Metabolic control and alimentary contribution of type 2 diabetic during Ramadan under repaglinide

We studied 14 diabetic patients with type 2 diabetes [9 men and 5 women] in the aim to evaluate their metabolic control when treated with repaglinide while fasting during the month of Ramadan; their mean age was 50.6 +/- 2.2 year and their mean diabetes duration was 6.2 +/- 1. 3 years. We followed closely incidences of diurnal hypoglycemia and post prandial hyperglycemia. Mean glycosylated hemoglobin before Ramadan was 7.3 +/- 0.3% and none of our subjects had micro or macroangiopathy. During Ramadan, patients received repaglinide [l.l +/- 0.1mg at Iftar and 0.8 +/- 0.1mg at Shour] and metformine was continued in the 13 patients who were taking it prior to our study. Mean capillary glycemia at the end of the daily fasting was 1.32 +/- 1.06 g/l compared to 1.19 +/- 0.06 g/l for a mean fasting blood glucose before the month of Ramadan. Their mean postprandial 2H blood glucose after Iftar was 2. 15 +/- 0.17 g/l compared to 1.86 +/- 0.19 g/l for postprandial blood glucose after dinner. The mean blood glucose 2H after Shour was 1.76 +/- 0.20 g/l compared to 1.71 +/- 0.18 g/l for postprandial blood glucose after breakfast. The patients' weight remained stable; Fructosamine increased by 20.2 +/- 25.6 micro mol/l and glycosylated hemoglobin by 0.3 +/- 0.1%. Total food caloric intake and food composition remained unchanged. Only one event of clinical hypoglycemia occurred. Use of repaglinide during Ramadan decreases postprandial hyperglycemia without increasing the risk of diurnal hypoglycemia

[Consequences of early in the month of ramadan diabetic type 2 initially mal control]

Consequences of fasting in Ramadan on the metabolic control of previously poorly. Controlled diabetics are obvious but little described. We followed 20% type 2 diabetic patients with no known complications. They were receiving oral antidiuretic treatment and were poorly controlled with a HhAlc of 9, 6 +/- 2, 1%. They insisted on fasting even when advised not to do it. Clinical parameters, glycaemic and lipoproteins levels were evaluated three times: 20-30 days before Ramadan, between 20 - 27 day in Ramadan and 20 days after the end of Ramadan. Fasting did not change their- weight nor there. Blood pressure. But it worsened the glycaemic control fasting glycemia increased by 2, l mmol/l [p < 0, 01] and fructosamine by 93 rmol/l [p < 0, 03]. However glycated hemoglobin remained unchanged. A 39% reduction in the HDL-cholesterol [p<0,003] was associated with a 24% increase in LDL cholesterol [p < 0, 02]. These parameters returned to their initial levels 20 days after the end of Ramadan. Ramadan, fasting may significantly worsen glycemic and lipoprotein control in initially poorly controlled type 2 diabetic patients

[Experience Clinique du repaglikide chez 268 diabetiques Tunisians]

Alterations in post-prandial glycaemia appear- very ear1y in the evolution of type 2 diabetes. The aim of this study was to evaluate the effectiveness of repaginate, alone or associated with metformin, in type 2 Tunisian diabetic patients. This metacentric prospective study included 268 patients [55% men], aged 54.4 +/- 11.1 years, who's BMI was 28.7 +/- 4.2 kg/m2 and diabetic duration 5.0 +/- 5.5 years. The patients were divided into 4 groups according to their previous treatment: group I was treated with metformin [n=82]; group 2 with a sulfonylureas [N= 43]: group 3 with metformin and a sulfonylurea [N= 51]; group 4 was not treated [N= 92]. At the beginning of the study, the sulfonylurea was stopped and metformin maintained. Patients received 0.5 to 3 mg of repaginate tid before each meal. Total duration of the study was 12 weeks. Initially .HbAlc was 9.28 +/- 1.76%, fasting glycaemia 2.19 +/- 0.89 g/l and post prandial glycaemia 2.63 +/- 0.88 g/l: at tile end of the study the values were respectively 7.67 +/- 1.17% [p<0.001], l.50 +/- 0.67 g/l [p<0.001] and I. 73 +/- 0.67 g/l [p < 0.001]. Glycated hemoglobin was lowered by1.50% in group I, by 1.36% in group 2, by 1.70% in group 3 and by 1.76% in group 4. 5% of the patients [n= 13] presented side effects such as mild hypoglycemia [12 episodes] or digestive intolerance [2 cases] which lead to interruption of treatment in I case for hypoglycemia arid in I case for digestive disorders. This study confirms the effectiveness and the good tolerance of repaginate in the treatment of poorly, controlled diabetic type 2 patients

