Biomedical subjects
Publications and source records attributed to M Buysschaert.
The authors report the case of two patients with secondary hemochromatosis in whom a C282Y mutation in the heterozygotic form was observed. They discuss the potential relationship between secondary hemochromatosis and the presence of the genetic abnormality.
The aim of this study was to evaluate the daily caloric intake as well as the distribution of carbohydrates, fat, protein and alcohol in a Belgian population with type 1 and 2 diabetes, in the view of the recent ADA recommendations. Dietary intake and repartition of nutriments was based upon the three days evaluation recall. Our results show excessive caloric intake in type 2 diabetic patients when compared with type 1 subjects (2652 +/- 850 vs. 2271 +/- 546 Kcal/day; P < 0.005). We also show an inadequate repartition of carbohydrates (41 +/- 5 and 39 +/- 6% in type 1 and 2 diabetic patients, respectively) and lipids (39 +/- 5 and 39 +/- 7%). Protein intake was 16% of the total caloric amount. Fibers intake was adequate. High consumption of alcohol was assessed in both type 1 and 2 diabetic patients. In conclusion, our data evidenced several pitfalls in the diet of type 1 and 2 diabetic patients. They emphasize the need for more (and repeated) practical diabetic information in order to improve daily nutritional habits.
We analysed the clinical characteristics, the degree of glycaemic control and the prevalence of complications in 465 type 1 diabetic adult patients (232 males), in view of current recommendations for metabolic and blood pressure control. Age and diabetes duration were 45 +/- 17 and 20 +/- 13 years respectively (mean +/- 1 SD). Daily insulin dose was 0.65 +/- 0.24 U/kg b.w. 73% of patients received > or = 3 injections/day, while 11% had continuous subcutaneous insulin infusion. All were practicing home blood glucose monitoring. Current HbA1c was 8.5% [7.7-9.3%] (median [percentiles 25-75]). There was no difference in HbA1c according to number of injections or CSII use. When patients were divided according to HbA1c quintiles, significantly lower prevalences of retinopathy and neuropathy were found in quintile 1 individuals. A mean of 53 severe hypoglycaemic episodes was reported per 100 patients/year, and they were more frequent in subjects exhibiting better glycaemic control. High blood pressure levels were found in 27% of subjects according to JNC-VI criteria. Fasting cholesterol (C), LDL-C, HDL-C and triglycerides were within normal range. However, according to current guidelines emphasizing on lower target thresholds, up to 27% of patients exhibited some degree of dyslipidaemia, in particular LDL-C higher than 3.3 mmol/l. In conclusion, in this large cohort of type 1 diabetic patients regularly attending a University Centre, overall glycaemic control remains above the satisfactory levels inferred from optimization studies. Although mean blood pressure and blood lipids were up to recently deemed adequate, a (too) high proportion of diabetic patients exhibited either hypertension and/or dyslipidaemia according to revised therapeutic goals cut-offs.
We compared the metabolic profile of two ethnic populations with type 2 diabetes, one from Bantu (n = 23; Ban) and the other from Belgian (n = 314) extraction followed at St Luc Hospital. Further comparison with a Belgian sub-cohort (n = 64; Be) matched for age (52 yrs) and sex distribution (M/F: 61/39%) showed no significant difference between Belgian and Bantu subjects with regards to diabetes duration (9 and 11 yrs; Ban and Be respectively), age at diabetes diagnosis (43 and 42 yrs), HbA1c (8.1 +/- 1.9 vs. 8.5 +/- 1.9%; NS), and achieved education level. BMI was lower in Ban (29 +/- 4 vs. 32 +/- 7 in Be; p < 0.02), as were body fat (33 +/- 12 vs. 37 +/- 11 kg; NS) and waist diameter (99 +/- 9 vs. 106 +/- 16 cm; p < 0.02). Forty-eight and 72% of Ban and Be were on metformin (p < 0.05), while insulin was given to 39 and 34%. Daily insulin dose was lower in Ban (0.31 +/- 0.20 vs. 0.47 +/- 0.18 IU.kg-1.24 h-1; p < 0.001). There was no difference in beta-cell function (% beta; normal: 100%) or insulin