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Biomedical subjects

Gérard Reach

Publications and source records attributed to Gérard Reach.

15 recordsLinked to original sources
PubMed2006

[Treatment of super super morbid obesity by sleeve gastrectomy].

UNLABELLED: INTEREST OF WORK: The longitudinal or "sleeve" gastrectomy was recently introduced into the therapeutic arsenal of the bariatric surgeon. It is a restrictive procedure that reduces stomach capacity by 75%. We present here a preliminary experience with four patients. METHODS: Four patients with super super obesity (body mass index (BMI)>60 kg/m2) underwent longitudinal or "sleeve" gastrectomy. Their average preoperative weight was 173 kg (range: 147-190 kg) and mean BMI 65 kg/m2 (range: 61-67 kg/m2). RESULTS: The average post-operative follow-up was 6 months (range: 2-12 months). Average weight loss at 6 months was 40 kg (range: 20-60 kg) and average decrease in BMI at 6 months 16.3 kg/m2 (range: 6-23 kg/m2). We noted a postsurgical complication in only one patient (subdiaphragmatic abscess treated with drainage). PERSPECTIVES: These preliminary results suggest that the sleeve gastrectomy is associated with few perioperative complications and offers rapidly effective treatment for super super morbid obesity. Long-term results require further investigation.

Adult↗
PubMed2005

Pancreatic islet response to hyperglycemia is dependent on peroxisome proliferator-activated receptor alpha (PPARalpha).

This study tests the hypothesis that islet peroxisome proliferator-activated receptor alpha (PPARalpha) influences insulin secretion. Freshly isolated islets of normoglycemic PPARalpha-null mice display no major alteration of glucose-stimulated insulin release. However, after 24 h of culture in high glucose, PPARalpha-null islets exhibit elevated basal insulin secretion and fail to increase insulin mRNA. 24-h culture with palmitate replicates this phenotype in wild-type islets. The data suggest that PPARalpha is needed to ensure appropriate insulin secretory response in situation of short-term hyperglycemia, likely by maintaining islet lipid homeostasis. As such, islet PPARalpha could contribute to delay the progression of type 2 diabetes.

Animal Feed↗
PubMed2005

Adjusting insulin doses: from knowledge to decision.

The aim of this study was to analyze the absence of adjustment of insulin doses in type 1 diabetic patients with poorly controlled diabetes. Twenty-eight patients (HbA(1)c higher than 8.5% during the last 6 months, performing at least three capillary blood glucose determinations per day), completed a questionnaire on the degree of confidence in their own knowledge, the nature of their health beliefs, their fear of hypoglycemia, their own appreciation on how they adjust their insulin doses (subjective score). An analysis of their diabetes logbook provided an objective score of the adjustment of doses actually performed. The results show that the subjective and objective scores of adjustment were not significantly correlated. Further there was a significant negative correlation between the score of uncertainty on knowledge and the subjective score of adjustment of the insulin doses, but not with the objective score. There was a significant correlation between the score of positive health beliefs and the subjective score of adjustment of the insulin doses, but not with the objective score. No correlation was found between the score of fear of hypoglycemia and the subjective score of adjustment of the insulin doses. Correlation with the objective score was higher, but not significant. Actually, the fear of hypoglycemia was the most frequently given reason for not adjusting the insulin doses, when the question was asked to the patients with an open answer. This study illustrates the difference between thinking and doing. It also shows that the degree of confidence in one's own knowledge, the health beliefs, and the fear of hypoglycemia differently influence the perception that the patients have of their behavior, and what they really do.

Adolescent↗
PubMed2005

Association among individual deprivation, glycemic control, and diabetes complications: the EPICES score.

