivariate analysis, abnormal MPI was the strongest predictor for CEs [odds ratio (OR) (95% CI) = 5.6 (1.7-18.5)]. Low-density lipoprotein cholesterol > or = 3.35 mmol/l [OR (95% CI) = 7.3; 1.5-34.7] and age > median [OR (95% CI) = 6.0 (1.2-28.6)] were additional independent predictors for CE. The independent predictors for abnormal MPI were male gender, plasma triglycerides > or = 1.70 mmol/l, creatinine clearance < 60 ml/min and HbA1c > 8%, with male gender the strongest [OR (95% CI) = 4.0 (1.8-8.8)]. CONCLUSIONS: Asymptomatic patients with diabetes in this study had a very low hard cardiac event rate over an intermediate period. This could be explained by the effects of intervention or by the low event rate in the background population. Randomized studies of cardiac heart disease screening are required in asymptomatic subjects with diabetes to determine the effectiveness of this intervention.

Aged↗
PubMed2005

Obesity management: attitudes and practices of French general practitioners in a region of France.

OBJECTIVES: To document the attitudes and practices of French general practitioners (GPs) regarding obesity management. RESEARCH METHODS AND PROCEDURES: A cross-sectional survey of a randomly selected sample of 744 French GPs was conducted, of which 607 questionnaires were returned. The measures included views on weight management, definitions of success, approaches to and strategies recommended for weight management and prevention, problems, frustrations, and expectations in managing obesity. RESULTS: GPs have a high awareness of obesity as a medically relevant issue, with 90% of them considering it to be a disease. However, they are only 42% to consider themselves well prepared to manage obesity and 51% to find obesity management professionally rewarding. They are 66% to believe that only a small percentage of patients can lose weight and maintain that loss but have unrealistic goals, with only 20% of them considering weight maintenance as a success. They do not consider collaboration with other health professionals like dietitians as a priority. Only 34% of the GPs believe that the currently available drugs are effective. Their views regarding bariatric surgery are in agreement with the recommendations of international experts. Their main expectations regarding obesity management are to improve their professional intervention through formation, education and easy-to-use tools, rather than improving their collaboration with other health professionals. DISCUSSION: There remains considerable opportunity to improve GPs' practice in obesity management. Medical education, increased cooperation with dietitians, improved long-term follow-up, and implementing better use of the available documents are key issues.

Adult↗
PubMed2003

Outcome of patients consulting in an outpatient nutrition clinic for excessive body weight.

OBJECTIVE: Few data are available concerning long-term outcome of patients after individually consulting a nutrition specialist, without entering a structured program. The objective of the present study was to evaluate outcome and predictors of body weight loss (BWL) after consulting in an outpatient nutrition clinic. METHODS: Phone interview of 95 patients (age 46.1 +/- 1.4 years, BMI 33.8 +/- 0.7 kg/m(2)) out of 299 who consulted consecutively for the first time in an outpatient nutrition clinic for excessive body weight. RESULTS: The mean time interval between first visit and phone interview was 2.1 +/- 1.3 years. Average BWL was 6.7 +/- 1.2 kg for the entire group. Forty-eight patients (50.5%) had lost more than 5% of initial body weight and were considered to be successful. Initial BMI was associated with% BWL (r=0.42, p<0.0001). Underreporting of energy-intake at initial dietary history was positively associated with BWL (- 11.8 +/- 1.1 vs. - 5.1 +/- 3.9 kg, p<0.05) as well as the number of visits attended by the patient (p=0.04). No relation was found between sex, age and physical activity at initial visit, past history of dieting or time elapsed since first or last visit and BWL. In multivariate analysis under reporters had 4.3 times more chances to lose more than 5% of their body weight (p<0.05). CONCLUSION: Visiting a nutrition specialist to receive individual counseling and prescription of a balanced low calorie diet is part of a positive behavior change leading to body weight loss.

Adult↗
PubMed2001

Rare side-effects of fenofibrate.