sensitivity (%S; normal: 100%) as determined with HOMA between groups. % beta (median [perc 25-75]) was 51 [23-119] and 67 [45-84] in Ban and Be, while %S was 32 [29-37] and 37 [27-45]. Smoking (past & current) prevalence was 5 and 47% in Ban and Be (p < 0.0001). Prevalence of micro- and macroangiopathy did not differ between groups, although Ban had more macroalbuminuria (29 vs. 9%; p < 0.05), and were more often treated with Ca(2+)-channel- and beta-blockers than Be subjects (36 and 39% vs. 16 and 8%; p = 0.07 and < 0.05, respectively). Fasting (F) and interprandial (IP) triglycerides (TG) were lower in Ban: 115 [81-149] vs. 189 [155-325] mg.dL-1 for F-TG and 127 [81-160] vs. 170 [128-305] mg.dL-1 for IP-TG (p < 0.0001), as was total cholesterol (201 +/- 53 vs. 223 +/- 40 mg.dL-1 (p < 0.05), despite lower use of hypolipidaemic drug (13 vs. 44%; p < 0.01). African-heritage subjects with type 2 diabetes have similar degree of diabetes control and complications, in the presence of leaner biophysical status, minimal tobacco exposure and lower fasting and interprandial triglycerides.
The aim of this study was to report the clinical characteristics of 13 patients with Hürthle carcinoma. In the vast majority of them, disease was suspected by a palpable thyroid nodule. The results of preoperative examination (scintigraphy, ultrasonography, thyroglobulin) are also discussed as well as the pathological aspects and follow-up characteristics after total thyroidectomy.
Major studies have demonstrated an association between poor glycaemic control and the development of micro - and macrovascular complications in type 2 diabetes. Optimized metabolic control, including treatment of hyperglycaemia and other risk factors, reduces the risk of complications. Current strategies aiming at achieving the best possible control include a non-pharmacological approach consisting of lifestyle intervention using physical exercise and modification of nutrition intakes in the early stage of type 2 diabetes, or in later stages, combined with pharmacotherapy. Such an approach is also efficient in preventing type 2 diabetes in patients with impaired glucose tolerance. The purpose of this review is to analyse, in a clinical practice perspective, the current recommendations with respect to lifestyle modifications.
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The management of nontoxic multinodular goitre (NMNG) remains controversial. The challenge for the clinician is to identify the small proportion of NMNG patients with associated thyroid carcinoma who would thus benefit from surgery. We studied retrospectively the medical records of 80 patients with NMNG and coexisting thyroid carcinoma who underwent total thyroidectomy. Eighty total thyroidectomy patients with NMNG whose histology was benign were then randomnly chosen as controls. In univariate analysis, the following parameters were significantly more frequent in the carcinoma group: rapid growth of the goitre (p = 0.002), presence of microcalcifications (p = 0.01), hypoechogenicity (p = 0.02), firm consistency of a nodule (p = 0.03), and presence of a dominant cold nodule on scintigraphy (p = 0.03). In the multiple regression analysis, the variables significantly associated with carcinoma were rapid growth (Odds ratio (OR) = 4.13, 95% confidence interval(CI): 1.72-9.89), hypo-echogenicity (OR = 3.11, 95% CI: 1.13-8.51) and the presence of a dominant nodule (OR = 2.26, 95% CI: 1.06-4.79)). In the cancer group, tumour size was positively correlated with compression signs (p = 0.01), age (p = 0.02), the presence of a dominant nodule on scintigraphy (p = 0.02), and with rapid growth (p = 0.04). Concerning nodule size estimated on US (ultrasound), the majority (65%) of patients without carcinoma had nodules < 3 cm, whereas 73% of patients with clinical thyroid carcinoma (> or = 1 cm on histology) had nodules with a diameter of > or = 3 cm on US (p = 0.02). In conclusion, our study suggests that surgical treatment of NMNG should be proposed in the presence of rapid nodular growth, compression signs, dominant nodule on scintigraphy, nodule size > or 3 cm and hypo-echogenicity.
