[Another way to take care of diabetic patients: diabetic pathway "diabaide"]. / Une autre prise en charge des patients diabétiques: la filière de soins coordonnée "diabaide".

The diabetic pathway project is based on the objective of bettering the care of diabetic patients, through a new organisation of the care which should be more based on collaboration, on the sharing of information and on the coordination of activities. This project concern 6000 patients. The diabetic pathway is organised into three groups of intervention. The group called "first intention" (patient, physician and pharmacist), the multidisciplinary group (team of specialized professionals in diabetes care) and the group of independent professionals. The patients care is based on common procedures and guidelines. The physician remains the agent of the patient.

The pH-partition profile of the anti-ischemic drug trimetazidine may explain its reduction of intracellular acidosis.

PURPOSE: The anti-ischemic drug trimetazidine (TMZ) acts by a combination of molecular mechanisms which begin to be understood. Thus, it acts in the micromolar range to significantly reduce intracellular acidification during ischemia. To search for a possible physicochemical explanation of this phenomenon, we investigated the transfer mechanisms of the various electrical forms of this dibasic drug. METHODS: The transfer characteristics of TMZ were studied by electrochemistry at the water/1,2-dichloroethane interface. Cyclic voltammetry was used to measure the formal transfer potentials of singly and doubly protonated forms of TMZ (noted TH+ and TH(2)2+, respectively) as a function of aqueous pH, and the partition coefficient of neutral TMZ (log P(T)) was measured by two-phase titration. RESULTS: log P(T) was measured to be 1.04 +/- 0.06, and the acid-base dissociation constants in water were deduced to be pK(w)a1 = 4.54 +/- .02 and pK(w)a2 = 9.14 +/- 0.02. The partition coefficients of TH+ and TH(2)2+ were found to be respectively log P0'TH+ = -3.78 +/- 0.16 and log P0'TH(2)2+ = -9.84 +/- 0.30, which agrees well with the charge being delocalized on two nitrogen atoms in TH+. The pH-partition profile of TMZ was then established in the form of its ionic partition diagram, which showed that the affinity of the ions for the organic phase is pH-dependent and strongly increased by the interfacial potential. CONCLUSIONS: This behavior suggests a physicochemical mechanism whereby efflux of protonated TMZ out of an acidified cell is facilitated, in effect exporting protons to extracellular space.