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H Leblanc

Publications and source records attributed to H Leblanc.

At least 37 records · Page 2Linked to original sources
PubMed1988

[Absence of effect of enalapril on the glycemic control and peripheral sensitivity to insulin in 10 diabetic patients treated with subcutaneous continuous infusion of insulin].

In diabetic patients, it has been suggested that angiotensin converting enzyme inhibitors may be associated with unexplained hypoglycaemic episodes. Such a side effect may limit the use of these drugs in diabetic hypertensive patients. Ten insulin-dependent diabetic patients mean age 38.4 +/- 13.1 years, mean diabetes duration 10.3 +/- 6.6 years (m +/- SD) were selected on the basis of good glycaemic control: HbA1: 7.6 +/- 0.9 per cent (upper limit of normal value less than 7.5 per cent) on continuous subcutaneous insulin infusion. In a double blind study, they were randomly and successively allocated for a 3 months period to enalapril 20 mg daily or placebo. Before treatment, after enalapril and placebo, mean blood glucose values, HbA1, daily insulin dosage were recorded as well as the number of clinical and biological (less than 3 mmol/l) hypoglycaemic episodes. Peripheral insulin sensitivity was assessed by euglycaemic insulin clamp technique. Compared to placebo, enalapril did not induce any modification of daily insulin dosage, glycaemic control. The incidence of hypoglycaemic episodes was similar. Neither peripheral insulin sensitivity was modified by enalapril. In the conditions of this study, enalapril did not interfere with glycaemic control in insulin-dependent diabetics in good metabolic control.

Administration, Cutaneous↗
PubMed1988

Prevention of diabetic nephropathy with enalapril in normotensive diabetics with microalbuminuria.

STUDY OBJECTIVE: To assess the effectiveness of inhibition of angiotensin converting enzyme in preventing diabetic nephropathy. DESIGN: Randomised follow up study of normotensive diabetics with persistent microalbuminuria (30-300 mg/24 hours) treated with enalapril or its matched placebo for one year. Double blind for first six months, single blind for last six months. SETTING: Diabetic clinic in tertiary referral centre. PATIENTS: Treatment group and placebo group each comprised 10 normotensive diabetics with persistent microalbuminuria. INTERVENTIONS: Treatment group was given enalapril 20 mg daily and controls matched placebo. Patients were given antihypertensive treatment after one year. END POINT: Albumin excretion, arterial pressure, and renal function. MAIN RESULTS: In last three months of trial three of 10 patients taking placebo had diabetic nephropathy (albumin excretion greater than 300 mg/24 hours). No patients taking enalapril developed nephropathy and five showed normal albumin excretion (less than 30 mg/24 hours) (p = 0.005, Mann-Whitney test). Mean arterial pressure was reduced by enalapril throughout study (p less than 0.005) but increased linearly with placebo (p less than 0.05). Albumin excretion decreased linearly with enalapril but not placebo. An increase in albumin excretion with placebo was positively related to the increase in mean arterial pressure (r = 0.709, p less than 0.05, Spearman's rank test). With enalapril total renal resistances and fractional albumin clearances improved progressively (time effect, p = 0.0001). CONCLUSION: Inhibition of angiotensin converting enzyme prevents development of nephropathy in normotensive diabetics with persistent microalbuminuria. This may be due to reduction in intraglomerular pressure and to prevention of increased systemic blood pressure. Future studies should compare long term effects of inhibitors of converting enzyme with other antihypertensive drugs.

Adult↗
PubMed1987

[Relations between arterial hypertension and diabetic nephropathy].

In insulin-dependent diabetics the course of the renal disease can be followed by measuring arterial blood pressure and urinary albumin excretion. Already at the stage of incipient nephropathy (microalbuminuria) a moderate but gradually increasing rise in blood pressure is noticeable. At the stage of patent nephropathy (macroalbuminuria) nothing but an effective antihypertensive treatment can slow down the deterioration of renal function and delay by a few years the occurrence of end-stage renal failure. When macroproteinuria or obvious arterial hypertension are present, it is much too late to institute an antihypertensive treatment. To really prevent diabetic nephropathy, this treatment must be given earlier, as soon as microalbuminuria is detected and irrespective of blood pressure values. Prescribing antihypertensive drugs, and especially angiotensin-converting enzyme inhibitors, seems to be the most effective way of reducing urinary albumin excretion. 6

Diabetes Mellitus, Type 1↗
PubMed1987

Converting enzyme inhibition and kidney function in normotensive diabetic patients with persistent microalbuminuria.