The aim of this cross-sectional study is to analyse the current treatment schemes as well as the quality of control (metabolic; blood pressure) in a cohort of 800 type 2 diabetic patients recruited in a University Center and not by generalist practionners, in scope with current international recommendations. Insulin therapy was administered, alone or combined with oral antihyperglycaemic drugs, to 48% of subjects. HbA1c was 7.7% (6.7-8.7 (median; percentiles 25-75)). Antidyslipidaemic drugs were used in 45% of individuals. However, only 27% of the cohort had LDL levels lower than 100 mg/dl while 58% of males and 48% of females attained HDL targets. Systolic and diastolic blood pressure levels were 144 +/- 21 and 81 +/- 12 mmHg (mean +/- SD), despite one or more antihypertensive agent(s) prescribed to 68% of subjects. In conclusion, in a Belgian adult type 2 diabetic population attending a tertiary centre for follow-up, overall metabolic and blood pressure controls remain unsatisfactory according to targets defined by international guidelines. This audit makes a multi-faceted intervention aimed at intensifying current therapies all the more necessary.
The aim of our study was to analyse the quality of metabolic and blood pressure control in a cohort of 101 patients with type 2 diabetes (54 males; 47 females), previously followed in primary care settings and admitted for the first time to the diabetes centres of Saint-Luc (n=66) or Mont-Godinne (n=35) University Hospitals. Age and (known) duration of diabetes were 64 +/-12 and 6 +/- 7 years (mean +/- SD), respectively. Body mass index was 31 +/- 7 kg/m2. Systolic and diastolic blood pressures were 140 +/-12 and 81 +/-11 mmHg. Homeostasis model assessment (HOMA) showed insulin sensitivity at 63 +/-32% and P-cell function at 49 +/- 44% (n=34). Forty-seven percent of patients received either diet alone or combined with an oral antidiabetic monotherapy. Seven-teen percent of all patients were on insulin monotherapy or associated with oral drugs. HbAlc was 9.0 +/- 2.3%, with 22% of patients within HbAlc targets of < or = 7%. Only a subset of patients reached international targets of care in terms of blood pressure and lipidic profile, despite antihypertensive and lipid-lowering agents in 62% and 36% of patients, respectively. Forty-five percent of individuals had at least one diabetes-related long-term complication. In view of this unsatisfactory control, our results suggest that "anti-diabetic" treatment should be intensified earlier in primary care settings.
The aim of our study was to measure the gastric emptying rate for a solid meal in diabetic patients who had no gastrointestinal complaints with (group 1, n = 12) or without (group 2, n = 10) cardiac autonomic neuropathy and in normal controls comparable in age and sex (group 3, n = 10). Gastric emptying rate was assessed with a sequential scintiscanning method. The percentages of the initial isotope activity remaining in the stomach at different times (20, 40, 60, 80, 100, and 120 min) after the ingestion of a Tc-99m-labeled test meal and the emptying half-time were calculated. Cardiac autonomic neuropathy was determined by the beat-to-beat variations in heart rate during deep breathing. A significant reduction of the gastric emptying rate was observed in group 1. Indeed, at 80, 100, and 120 min the percentage of residual isotope activity was 73 +/- 4, 60 +/- 6, and 50 +/- 6% (mean +/- SE), respectively, in group 1 versus 61 +/- 3 (P less than .05), 45 +/- 4 (P less than .05), and 32 +/- 4% (P less than .02) in group 2. In group 3, residual isotope activity was 57 +/- 4 (P less than .05 vs. group 1), 41 +/- 4 (P less than .05), and 29 +/- 4% (P less than .02), respectively. Emptying half-time was also longer in group 1 (121 +/- 9 min) than in group 2 (95 +/- 6 min, P less than .05) or group 3 (90 +/- 4 min, P less than .02).(ABSTRACT TRUNCATED AT 250 WORDS)
To study whether the release of atrial natriuretic factor (ANF) was altered in diabetic cardiac autonomic neuropathy (CAN), we determined plasma ANF concentrations during exercise and changes of posture in three groups of age- and sex-matched subjects (9 healthy subjects, 7 diabetic patients with CAN, and 7 diabetic patients without CAN). During exercise, plasma ANF concentrations rose threefold (P less than .001), and this increase was similar in the three groups. However, heart-rate response to exercise was impaired in the two groups of diabetic patients (P less than .004 vs. healthy subjects) but was more severely impaired in patients with CAN (P less than .03 vs. patients without CAN). In healthy subjects and patients without CAN, the increases of ANF during exercise correlated significantly with those of heart rate, systolic blood pressure, and rate-pressure product (P less than .01). In patients with CAN, the correlation was found exclusively with heart rate (P less than .01). An increase of ventricular ejection fraction occurred in all groups (P less than .001) but without showing statistical differences between groups. After 30 min of standing, a similar postural drop of plasma ANF concentrations (P less than .002) was observed in all subjects, reflecting preserved sympathetic control of vessels. In conclusion, exercise induces an increase of plasma ANF in diabetic patients with CAN. This increase, occurring similarly to healthy subjects, indicates that autonomic activation plays a minor role in ANF release during exercise. Impaired heart-rate response to exercise in patients without CAN suggests early damage of autonomic function, undetected by conventional rest tests.
