Functional insulin therapy in type 1 diabetics: Short-term effects on weight and nutritional intake.

INTRODUCTION-AIM: Flexible insulin therapy is currently considered the gold standard therapy of type 1 diabetes. We aimed to study the evolution of glycemic control, weight and nutritional intake of a group of patients with type 1 diabetes, three months after the initiation of functional insulin therapy (FIT). METHODS: This was a prospective longitudinal study having included 30 type 1 diabetic patients hospitalized for education to FIT. Each patient underwent an assessment of glycemic control (glycated hemoglobin (A1C) and number of hypoglycemia), weight and nutritional intake before FIT and 3 months after the initiation of this educative approach. RESULTS: The mean age of patients was 21,8 ± 7,9 years and the sex ratio was 0,5. The mean duration of diabetes was 7,2 ± 6 years. Three months after initiation of FIT, we observed a significant lowering of A1C, which went from 9,2 ± 1,6% to 8,3 ± 1,4% (p<0,001) of the number of minor hypoglycemia (p=0,001) and that of severe hypoglycemia (p= 0,021). the average weight went from 64,6 ± 13,1 kg to 65,5 ± 13,5 kg (p = 0,040) with a significant increase in BMI (p = 0,041). Weight gain was observed in 67% of patients. This weight gain contrasted with a significant decrease in caloric (p = 0,040) and in carbohydrates intakes (p = 0,027). CONCLUSION: Weight gain, associated with better glycemic control, should encourage the healthcare team to strengthen therapeutic education of patients undergoing FIT in order to limit weight gain.

Case Report: Swept-source Optical Coherence Tomography and Angiography Findings in Lipemia Retinalis.

SIGNIFICANCE: Lipemia retinalis is a very rare ocular manifestation of severe hypertriglyceridemia. It is usually symptomatic and regresses after normalization of triglycerides levels. Early recognition is important to prevent ocular and life-threatening complications. PURPOSE: This study aimed to report a case of marked lipemia retinalis secondary to type V hypertriglyceridemia assessed with swept-source optical coherence tomography (OCT) and OCT angiography (OCT-A), with follow-up after dietary lipid restriction. METHODS: Observational case report of lipemia retinal findings on color fundus photography, swept-source OCT and OCT-A, initially and after triglycerides lowering. CASE REPORT: A 32-year-old pregnant patient with gestational diabetes and a history of hypertriglyceridemia was referred for diabetic retinopathy screening. Fundus examination revealed bilateral milky-white discoloration of retinal vessels with a "salmon-colored" retina. Swept-source OCT and OCT-A revealed extremely hyperreflective and dilated retinal vessels and multiple high-flow retinal hyperreflective dots, corresponding to dilated retinal capillaries. Choroidal vessels were enlarged and engorged, and choriocapillaris layer appeared thickened and hyperreflective with dilated and tortuous capillaries. Serum triglycerides were very high (70.02 mmol/L). After 21 days of very-low-fat diet, it was lowered to 15 mmol/L. We noted a normalization of the clinical, structural, and vascular findings. However, peripheral retinal vessels remained hyperreflective, despite their clinical normalization. CONCLUSIONS: Swept-source OCT and OCT-A were beneficial in assessing lipemia retinalis noninvasively and monitoring choroidal and retinal vascular changes. Lipemia retinalis signs regressed initially in the posterior pole, choroidal anomalies were first to resolve, and clinical normalization preceded tomographic resolution.

Nephropathy in type 2 diabetics : predictive factors and evolving aspects.

INTRODUCTION: Diabetic nephropathy (DN) is the most common cause of end-stage renal disease. AIM: To study the evolution of nephropathy in a group of type 2 diabetics in order to determine the predictive factors of progression. METHODS: We conducted a longitudinal retrospective, descriptive study witch involved 100 type 2 diabetics patients with confirmed DN for at least 10 years. The patients were divided into 2 groups according to the evolution of their DN: stable DN (group 1) and progressive DN (group 2). RESULTS: At the time of diagnosis of DN, the majority (82%) of the patients were in the stage of incipient DN while 18% were in the stage of established DN. Univariate regression analysis showed that higher baseline values of albuminuria (p=0.038), creatinine (p=0.001), systolic blood pressure (p=0.009), uricemia (p=0.01) as well as a lower glomerular filtration rate (GFR) (p<0.001), and smoking (p=0.023) were significantly associated with an unfavorable evolution of DN.A high mean value during monitoring in albuminuria (p<0.001), creatinine (p<0.001), systolic blood pressure (p<0.001), uric acid (p<0.001) as well as a lower GFR (p<0.001), and a higher frequency of hypertriglyceridemia (p=0.004) were considered to be risk factors for an unfavorable development of DN detectable during follow-up. CONCLUSION: We have found several predictors of the progression of DN in our work whose multifactorial approach could improve the outcome of our patients as well as their quality of life.