OBJECTIVE: Previous studies have related poor glycemic control and/or some diabetes complications to low socioeconomic status. Some aspects of socioeconomic status have not been assessed in these studies. In the present study, we used an individual index of deprivation, the Evaluation de la Précarité et des Inégalités de santé dans les Centres d'Examens de Santé (Evaluation of Precarity and Inequalities in Health Examination Centers [EPICES]) score, to determine the relationship among glycemic control, diabetes complications, and individual conditions of deprivation. RESEARCH DESIGN AND METHODS: We conducted a cross-sectional prevalence study in 135 consecutive diabetic patients (age 59.41 +/- 13.2 years [mean +/- SD]) admitted in the hospitalization unit of a French endocrine department. Individual deprivation was assessed by the EPICES score, calculated from 11 socioeconomic questions. Glycemic control, lipid levels, blood pressure, retinopathy, neuropathy, and nephropathy were assessed. RESULTS: HbA(1c) level was significantly correlated with the EPICES score (r = 0.366, P < 0.001). The more deprived patients were more likely than the less deprived patients to have poor glycemic control (beta = 1.984 [SE 0.477], P < 0.001), neuropathy (odds ratio 2.39 [95% CI 1.05-5.43], P = 0.037), retinopathy (3.66 [1.39-9.64], P = 0.009), and being less often admitted for 1-day hospitalization (0.32 [0.14-0.74], P = 0.008). No significant relationship was observed with either nephropathy or cardiovascular risk factors. CONCLUSIONS: Deprivation status is associated with poor metabolic control and more frequent microvascular complications, i.e., retinopathy and neuropathy. The medical and economic burden of deprived patients is high.

Blood Glucose↗
PubMed2004

[Pituitary involvement in Wegener's granulomatosis. Two cases].

INTRODUCTION: Wegener's granulomatosis is a necrotizing vasculitis, usually localised in the upper respiratory track, lungs and kidneys. Less than 20 cases of pituitary involvement have been published, and many of them localized to anterior pituitary lesions, revealed by diabetes insipidus. OBSERVATION: We report two cases of Wegener's granulomatosis, with anterior pituitary manifestations: the first patient exhibited diabetes insipidus, with secondary revelation of panhypopituitarism. In the second, the anterior pituitary involvement was manifested in the form of amenorrhoea and galactorrhoea. The outcomes followed the course of the systemic disease. DISCUSSION: Endocrine manifestations can easily be occulted by the general symptoms of Wegener's granulomatosis, and systematic screening should be applied in cases of pituitary involvement.

Diabetes Insipidus↗
PubMed2004

Insulinotropic agent ID-1101 (4-hydroxyisoleucine) activates insulin signaling in rat.

ID-1101 (4-hydroxyisoleucine), an amino acid extracted from fenugreek seeds, exhibits an interesting glucose-dependent insulin-stimulating activity. The present study was undertaken to investigate a possible extrapancreatic effect of ID-1101 on insulin signaling and action besides its previously described insulinotropic action. Insulin-sensitizing effects of ID-1101 were investigated in rat in vivo by three different approaches: 1) using euglycemic hyperinsulinemic clamps in two different rat models of insulin resistance, i.e., Zucker fa/fa rats and rats fed a sucrose-lipid diet; 2) measuring liver and muscle phosphatidylinositol (PI) 3-kinase activity after an acute injection of ID-1101 in normal and insulin-resistant diabetic rats; and 3) after chronic treatment in two rat models of insulin resistance. Euglycemic hyperinsulinemic clamp experiments revealed that ID-1101 can improve insulin resistance through an increase of peripheral glucose utilization rate in sucrose-lipid-fed rats and by decreasing hepatic glucose production in Zucker fa/fa rats. Moreover, we demonstrated that a single injection of ID-1101 activates the PI 3-kinase activity in liver and muscle from normal rats but also in muscle from diabetic rats. Finally, chronic ID-1101 treatment significantly reduced insulinemia in type 2 diabetic rats and reduced the progression of hyperinsulinemia in insulin-resistant obese Zucker fa/fa rats. These findings clearly demonstrate that ID-1101 can reduce insulin resistance through activation of the early steps of insulin signaling in peripheral tissues and in liver. In summary, ID-1101, besides its insulinotropic effect, directly improves insulin sensitivity, making it a potentially very valuable therapeutic agent for diabetes treatment.