The effects of a long term reduction in blood pressure on the kidney function of normotensive diabetic patients who had persistent microalbuminuria (30-300 mg albumin/24 hours) were studied in two groups of 10 such patients before and during six months of treatment with either 20 mg enalapril or placebo daily. Treatments were assigned randomly in a double blind fashion. Before treatment both groups had similar clinical characteristics, weight, diet, total glycosylated haemoglobin, median albumin excretion rate (enalapril group 124 mg/24 h, placebo group 81 mg/24 h), and mean arterial pressure (enalapril group 100 (SD 8) mm Hg, placebo group 99 (6) mm Hg). During treatment weight, urinary urea excretion, and total glycosylated haemoglobin remained unchanged. The mean arterial pressure decreased in the enalapril group but not in the placebo group (enalapril group 90 (10) mm Hg, placebo group 98 (8) mm Hg). The median albumin excretion rate also fell in the enalapril group but not in the placebo group (enalapril group 37 mg/24 h, placebo group 183 mg/24 h.) The glomerular filtration rate rose in the enalapril group from 130 (23) ml/min/1.73 m2 to 141 (24) ml/min/1.73 m2, and total renal resistances and fractional albumin clearance decreased while fractional albumin clearance increased in the placebo group. These results show that in patients who have diabetes but not hypertension a reduction in blood pressure by inhibition of converting enzyme for six months can reduce persistent microalbuminuria, perhaps by decreasing the intraglomerular pressure.

Adult↗
PubMed1987

Prevalence and risk factors of diabetes mellitus in the rural region of Mali (West Africa): a practical approach.

A wide-range analytical study for screening diabetes mellitus in the rural region of the Republic of Mali was carried out on 7,472 subjects in whom fasting glycaemia was determined using reflectometry kits. Our results represent a breakthrough in the field of epidemiology of diabetes mellitus in West Africa. The prevalence rate of fasting hyperglycaemia equal to or over 7.00 mmol/l was 0.92%. The statistical analysis of data collected in this manner showed an increased prevalence in the Caucasian and Fulani ethnic groups, and a decreased prevalence in the Negroid ethnic groups. Age and body mass index are also risk factors in this population.

Adolescent↗
PubMed1986

[Relation between urinary albumin excretion and retinopathy in insulin-dependent diabetics].

To study the relationship between retinal and renal microangiopathy, the albumin excretion rate (AER) was measured by radioimmunoassay in 111 insulin-dependent diabetics and compared to their stages of retinopathy, as assessed by ophthalmoscopic examination and fluorescein angiography. The prevalence of pathological AER differed from that of diabetic retinopathy. The stage of retinopathy was related to the duration of diabetes (r = 0.59; P = 0.001), which was not the case for AER (r = 0.06; ns). Half of patients with proliferative retinopathy (11/22) had a normal AER, while 12% of those without retinopathy had a pathological AER (microalbuminuria). No relationship was found between glycaemic control and AER. The highest prevalence of hypertension was found in patients with macroalbuminuria (greater than 500 mg/24 h) and/or severe retinopathy. The mean AER was higher in hypertensive diabetics than in non-hypertensive diabetics (P less than 0.005). These results suggest that the risk of retinopathy is dissociated from the risk of glomerulopathy in diabetics, and that hypertension associates with diabetes mellitus in a greater risk of pathological AER.

Adolescent↗
PubMed1986

[Reduction of hypoglycemia in 10 diabetic patients treated with continuous subcutaneous infusion of insulin].

Opinions diverge as to the frequency of hypoglycaemia in patients under continuous subcutaneous insulin infusion (CSII). In this prospective study the incidence and severity of hypoglycaemia were evaluated in 10 type I brittle diabetic patients under conventional treatment (period A), then under chronic treatment with CSII for at least 1 year (period B: the first 3 months; period C: the last 3 months). Metabolic control (as assessed from mean blood glucose, glycaemia lability indices and glycosylated haemoglobin A1) significantly improved between periods A and B (p less than 0.01). The occurrence of biochemical hypoglycaemia (less than 3 mmol/l) was reduced by 52% and that of clinical hypoglycaemia by 60%. The results observed in period C were not different from those observed in period B. One hypoglycaemic coma occurred under CSII (as opposed to 4 during period A); it was secondary to reduction in food intake and had no sequelae. Thus, in this study, the improvement in metabolic control was associated with a reduction in the frequency and severity of hypoglycaemia. We consider that patients presenting with frequent and severe attacks of hypoglycaemia under conventional insulin treatment can and should benefit from CSII.

Adult↗
PubMed1985

[Treatment of arterial hypertension in diabetics. Contribution of converting enzyme inhibitors].

The treatment of arterial hypertension in diabetic patients still raises numerous problems. In this type of patients, the most commonly prescribed drugs (beta-blockers, diuretics, antihypertensive agents acting on the central nervous system) have troublesome and potentially detrimental effects (e.g. effects on lipids). The new categories of antihypertensive drugs recently introduced (angiotensin-converting enzyme inhibitors, calcium antagonists) are likely to be most useful in these patients. In an open trial in non-insulin-dependent diabetics with arterial hypertension followed-up for 1 year, enalapril administered alone has proved effective and devoid of clinical and biochemical side-effects. If these results are confirmed, angiotensin-converting enzyme inhibitors will rank high as first-choice treatment of arterial hypertension in diabetics.

Adrenergic beta-Antagonists↗
PubMed1984

[Prevalence of antinuclear antibodies in hypertensive diabetics treated with acebutolol].