Fibrates are widely prescribed as hypolipidemic drugs and are considered as safe. We report the case of a 69 year-old woman who probably developed a major allergic reaction following a Fenofibrate prescription (generic form) of 300 mg per day. Clinical features included asthenia, hyperthermia (40.5 degrees C) and slight muscular pain. Biological abnormalities were mildly elevated muscular enzymes and pancytopenia rapidly developed. All bacteriologic, virologic, immune and radiologic investigations were normal. Evolution was spontaneously favorable with Fenofibrate withdrawal. This is the first reported case of major fever and pancytopenia following a Fenofibrate prescription. Adverse effects of Fenofibrate are briefly reviewed and their usual favorable outcomes following drug removal are outlined.

Aged↗
PubMed2001

[Insulin sensitivity and stress].

Metabolic adaptation is part of the response to stress and participate to produce a favorable state for cure. Carbohydrate metabolism is profoundly altered with an increase in basal cellular glucose uptake and utilization and in endogenous glucose production; insulin sensitivity is decreased. Glucose tolerance is altered and hyperglycemia develops. This state of hyperglycemia is most obviously directed to satisfy the increased need of the injured organs and of the inflammatory cells. The role of the cytokines in association to the stress hormones is important to these metabolic adaptations. This article reviews the main features of glucose homeostasis and the potential mechanisms leading to stress induced insulin resistance.

Blood Glucose↗
PubMed2000

Energy metabolism and substrates oxidative patterns in type 2 diabetic patients treated with sulphonylurea alone or in combination with metformin.

OBJECTIVE: To compare substrates oxidative patterns in type 2 diabetic patients treated with sulphonylurea alone or in combination with metformin. METHODS: Plasma glucose (PG), plasma insulin (PI) and substrates oxidation rates measured by indirect calorimetry were compared during a test day at 8.00 a.m. (before breakfast), 11.00 a.m. (before the lunch), 2.00 p.m. (2 h after the lunch) and at 5.00 p.m. in 56 diabetic patients treated with diet (group C, n = 14), sulphonylurea (group S, n = 14) or with a sulphonylurea-metformin combination (group SM, n = 28). RESULTS: The three groups were comparable for age, body mass index (b.m.i.), body composition and PG levels. Mean glucose oxidation (Gox) was increased since mean lipid oxidation (Lox) was decreased in group S in comparison both with group C (3.02+/-0.08 vs. 2.62+/-0.08 g/min/kg/10(3), p < 0.05; 0.53+/-0.04 vs. 0.88+/-0.09 g/min/kg/10(3), p < 0.01). Mean Lox was also decreased in group S in comparison with group SM (0.88+/-0.06 vs. 0.53+/-0.04 g/min1/kg1/10(3), p < 0.0001) whereas the difference in Gox between these latter two groups was only significant in the basal state (1.94+/-0.17 vs. 2.47+/-0.17 g/min1/kg1/10(3), p < 0.05). Mean respiratory quotient (RQ) was increased in group S (0.90+/-0.01) in comparison both with group C (0.86+/-0.01, p < 0.001) and with group SM (0.86+/-0.01, p < 0.001). Mean energy expenditure was lower in group S than in group SM (21.4+/-0.6 vs. 23.6+/-0.6 kcal/min/kg/10(3), p < 0.05). Substrates oxidative patterns, RQ values and energy expenditure were similar in group C and in group SM. CONCLUSIONS: When compared to patients treated with a sulphonylurea-metformin bitherapy, patients treated with a sulphonylurea monotherapy have a shift in their ratio of fat to carbohydrate oxidation that could make body weight loss more difficult in this latter group.

Blood Glucose↗
PubMed2000

[Specific effect of postprandial glycemic peaks on HBA1c and angiopathy].

Most studies argue for a strong relation between postprandial blood glucose and cardiovascular risk. Thus the DIS study establishes a significant link between postprandial glucose and the incidence of myocardial infarction as well as the occurrence of death. The DECODE study shows that identifying individuals at risk for death can be done through OGTT 2 h blood glucose, whatever fasting glycemia is. Kumamoto study shows a reduction in microangiopathic complications when postprandial blood glucose is corrected by a multiinjection protocol. Finally, a study conducted in Montpellier shows that postprandial blood glucose better reflects the overall diabetes control than fasting glycemia. Altogether, these data suggest that managing postprandial blood glucose is essential for the prevention of vascular outcome in diabetic patients.

Blood Glucose↗
PubMed1999

[Diet and fitness in type 2 diabetes].