Animals↗
PubMed2003

[Can patient compliance be improved?].

The analysis of the different factors leading to non-observance (linked to the patient and his (her) environment, to the disease and its symptoms, to the care system) permits to propose different approaches aimed to improve therapeutic observance. Tackling this major challenge will help to improve the efficiency of diabetes care, since diabetes represents a disease particularly prone to non-observance, the frequency and the paramount importance of which is now recognised as a major issue.

Delivery of Health Care↗
PubMed2003

In vivo induction of insulin secretion by ornithine alpha-ketoglutarate: involvement of nitric oxide and glutamine.

We previously demonstrated that ornithine alpha-ketoglutarate (OKG), known for its anabolic properties, induces insulin secretion in vitro. The present study was undertaken to further characterize this effect in vivo and investigate a possible interaction with glucose both in vivo and in vitro. Male Wistar rats received an intravenous bolus of OKG (25 mg/kg) and/or glucose (0.8 g/kg) or saline, and their plasma insulin and glucose levels were monitored for 30 minutes. OKG alone increased plasma insulin to a similar extent to glucose. In combination with glucose, OKG significantly increased glucose-induced insulin secretion in vivo and in vitro, and led to a significant increase in glucose utilization in vivo. The absence of significant variations in plasma arginine and glutamine suggests a direct effect of OKG on the pancreas. To assess the involvement of the synthesis of nitric oxide and glutamine in OKG-induced insulin secretion, the experiments were repeated in the presence of inhibitors of these 2 pathways, respectively L-nitroarginine-methylester (L-NAME) and methionine sulfoximine (MSO). Both inhibitors were able significantly to reduce OKG-induced insulin secretion without affecting either basal or glucose-induced insulin release. Thus OKG acts directly with glucose on islets to induce insulin secretion via mechanisms involving NO and glutamine synthesis. In addition, our results suggest that OKG and glucose act via separate pathways.

Animals↗
PubMed2003

Effects of ornithine alpha-ketoglutarate on insulin secretion in rat pancreatic islets: implication of nitric oxide synthase and glutamine synthetase pathways.

Ornithine alpha-ketoglutarate (OKG) administration in human subjects elicits insulin secretion. We investigated whether this action was related to an effect of OKG on islets of Langerhans, and addressed the underlying mechanisms of action. For this purpose the influence of OKG on insulin secretion was measured in isolated rat islets of Langerhans under two different conditions. In incubated islets, OKG (0.25 to 2.5 mmol/l) significantly and dose-relatedly increased insulin secretion (1.7- to 4.2-fold; P<0.05 v. basal). To study the kinetics of OKG-stimulated insulin secretion, perifusion experiments were performed, which showed that OKG affected insulin secretion in both initial and later phases. Experiments using alpha-ketoglutarate (alpha-KG) (1 mmol/l) or ornithine (Orn) (2 mmol/l) alone, in concentrations equal to that of OKG, showed that the OKG-induced insulin secretion could not be obtained by either component alone, suggesting that an alpha-KG-Orn interaction is mandatory for the insulin-secreting effect to occur. Since data obtained in vivo suggest that effects of OKG may depend on the synthesis of NO, glutamine and/or polyamines, three metabolic pathways potentially involved in insulin secretion, we then evaluated their contribution by means of their respective inhibitors: l-NG-nitroarginine methyl ester (l-NAME), methionine sulfoximine (MSO) and difluoromethylornithine (DFMO). Both l-NAME and MSO were able significantly to reduce OKG-induced insulin secretion (30 and 40 % respectively; P<0.05), while DFMO was ineffective. Thus OKG is an effective stimulator of insulin secretion, requiring the joint presence of both Orn and alpha-KG, and acting mainly via the synthesis of NO and glutamine. A better understanding of OKG insulino-secretory properties and its mechanisms of action are a prerequisite for its use in insulin-compromised situations.