Severe gestational hypertriglyceridemia: a rare but serious situation.

The severe hypertriglyceridemia during pregnancy is a rare condition. It is a problem for diagnostic, prognostic and therapeutic. This dyslipidemia benefit from specific and effective treatments, but it is still poorly codified. Dietary is still the essential therapeutic, but fetal extraction should also be considered if the gestational age permits. Post-partum monitoring is required but etiologic thorough is not recommended if the triglycerides rate normalizes. The major complication of hypertriglyceridemia should be actively sought because of important maternal mortality rate.

Influence of vitamin D supplementation on glycemic control in type 2 diabetics.

INTRODUCTION: Several studies have suggested a benefic impact of vitamin D supplementation on glycemic control and insulin resistance among patients with type 2 diabetes mellitus. The aims of our study were to assess vitamin D status in individuals with type 2 diabetes mellitus and to investigate the effects of vitamin D supplementation on glycemic measures in patients having vitamin D deficiency. METHODS: We conducted a comparative prospective study involved 100 Tunisian patients with type 2 diabetes followed at the National Institute of Nutrition and Food Technology of Tunis. Glycemic control and insulin resistance were evaluated in the beginning of the study and three months after supplementation. RESULTS: Baseline mean 25-Hydroxy vitamin D  (25(OH)D) level was 17.5±9.8 ng/ml. Vitamin D status was deficient in 60%, insufficient in 26% and sufficient in 14% patients. After vitamin D supplementation, mean serum 25(OH)D concentration increased significantly (p˂10-3). We observed a negative correlation between the variation of plasma 25(OH)D level and the waist circumference's variation (r=-0.266 and p=0.018). This correlation persisted after adjustment for therapeutic management. Vitamin D supplementation did significantly improve neither glycemic control nor insulin resistance parameters. CONCLUSION: Vitamin D deficiency is frequent in patients with type 2 diabetes mellitus. The metabolic effects of supplementation are controversial, hence the need of expanding studies to better demonstrate these effects.

Anthropometric profile of children and adolescents from diabetic pregnancies.

BACKGROUND: Exposure in utero to maternal diabetes is a risk factor for obesity and type 2 diabetes. It may contribute to the current epidemic outbreak of these diseases. AIM: to evaluate the impact of the exposure to maternal diabetes on the anthropometric profile of the offspring. METHODS: This cross-sectional study was conducted in the department "A" of the National Institute of Nutrition. It involved 120 children and adolescents who were from 5 to 19 years old and recruited between October 2008 and November 2009. They were divided into two groups : • A first group of 80 children from diabetic mothers ; • A second control group of 40 children from non-diabetic pregnancies. They have had a clinical examination. Data about diabetic pregnancies were collected from the mothers'medical records. RESULTS: body mass index and waist circumference of children from both groups were comparable. In both groups, two thirds of children had a normal weight (62.5 % in the first group versus 65% in the control group). Obesity is more common in children exposed to maternal hyperglycemia (31.3% versus 25% in the control group), but the difference is not statistically significant. The majority of obese children (88%) are those from diabetic mothers with type 2 or gestational diabetes. CONCLUSION: our results underline the need for early screening for gestational diabetes and an optimal management of diabetic pregnancy to reduce the metabolic risk in the offspring.

Metabolic syndrome in Tunisian obese children and adolescents.

AIM: To determine the frequency of cardiovascular risk factors and the prevalence of metabolic syndrome (MS) in obese children and adolescents. METHODS: This cross-sectional study concerned 186 obese children and adolescents (137 girls and 49 boys), between the ages of 6 and 18 years, recruited in the research unit on human obesity of the National Institute of Nutrition between December 2007 and October 2008. Metabolic syndrome was defined with the International Diabetes Federation (IDF) criteria. RESULTS: The frequency of MS was 34.4%. It was higher in males (40.8%) than in females (32.1%) but without statistical significance (p=0.27). Body mass index and waist circumference were significantly higher in subjects with metabolic syndrome than that of subjects without metabolic syndrome. The frequency of MS increases with age. Family history of obesity, birth weight and breastfeeding did not influence the prevalence of MS. The most common component, associated with abdominal obesity, was Glucose tolerance abnormalities observed in 51 % of the sample. 65.6% of subjects with MS had 3 criteria of the five proposed by the IDF. CONCLUSION: Metabolic syndrome is prevalent in our young obese population. Early identification of young at risk is crucial to the prevention of early cardiovascular diseases.

