[Results of weight-loss treatment at a hospital. Significance of the administration of triiodothyronine in small doses during a protein diet]. / Résultats de cures amaigrissantes en milieu hospitalier. Intérêt de l'administration de triiodothyronine à petites doses au cours de la diète protidique.

We report the short-term effects of very-low-calorie liquid formula diet (n = 51) and of 600 Kcalories diet (n = 13) in patients who were hospitalized during 3 weeks. Weight loss averaged 278 +/- 14 g/day (m +/- SEM). It was slightly higher with the very-low-calorie liquid formula diet (293 +/- 21 g vs 242 +/- 25 g, N.S.). Individual weight-loss was unpredictable and highly variable; it ranged from 62 to 636 g/day. During the very-low-calorie formula diet, the expected low T3 syndrome was observed and 12 patients were given T3 (25 micrograms during the second week and 50 micrograms during the third week). These rather small doses corrected T3 values, but lowered total and free T4 levels. T3 administration did not modify the magnitude of weight loss in our patients.

The usefulness of fructosamine determination in diabetic patients and its relation to metabolic control.

In 116 diabetics and 101 control subjects, we measured both HbA1 and fructosamine values, neither could definitely separate the 2 populations. We observed an excellent correlation between both variables and between each of them and various other parameters of metabolic control. It appeared that the correlation with recent (4 weeks) diabetes control was better with fructosamine than with HbA1 levels. The opposite was true when a 8 week period was considered. The presence of diabetic complications did not modify the fructosamine levels. These results confirm the value of fructosamine measurement in the evaluation of recent diabetes control, but clearly, HbA1 determination remains the best parameter of long-term glycemic control.

Long-term management of insulin-treated diabetic patients with continuous subcutaneous insulin infusion.

Ten ambulatory diabetics were submitted to continuous subcutaneous insulin infusion (CSII) for periods of 6-18 months. With the exception of a patient who demonstrated a subcutaneous abscess, local tolerance was good. One patient suffered a severe hypoglycemic attack during the first days of CSII. Among the other subjects, hypoglycemic reactions were rare. However, blood glucose values under 50 mg/dl were recorded as frequently as during the control period. There was a non significant increment in insulin requirements and weight increased in almost all patients. In comparison with prepump period, we observed at the end of the study a significant decrease of mean blood glucose (140 vs 203 mg %), of urinary glucose output (8 vs 21 g/24 hr) and of HbA1 levels (7.6 vs 9.6%). As a rule, the improvement of diabetes control was noted throughout the study period. Nevertheless, normoglycemia was rarely reached. Diabetes stability improved as evidenced by a decrease of the standard deviation of monthly blood glucose values and by a reduction of M and MAGE indexes. In spite of the better metabolic control, we did not observe an improvement of renal function while lipid values were slightly modified. Motor nerve conduction velocities increased in 6 patients and ocular fluoroangiographic records demonstrated a reduction of microaneurysms and/or microhemorrhagic dots. As a group, the patients were satisfied with CSII and 8 of them wished to continue indefinitely with this treatment.

Pancreatic B-cell response to a test-meal in lean and obese diabetic patients: relation to metabolic control.

We have measured fasting C-peptide reactivity (CPR) as well as CPR responses to a test meal in 83 diabetic patients and 41 non diabetic controls. In comparison to controls, basal CPR was decreased in lean insulin-treated diabetics with stable or brittle diabetes and in obese patients with brittle diabetes. Lean and obese maturity-onset diabetics had increased CPR levels and so had obese insulin-treated patients. Nevertheless, the CPR response to the test meal was clearly inadequate in all diabetics. In control patients, there was a positive correlation between fasting blood glucose and CPR levels. On the contrary, lean diabetics demonstrated a negative correlation between these parameters. Hemoglobin A1 levels were negatively correlated to fasting CPR levels in lean diabetics, indicating the importance of residual B-cell function for diabetes control. These correlations were obscured in obese diabetics. In our patients, circulating insulin antibodies had apparently no deleterious effect on metabolic control.

The usefulness of a rapid method for total fast hemoglobins determination in screening for diabetes control.

We have used a simple and rapid method for the determination of total fast hemoglobins (HbA1a+b+c) in 102 diabetics and 36 normal controls. The method was described by Kynoch and marketed by Isolab. It proved to be useful in screening for patients with inadequate metabolic control in whom as a rule, total fast Hb values were higher than 8.5%. Mean Hb A1a+b+c value was significantly higher in the group of diabetics in comparison with normals (9.9 +/- 0.2 versus 6.9 +/- 0.8%). The diabetic patients were separated into four groups according to predetermined criteria of recent metabolic control. Even the patients considered to have a very good diabetes control during the past eight weeks, had supranormal total fast Hb values (7.7 +/- 0.2%). In the patients with good, poor and bad diabetes control, mean total fast Hb levels were respectively 9.3 +/- 0.3, 10.1 +/- 0.3 and 12.5 +/- 0.4%. In normals, there was a positive correlation between individual fasting blood glucose and total fast Hb values and in diabetics, mean blood glucose values correlated with total fast Hb levels. Hb A1a+b+c determinations also correlated with triglyceride values. We could find no significant association between high total fast Hb levels (greater than 8.5%) and the prevalence of retinopathy.