The present study was undertaken to examine the feasibility of determining the most appropriate subcutaneous insulin treatment in unstable diabetes on the basis of the circadian hormonal profile delivered by an artificial pancreas. The metabolic control of 11 brittle diabetic subjects, as assessed by the M value and the MAGE index (used as indexes of blood glucose control and of glycemic fluctuations, respectively), was compared during a 5-day period before and after a 24-h connection to the artificial pancreas. The usual insulin treatment was continued to that day. Examination of the insulin pattern revealed by the artificial pancreas suggested that a valid scheme for subsequent treatment should consist of two daily injections of a mixture of short-acting and intermediate-acting insulins, which was administered to the patients beginning with the injection given after the artificial pancreas onwards. The new insulin regimen was characterized by a total daily dose that increased from 0.93 +/- 0.10 to 1.20 +/- 0.10 U/kg body weight (mean +/- SEM; P less than 0.005) as well as by a higher proportion of the dose given as regular insulin (37.1 +/- 6.9% before vs. 56.0 +/- 2.1% after; P less than 0.05). These changes led to a better control of blood glucose in 10 patients, as evidenced by a decrease of both the M value and the mean of all blood glucose levels. The mean MAGE index was not decreased, however, by the new insulin program, thereby suggesting that the lability of the disease remained unabated. These results indicate that subcutaneous treatment consisting of two daily injections of regular and intermediate-acting insulins and comprising 50 to 60% of the former could improve the metabolic control in unstable diabetes. The artifical pancreas provided a rapid and simple means to determine the appropriate doses for each type of insulin.
The plasma glucose and plasma free insulin profiles of six totally insulin-dependent diabetic patients were compared during periods of 4 days in hospital under a conventional insulin therapy (ICIT) comprising 4 daily injections of regular insulin and under continuous subcutaneous insulin infusion (CSII). Two profiles of prandial insulin administration with CSII were compared: a rectangular (R) and an exponential wave (E) in which 50% of the dose was given rapidly followed by an exponential decrease. In both cases, the basal infusion rate was increased by 30-50% between 5 a.m. and 8 a.m. Mean circadian blood glucose was equally good with ICIT: R and E: 7.0 +/- 0.9, 7.3 +/- 1.0, and 7.1 +/- 1.0 mmol/L, respectively. In five patients, fasting plasma glucose was higher with ICIT than with R and E (12.7 +/- 1.8 versus 6.9 +/- 1.0 and 6.8 +/- 0.8 mmol/L, respectively; t test: P less than 0.05; Wilcoxon: P = 0.06). Mean plasma free insulin level was significantly higher (t test: P less than 0.005; Wilcoxon: P less than 0.05) with ICIT (0.46 +/- 0.04 nmol/L) than with R (0.37 +/- 0.04 nmol/L) or E (0.36 +/- 0.05 nmol/L), although the daily doses were similar. In conclusion, CSII leads to a better glycemic control than ICIT, since it appears to prevent the morning rise of blood glucose.