Efficacy and safety of statins in the treatment of diabetic dyslipidemia.

BACKGROUND: The Adult Treatment Panel III recommends 3-hydroxy-3-methylglutaryl coenzyme A reductase inhibitors or statins as first-line-lipid-altering therapy for all adult patients with diabetes mellitus. This is based on the well-characterized efficacy and safety profiles of this class of agents as well as several clinical trials demonstrating that statin treatment reduces the risk of cardiovascular events. AIM: The objective of our study was to investigate the efficacy and safety of statin therapy in patients with diabetes type 2. METHODS: We analyzed data from 120 individuals with diabetes type 2. For all patients, the mean baseline LDL-cholesterol level was 4.26 +/- 0.82 mmol per liter, the total cholesterol level was 6.52 +/- 0.75 mmol/l, HDL-cholesterol level was 1.15 +/- 0.31 mmol/l and triglyceride level was 1.77 +/- 0.67 mmol/l. RESULTS: There was a significant reduction in total cholesterol (P = 2.10-3) and LDL-cholesterol (P = 5.10-4) with statins; the mean LDL-cholesterol level was reduced from 4.26 +/- 0.82 mmol/l at baseline to 2.8 +/- 0.59 mmol/l at 12 months. The percentage variation of LDL-cholesterol was between 24 and 35%; in addition, the percentage reduction of total cholesterol was between 22 and 28%, the mean reduction in TG levels was between 11 and 16%. There was a no significant increasing in HDL cholesterol. Among these 120 patients, 5.1% had a moderate CK elevation. Moreover 2% had a significant elevation of transaminase levels. Statins have also been associated with muscle-related adverse events; so milder complaints (myalgia) are reported by approximately 3.6% of patients who take statins. CONCLUSION: Statins as highly efficacious agents for the lowering of low-density lipoprotein-cholesterol (LDL-C) revolutionized treatment of hypercholesterolemia, a long established risk factor for premature coronary heart disease and they are not only exhibit a remarkely high benefit to risk ration, but are equally characterized by a safety profile with excellent tolerance.

Effects of dietary intervention on weight loss and improvement of metabolic cormorbidities in a population of obese adults.

BACKGROUND: Weight loss improves most of the comorbidities associated with obesity. AIM: The purposes of this study are to determine the effects of dietary intervention and physical activity on weight management and to evaluate the beneficial effects of weight loss on metabolic profile of obese adults. METHODS: This prospective study concerned 24 obese and overweight patients recruited between 2003-2004. They have undergone a 6 months period of personalized diet and physical exercise. RESULTS: Average weight loss achieved at 6 months was 6.8 +/- 5.6 kg (P < 10). Mean fat mass reduction was 3.05 +/- 6.2% (P = 0.02) and average waist circumference reduction was 7.55 +/- 5.21 cm (P < 10(-3)). This improvement in anthropometric parameters reduced significantly fasting glycaemia (-0.58 +/- 0.87 mmol/l, P = 0.01), total cholesterol levels (- 0.37 +/- 0.69 mmol/l, P = 0.03), triglyceridemia (- 0.39 +/- 0.45 mmol/ l, P = 0.004) and increased HDL-Cholesterol levels (+ 0.1 +/- 0.38 mmol/l, P = 0.05). CONCLUSION: These results emphasize the urgent need to develop national strategies for the prevention and the management of overweight and obesity. Hence, we can improve metabolic abnormalities usually associated with obesity and reduce cardiovascular risk factors.

Frequency and risk factors of obesity in Tunisian adolescent.

UNLABELLED: The aim of the study was to determine the prevalence and the risk factors of obesity in Tunisian adolescent. METHODS: This prospective study included 1050 adolescents (aged 13 to 17 years) from two high schools according to the socioeconomic status. The aim was to evaluate the prevalence and the main risk factors of obesity in this studied group. The weight and height of every adolescent were measured and the Body Mass Index (BMI) was calculated for each of them. Using this criteria and referring to the curves of this Index for the age established by the National Health and Nutrition Examination Survey (NHANES) we found 49 obese adolescents. We evaluated the spontaneous food intake for each of them during three days. The results showed that the frequency of obesity is 5.1% without significant difference between the two schools. The highest obesity frequency is noticed at age 13 and 14 years in the two sexes. The obesity frequency is significantly more important in males of the high socioeconomic status. Family history of obesity was noticed in 51% of obese adolescents. Most of them (96%) had abnormal alimentary behavior. 52% of them had an excess of caloric intake and 82% an excess of lipid without significant difference between the two schools.