Benfluorex as a therapeutic option for insulin resistance in HIV lipodystrophy syndrome.

BACKGROUND: HIV lipodystrophy syndrome, characterized by a significant excess of visceral adiposity and a reduced subcutaneous fat mass in association with insulin resistance and dyslipidemia, still affects the majority of antiretroviral-treated HIV-infected patients. The therapeutic management of this syndrome has not yet been well established. Benfluorex is known to decrease insulin resistance with no side effects on lactate levels in HIV-negative patients. METHOD: We conducted an open-label study of benfluorex (150 mg, 2-3 times a day) that was prescribed for 60 HIV-infected patients who were diagnosed with glucose metabolism abnormalities by oral glucose tolerance test (OGTT); 47 of these patients had visceral fat accumulation measured by computed tomography (VAT). Median follow-up was 12 months (interquartile range [IQR] = 6-12 months). The great majority of patients (90%) were treated with at least triple therapy (in 70% the therapy included at least one PI), with a nonsignificant change over the study period. RESULTS: Added to antiretroviral therapy, benfluorex improved OGTT in 47/60 cases, including total normalization in 34/60 without lactate concentration modification. A trend toward a decrease in VAT distribution was observed (p =.06). No significant difference was observed in subcutaneous fat distribution, although an increase in subcutaneous thigh adipose tissue was observed in 17/47 (36.2%) cases and 6 patients (12.7%) presented both subcutaneous fat increase and VAT decrease.

How and when to use an alternative site in self-monitoring of blood glucose.

Taking care of diabetic patients has considerably been improved for approximately fifty years both in the therapeutic field and in the glycaemia monitoring field. Prospective studies conducted on large cohorts have clearly shown the importance of taking optimal care of such patients in order to prevent the occurrence or aggravation of chronic diabetes-associated complications. However, despite the simplification of self-monitoring of blood glucose through technological developments, drawbacks, some of which are linked to the sampling site, the fingertip, still slow down the patients' compliance. The use of an alternative site seems to be one of the solutions to offer in order to improve their monitoring and hence, their metabolic control. The development of such a monitoring mode has been slowed down after revealing, in some studies, a probably physiological delay in the detection of glycaemia variations, at the level of the alternative sites. Despite such conflicting observations, interest of using such alternative sites is to be defined in self-monitoring. Beside fast glycaemia variations, it proved to be reliable.