Fitness and dietary measures remain the corner stone of the treatment of type 2 diabetic patients. The two objectives of these measures are: (i) to improve the glycemic control and to normalize the biological abnormalities which are frequently associated with the diabetic state; (ii) to prevent the micro and macrovascular complications. All these measures should be simplified, and sufficiently attractive to be acceptable and accepted by the patient. Weight-loss objectives in overweight diabetic patients should remain within reasonable limits: a few kilogram- loss is sufficient in many cases. In order to maintain the palatability of the diet, the dietary fat intake must be set at sufficient high levels, just by adjusting the carbohydrates/monounsaturates fat balance. When physical training is recommended, this activity must appear as a leisure and not as a constraint. More generally the management plan should be multifactorial and avoid contradictory measures.

Diabetes Mellitus, Type 2↗
PubMed1999

[Primary nutritional and drug prevention of atherosclerosis].

Atherosclerosis results from a multifactorial process. For that reason, primary prevention of cardiovascular diseases requires several measures that should exhibit antiatherogenic, antithrombotic, antioxidative and antihypertensive properties. Two types of therapeutic strategies can be individualized. Nutritional interventions are the first line measures for population wide primary prevention in subjects at low risk of developing atheroscleric diseases. In high risk individuals who have either one major risk factor (LDL cholesterol above 190 mg/dL) or several additional risk factors, dietary measures must be frequently combined with drug treatments. However, the cost-effectiveness ratio should be weighed prior to any treatment especially with statins. Dietary measures consist to reduce caloric intakes in overweight subjects, or more generally to adopt eating patterns which correspond to the following recommendations: (i) proteins = 15% of total calories; (ii) saturated and polyunsatured fats = 10% each; (iii) carbohydrates plus monounsaturated fats = 65%. Such dietary instructions permit individual dietary changes, just by adjusting the carbohydrates/monounsaturates balance, the sum of both nutrients remaining in all cases equal to two-thirds to total calories. Drug treatments are only indicated after secondary dietary failure. They are generally based on the use of statins since the efficacy of these treatments has been clearly established by such preventive trials as the WOSCOP Study, provided that the therapeutic interventions result in significant reduction of LDL cholesterol levels over several years. Antiplatelet agents (aspirin), antihypertensive therapies, antioxidant supplementations with vitamins E or C are also recommended in some individuals for completing the beneficial effects of the above mentioned measures.

Anticholesteremic Agents↗
PubMed1999

Assessment of insulin sensitivity from plasma insulin and glucose in the fasting or post oral glucose-load state.

OBJECTIVE: To compare insulin sensitivity indexes derived from plasma insulin (I) and glucose (G) in the basal state (Sib) and at the second hour (I2h and G2h) of an oral glucose tolerance test (OGTT, Si2h) (i) with measurements of insulin sensitivity using the insulin modified frequently sampled intravenous glucose tolerance test (FSIVGTT) [Si(IVGTT)] and (ii) with modelling of fasting glucose and insulin by the homeostasis model assessment (HOMA). SUBJECTS: 47 subjects entered the study. 31 subjects were classified as having normal glucose tolerance (NGT), 10 as having impaired tolerance to glucose (IGT) and six as type 2 diabetes mellitus according to the World Health Organisation (WHO) criteria. MEASUREMENTS: Sib and Si2h were calculated as follows. Sib = 10(8)/(I x G x VD), Si2h = 10(8)/(I2hr x G2hr x VD) where VD is an estimate of the apparent glucose distribution volume. A third insulin sensitivity index (SiM) was calculated by averaging Sib and Si2h. HOMA was calculated as follows: I/(22.5 x e(-lnG)) RESULTS: Si(IVGTT), Sib, SI2h and SiM were all significantly higher in subjects with NGT than in those with IGT or type 2 diabetes. Si(IVGTT) was highly correlated (P < or = 0.0001) with the three insulin sensitivity indexes found in the total population, in subjects with NGT and in those with IGT. In type 2 diabetic patients, a significant correlation was only noted when SiM was tested against Si(IVGTT) (P < or = 0.05). In most circumstances, the associations of Si(IVGTT) with Sib, SI2h and SiM were stronger than the corresponding associations with Ib, I2h or HOMA. SiM was the index that correlated best with Si(IVGTT) in the whole group (r = 0.92, P < 0.0001) as well as in NGT (r = 0.86, P < 0.0001), IGT (r = 0.96; P < 0.0001) and type 2 diabetes (r = 0.83, P < or = 0.05) subgroups. CONCLUSIONS: Calculations of sensitivity indexes from G and I concentrations in the basal state and during a conventional 2 h OGTT appear to be useful for coupling in the same simple and single test both a determination of glucose tolerance and an estimate of insulin sensitivity.