Acebutolol may induce the development of antinuclear antibodies and, exceptionally, of a lupus-like syndrome. The purpose of this study was to evaluate the prevalence of antinuclear antibodies in hypertensive diabetics under long-term treatment with acebutolol. Seventy-eight normal subjects, 75 diabetics under antidiabetic therapy only, and 75 hypertensive diabetics who received acebutolol in mean doses of 478 +/- 242 mg/day for at least one year were investigated. The 3 groups were comparable with regard to age and sex. Antinuclear antibodies were detected in 18.6% of diabetics under acebutolol, as against 3.8% and 1.3% respectively of subjects in the other groups (p less than 0.01). There was no correlation between the levels of antinuclear antibodies and the dosage or duration of acebutolol treatment. None of the sera tested contained antinative DNA antibodies, and none of the hypertensive diabetics exhibited signs of lupus-like syndrome.

Acebutolol↗
PubMed1984

[Lipoatrophic diabetes with acanthosis nigricans. Prolonged blood glucose normalization by continuous infusion of insulin].

Insulin resistance is a permanent feature of lipoatrophic diabetes, the resistance being almost regularly stubborn. We report the case of a 23-year old unmarried woman with generalized lipoatrophy and Acanthosis nigricans. Seven years after a diabetes resistant to all treatments was diagnosed, blood glucose levels were permanently around 25 mmol/l. Multiple and severe micro- and macroangiopathies were present. Partial resistance to insulin was demonstrated. This resistance could not be explained by abnormalities in anti-insulin hormones nor by a decrease in the number or affinity of insulin receptors, which suggested an intracellular abnormality below membrane receptors. Sustained control of glycaemia at a normal level was achieved by continuous infusion of insulin in high doses. It would appear that optimum insulin therapy using an insulin pump would offer hopes of therapeutic success in this particular form of insulin resistance.

Acanthosis Nigricans↗
PubMed1984

[Correlation between the mass and diameter of the left ventricle. Physiologic and physiopathologic consequences].

109 echocardiograms were recorded in 109 subjects, consisting of 51 hypertensive patients and 58 normal subjects, in order to study the correlation between hypertrophy and dilatation. The correlation between the left ventricular mass (LVM) and the end-diastolic left ventricular diameter (Dd) is highly significant (r = 0.72; p less than 0.001). This relation follows a sigmoid curve with two asymptotes for y (LVM) = 0 and y = M (M : estimated upper limit of the reaction of the left ventricle to hypertrophy, expressed in g) with the following formula: (Formula: see text). This relation reflects the adaptation of the LVM to a defined end-diastolic volume in physiological and pathological situations. This adaptation tends to maintain the stress exerted on the left ventricular wall at a constant value. On the basis of this relation, we can define three types of response of the LVM to the diameter: adequate hypertrophy follows the relation in normal limits (+/- 2 SD); inadequate hypertrophy, where the LVM is insufficient in relation to the Dd and inappropriate hypertrophy, where the LVM is exaggerated. Most of the subjects were distributed along the curve, below the point of inflection (corresponding to a Dd of 6.25 cm). Only a few hypertensive subjects were found above this point. The presence of inadequate hypertrophy seems to imply an intrinsic disease of the myocardium which limits normal regulation. Finally, if the stimulus responsible for hypertrophy is removed, the reaction should be reversible, at least to a certain degree.

Adolescent↗
PubMed1984

[Echocardiographic study of the left ventricular mass-dilatation ratio in hypertensive disease].

The object of this work is the exhaustive interpretation of 52 echocardiograms of hypertensive African subjects. The following parameters were measured on the echocardiogram: Dd (left ventricular end diastolic dimension), Ds (left ventricular end systolic dimension), DSd (interventricular end diastolic dimension), DEd (left ventricular posterior wall end diastolic thickness). Left ventricular performance was evaluated with the calculated Vcf, FR (fractional shortening) and EF (ejection fraction). A ratio "R" was estimated as he ratio of the left ventricular mass (MVG) measured with Bennett's formula: [(Dsd + DEd + Dd)3-Dd3] x 1,05] to the left ventricular end diastolic dimension. A carotid pulse and phonocardiogram were simultaneously recorded and systolic time intervals were measured and corrected for heart rate, using regression equations corresponding to African subjects. The analysis of the "R" ratio has led us to put forward a new concept of the progression of the hypertensive cardiomyopathy. It has been shown, in this study, that the hypertensive heart becomes hypertrophic, even under treatment and after return of blood pressure to normal. It appears that hypertrophy is a reaction tending to keep normal or almost normal the telediastolic left ventricular dimension and consequently to prevent left ventricular dilatation. This can be explained by the tendency of myocardial hypertrophy to reduce wall stress and oxygen consumption. The analysis of the correlation between MVG and Dd (good), TAM (mean arterial blood pressure) and Dd (poor) and TAM and MVG (nil) has les us to the conclusion that the stimulus to hypertrophy lies in the left ventricular dilatation.(ABSTRACT TRUNCATED AT 250 WORDS)

Cardiomegaly↗