The paper aims to review the prevalence and natural history of coeliac disease in patients with type 1A diabetes mellitus and autoimmune thyroid disorders. These diseases share a similar genetic background. In diabetic children and adults, the prevalence of (mostly asymptomatic) coeliac disease varies form 0.97 to 6.4%. Diabetes is usually diagnosed first. Screening in relatives may also be positive. Recurrent hypoglycaemia in diabetic subjects (indirectly) suggest the development of coeliac sprue. Thyroid disorders (thyroiditis and Graves' disease) are also usual in coeliac disease. A common etiopathogenic mechanism for the association CD/diabetes/thyroid disorders, with gluten as the driving antigen, was postulated. Thus, screening program for coeliac disease are recommended in individuals with type 1A diabetes and/or auto-immune thyroid conditions, as well as in their first-degree relatives.
This study reports on the proximal femur mineral content in 36 Type 1 and 60 Type 2 diabetic patients. Bone mass measurements were performed in the neck, Ward's triangle and in the trochanteric area of the femur, using dual-photon absorptiometry with 153Gd. Bone mineral density (BMD) was significantly decreased in Type 1 diabetic men and women as well in Type 2 men, when compared with a non diabetic matched population. In Type 1 men, neck and Ward's triangle densities were reduced from 0.94 +/- 0.05 to 0.86 +/- 0.11 (p = 0.007) and from 0.87 +/- 0.10 to 0.74 +/- 0.14 g.cm-2 (p = 0.011), respectively. In Type 1 women, BMD was reduced from 0.97 +/- 0.10 to 0.90 +/- 0.10 g.cm-2 (p = 0.023) in the femoral neck. In Type 2 men, BMD in Ward's triangle was also significantly lower than in controls: 0.69 +/- 0.14 vs 0.76 +/- 0.19 g.cm-2, respectively (p = 0.001). In contrast, no bone loss was observed in a group of Type 2 overweight diabetic women. No statistical correlation was observed between bone loss and age, duration of diabetes, body mass index, C-peptide levels, daily insulin doses, HbA1 and the presence of diabetic complications. In conclusion, long-standing Type 1 diabetic men and women and Type 2 diabetic men have a decrease in the proximal femur bone mass. Type 2 diabetic women appear to be protected from diabetic osteopenia.
We studied changes of atrial natriuretic factor (ANF) and catecholamines in three patients with pheochromocytoma occurring in the familial syndrome of multiple endocrine neoplasia type IIa. Previous studies have suggested a stimulating effect of catecholamines on ANF release. In pheochromocytoma, we observed normal basal ANF levels despite increased catecholamine secretion. In contrast, a rise in plasma ANF was observed when a hypertensive paroxysm occurred. Also during surgery, dissection of pheochromocytoma led to a rise in plasma ANF and catecholamines associated with an increase in blood pressure (in the 3 cases) and in pulmonary artery pressure (in 2 cases). We concluded that chronic elevation of basal catecholamines are without effect on plasma ANF but that manipulation of pheochromocytoma leads to a stimulation of ANF release, possibly mediated by either a direct effect of endogenously released catecholamines and/or an increase in atrial pressure.
The aim of this retrospective study was to evaluate the prevalence of microalbuminuria in type 1 and 2 diabetic patients with or without high blood pressure levels. 653 patients were involved in the study [type 1: n = 413 (normotensive: n = 298; hypertensive: n = 115); type 2: n = 240 (normotensive: n = 93; hypertensive: n = 147)]. In type 1 diabetic patients, the prevalence of microalbuminuria was of 21 per cent. Microalbuminuria was also found in 28 per cent of type 2 diabetic subjects (p less than 0.10 vs type 1). The prevalence of microalbuminuria was significantly higher in hypertensive than in normotensive diabetic subjects (28 vs 20 per cent; p less than 0.05). Blood pressure in type 1 and 2 normotensive patients was significantly higher in subjects with than without microalbuminuria. We also observed higher HbA1 levels in microalbuminuric type 1 diabetic patients. Finally, we also assessed that the prevalence of diabetic chronic complications was higher in type 1 patients with than without microalbuminuria (p less than 0.05). This relationship was not evidenced in type 2 diabetic patients. In conclusion, the prevalence of microalbuminuria in a population of type 1 and 2 diabetic patients is high. We confirm in this study the relationship between microalbuminuria, blood pressure, and HbA1.