Animals↗
PubMed2003

Observance in diabetes: from therapeutic education to therapeutic alliance.

The aim of this paper is to understand why non-observance is so frequent in diabetic patients, to delineate some of its mechanisms, which should make it possible to propose approaches to prevent non-observance. This will lead us to clarify the relationship between therapeutic education and observance, and to justify on a theoretical basis the concept of therapeutic alliance.

Diabetes Mellitus↗
PubMed2003

[Insulin autoimmune syndrome revealing systemic lupus erythematosus].

A 22-year-old woman was admitted in August 2001 for loss of consciousness due to hypoglycemia. Her serum insulin level during the hypoglycemic episode was high at 121 mU/l (normal range: 5-25 mU/l). She had never received an insulin injection. Insulin antibodies by radioimmunoassay were positive. During hospitalisation, the patient presented clinical and biological features of systemic lupus erythematosus (SLE). Treatment with high-dose corticosteroids and cyclophosphamide resulted in restoration of euglycemia associated with resolution of circulating anti-insulin antibodies and parallel improvement in clinical and laboratory features of SLE.

Adrenal Cortex Hormones↗
PubMed2002

A novel model of solute transport in a hollow-fiber bioartificial pancreas based on a finite element method.

Extravascular bioartificial pancreas based on hollow fiber seems to be a promising treatment of diabetes mellitus. However, solutes mass-transport limitations in such a device could explain its lack of success. To determine critical device parameters, we have developed a novel tridimensional model based on finite element method for glucose, insulin, and oxygen diffusion around an islet of Langerhans encapsulated in a hollow-fiber section. A glucose ramp stimulation was applied outside the fiber and diffused to the islet. Concomitantly, a stationary oxygen partial pressure was applied outside the fiber, and determined local oxygen partial pressure on the islet environment. An insulin secretion model stimulated by a glucose concentration ramp and corrected by the local oxygen partial pressure was also implemented. Insulin secretion by the islet was thus computed as a response to glucose signal. The model predictions notably showed that the fiber radius had to be small enough to favor a fast response for insulin secretion and to ensure a maximal oxygen partial pressure in the islet environment. Besides the effect of fiber radius, a better islet oxygenation could be achieved by adjustments on the islet density, i.e., on the fiber length dedicated to a single islet. These hints should allow the future proposal of an optimal design for an implantable bioartificial pancreas.

Biological Transport, Active↗
PubMed2002

Prevention of hypoglycemia using risk assessment with a continuous glucose monitoring system.

Due to the lag between sugar intake and the beginning of recovery from hypoglycemia, it is necessary to intervene in an anticipatory way if one wants to prevent, not only detect, hypoglycemia. This article presents the principle of a hypoglycemia prevention system based on risk assessment. The risk situation can be defined as the moment when the system estimates that the glucose concentration is expected to reach a hypoglycemia threshold in less than a given time (e.g., 20 min). Since there are well-known discrepancies between blood and interstitial glucose concentrations, the aim of this experimental study performed in nondiabetic rats was first to validate this strategy, and second to determine whether it can work when the glucose concentration is estimated by a glucose sensor in subcutaneous tissue rather than in blood. We used a model of controlled decrease in blood glucose concentration. A glucose infusion, the profile of which mimicked the appearance of glucose from an intragastric load, was administered either when hypoglycemia was detected or on the basis of risk recognition. Despite the lag between the beginning of the load and that of the increase in blood glucose concentration, which was in all experiments 15-20 min, hypoglycemia was fully prevented without overshoot hyperglycemia in the groups of rats in which the glucose load was started when the hypoglycemia risk was detected, on the basis of either blood or interstitial glucose concentration. This was, of course, not the case when the same glucose load was infused at the detection of the hypoglycemia threshold.

Animals↗