[Giganto-acromegaly: a report of a case]

The occurrence of acromegaly before the end of the growth period is very rare. We report a case of a patient who presented an acromegalo-gigantism. His height reached 2.45 m and his weight 145 kg. He had a typical facial dysmorphy and an insulin requiring diabetes mellitus. There was no sign of cardio-respiratory failure or of endocrine deficiencies. The echocardiography showed that the left ventricule was moderately dilated and hypertrophied but the systolic function was preserved. Hormonal investigation revealed high growth hormone [GH] levels without suppression after oral glucose load. Other pituitary secretions were normal. Initial tomodensitometry revealed an invasive macroadenoa. The patient had two trans-sphenoidal resections of the tumor completed by radiotherapy [45 Gy]. Afterwards, because of still unsuppressed GH levels, the patient was treated with Octreotide. This first published case of acromegalo-gigantism in Tunisia is particular not only by its rarity but also by its moderated effects on vital functions in spite of along spontaneous evolution

[Cortisol rhythm during Ramadan]

We studied the nyctohemeral cortisol secretion rhythm and the cortisol response to 1-24 corticotropin during Ramadan in 11 healthy, male volunteers aged 20-35 years. Their response to 250 mg 1-24 corticotropin was investigated 2 weeks before Ramadan by testing daily at 08:00 and 20:00 hours. After 16-22 days of fasting, their cortisol levels were measured at 08:00 hours and their response to 1-24 corticotropin at 20:00 hours. Before Ramadan, the baseline cortisol level was significantly higher at 08:00 hours than at 20:00 hours and the cortisol response to 1-24 corticotropin was also higher at 08:00 hours but this difference was not significant. During Ramadan, the cortisol level at 08:00 hours was lower than at the same time before Ramadan; the level at 20:00 hours was slightly higher than at the same time before Ramadan. There was no significant difference between the cortisol response to 1-24 corticotropin at 20:00 hours during Ramadan and the responses before Ramadan at 20:00 hours and 08:00 hours

[Metabolic effects of Ramadan fasting on type 2 diabetes]

We assessed the effects of Ramadan fasting on metabolic control, particularly change of HDL-cholesterol in 25 type 2 diabetic patients treated with diet or oral agents, with good metabolic control. Clinical and biochemical parameters and food intake were evaluated 3 weeks before Ramadan, in the fourth week of Ramadan and 3 weeks after Ramadan.There were no changes in body weight and blood pressure nor any metabolic complications. The mean plasma fasting glucose, serum fructosamin and haemoglobin A1c did not change. We found a negative relation between cholesterol intake during Ramadan and the change of HDL-cholesterol. When cholesterol intake was lower than 400 mg/day, plasma HDL-cholesterol increased by 13% at the end of Ramadan and by 23% 3 weeks after Ramadan

[Food intake, and anthropometrical and biological parameters in adult Tunisians during Ramadan]

We evaluated the effects of fasting during Ramadan on nutritional intake and plasma lipoproteins in 20 healthy adults of normal weight. A 5-day food questionnaire was completed for every participant. Clinical investigations, anthropometrical measurements and laboratory analysis were also undertaken. Body weight, blood pressure and blood glucose were not influenced by fasting but there were non-significant modifications in the plasma lipid fractions. The total cholesterol remained unchanged. Total daily energy intake was comparable before, during and after Ramadan despite the decrease in meal frequency during fasting. Thus fasting in Ramadan did not affect dietary intake, clinical, anthropometrical and most biological parameters

Prevalence de la lithiase biliaire symptomatique chez les diabetiques non insulino dependants

The authors report a prospective study of the incidence of cholelithiasis in non insulin dependent diabetics. 96 diabetics matched with 96 controls have had a tomo densitometric investigation of liver and biliary tract. No statistic difference was found between diabetics and controls, 10,4% versus 6,3%.[p=0,29]

Profil et strategie diagnostique de la maladie goitreuse au Nord-Ouest Tunisien [Nefza]: a propos de 375 cas

The authors present this epidemiological and clinical study about 375 cases, concerning the goitre in the North West of Tunisia. The objective is to reach a sure diagnosis with a minimum of exam's and times, for the interest of the ill and the society