Administration, Oral↗
PubMed1998

Use of a prostacyclin analogue in cholesterol crystal embolism.

The prognosis of cholesterol embolism is often poor, and no treatment is presently available. We report the use of a stable prostacyclin analogue in treating cholesterol embolism in a diabetic patient with arteriopathy. As a sole therapy, it improved cutaneous manifestations and pain, in parallel with an increased transcutaneous oxymetry. We think that prostacyclin analogues are novel candidates for the treatment of cholesterol embolism.

Aged↗
PubMed1998

Relationship between insulin sensitivity, obesity, body fat distribution and beta-endorphinaemia in obese women.

OBJECTIVE: To study the associations of obesity (as body mass index (BMI)), of body fat distribution (as waist to hip ratio (WHR)) and of beta-endorphinaemia (beta-EP-aemia) with fasting insulin and glucose concentrations, with insulin secretion (as first phase insulin response (FPIR)) and with insulin sensitivity (SI) in obese women. DESIGN: a cross-sectional study of insulin sensitivity in obese women. SUBJECTS: 45 obese women (age: 20-70 y, BMI: 27-50). MEASUREMENTS: Frequently sampled intravenous glucose tolerance test (FSIGTT), FPIR, fasting glucose, fasting insulin, BMI, body fat topography (WHR), beta-EP-aemia, plasma ACTH. RESULTS: In univariate analysis the following positive associations were observed: fasting glucose with age and WHR, fasting insulin with BMI and WHR, beta-EP plasma concentration with WHR; SI was negatively associated with BMI, WHR and beta-EP plasma concentrations. This pattern of associations remained unaltered in multivariate analysis including age, BMI and WHR as independent variables. The contribution of beta-EP plasma concentrations to SI variability was corroborated by a stepwise multiple regression analysis: 53.8% of SI variation could be explained by BMI (30.7%), by beta-EP plasma concentrations (17.2%) and by WHR (5.9%). Finally, women were divided into two groups according to whether they had a peripheral (P-BFD, WHR < or = 0.80, n = 24) or an abdominal (A-BFD, WHR > or = 0.85, n = 16) body fat distribution. After adjustment for age and BMI, SI values were lower while beta-EP and ACTH plasma concentrations were higher in the A-BFD compared to the P-BFD group. In this latter group, 54.8% of SI variation was explained by the same variables as in the whole group. In the A-BFD group, higher WHR was associated with lower FPIR. CONCLUSIONS: 1) The major finding of this study is that, in non-diabetic obese women (especially those with a P-BFD), higher beta-EP plasma concentrations are associated with lower insulin sensitivity. This association is independent of both the magnitude of obesity and the pattern of fat distribution, although these two parameters are strong predictors of SI. 2) The major reduction in SI observed in women with A-BFD probably results from the additive effects of obesity, of elevated beta-EP plasma concentrations and of metabolic and endocrine alterations in relation with the central pattern of fat distribution.

Adult↗
PubMed1998

[Changes in dietary management of diabetic patients].

In the late 1990s, diet remains the cornerstone of diabetes therapy. Dietary and nutritional recommendations should seek to reduce the hyperglycaemic state which is the main risk factor for microangiopathy. Furthermore, the prevention of macrovascular complications should lead to dietary prescriptions that combine such properties as antiatherosclerotic, antithrombotic, and antihypertensive measures and such advantages as reducing oxidative stress. The means for achieving such objectives are, first, weight-loss interventions in obese patients and, secondly, the choice of a judicious balance between carbohydrates and monounsaturated fats in all individuals. Dietary measures must achieve a compromise between their acceptability by the patient and medical requirements. For that reason, caloric restriction should be moderate, leading to progressive weight loss (-3 kg monthly), with reasonable weight targets at the end of the weight-reduction period. Compliance with dietary advice usually results in significant savings in medical costs. However, long-term maintenance of dietary measures is difficult to achieve in most individuals, except those enrolled in well-structured training programmes.

Body Weight↗