Attempt to improve glucose control in type 2 diabetic patients by education about real-time glucose monitoring.

The effectiveness of a specific educational programme involving the use of a real-time glucose-sensor system (Guardian RT) to improve glucose control was investigated in patients with poorly controlled type 2 diabetes despite insulin therapy. Ten patients participated in a randomized crossover study comparing two 3-month periods, during which glucose levels were monitored by either self-monitoring of blood glucose (SMBG) alone or by Guardian RT (restricted to 1 week per month) in addition to SMBG. Only four of the enrolled patients completed both periods, while dropouts were mainly due to technical difficulties in using the device. All six patients who completed the first 3-month period showed a reduction in glycated haemoglobin (HbA(1c)) level whatever the mode of glucose monitoring (study effect). A further reduction in HbA(1c) level was observed in two of the three patients using the Guardian RT during the second period. Less frequent symptomatic hypoglycaemic episodes were noted during the 3-month period with the device in the four patients who completed both study periods. These limited, but promising, results of this pilot study appear to justify the initiation of a larger study to assess the use of a real-time glucose sensor in carefully selected patients with type 2 diabetes.

[Hereditary hemochromatosis and diabetes mellitus: diagnostic approach and clinical evolution]. / Hémochromatose et diabète sucré: approche diagnostique et évolution clinique.

We report the characteristics of diabetes mellitus in 10 patients with a suspicion of hereditary hemochromatosis. The results of this personal series were compared to literature's data described in a recent article. Early diagnosis and treatment by phlebotomy can improve blood glucose control in the early stages of the disease. If diagnosis occurs later, when the patient already needs insulin therapy, diabetes will not be improved by phlebotomy anymore.

[Hemochromatosis: the most common of rare diseases]. / L'hémochromatose. La plus fréquente des maladies rares.

Familial (hereditary) haemochromatosis (HH) is an iron storage disorder characterized by an increased intestinal absorption of iron and its accumulation in numerous tissues. The disease generates an iron overload with tissue damages also seen in haematologic disturbances (with dyserythropoiesis and haemolysis) and hepatic disorders. Besides typical mutations linked to HH (C282 Y and H63D, HFE locus), three other mutations have been identified and more have to be defined. A complete genetic testing is important to assess the risk of morbidity. Indeed, the clinical picture of HH is dependent upon the specific mutations as well as the individual context (sex, environment, associated hepatic and/or haematologic disorders). Porphyria cutanea tarda (PCT) has for long been found significantly associated with HH. It is now considered that hepatic iron overload related to the combination of heterogeneous genetic traits and environmental factors, including alcoholism and viral hepatitis, precipitates the expression of PCT through the inhibition of uroporphyrinogen decarboxylase (Uro.D).

[Hematochromatosis and diabetes]. / Hémochromatose et diabète.

Nowadays, haemochromatosis is often diagnosed when the patient is monosymptomatic. Diabetes is frequently the first expression of the disease. So, it is important to know the clinical and biologic characteristics to evoke diagnosis as early as possible. Uncommon presentations request systematic screening.

[Diagnosis and etiology of hyponatremia]. / Comment j'explore ... une hyponatrémie.

The unexpected finding of hyponatremia should prompt a clinical and biological investigation to find the etiology. Hyponatremia can be the first manifestation of hyperlipemia, unknown paraproteinemia or the Schwartz-Bartter syndrome. Indeed, a quick diagnosis and appropriate treatment are often necessary to reduce morbidity.

[Management of hyponatremia]. / Comment je traite ... une hyponatrémie.

Hyponatremia is the most commonly encountered ionic disorder and, yet, its management remains uneasy. Inappropriate treatment of severe hyponatremia can nevertheless lead to significant neurological damage. The acute (< 48 h) or chronic (> 72 h) character of the disorder must first be determined. Acute hyponatremia is usually observed during a post-operative period and is generally associated with a neurological symptomatology. This requires prompt treatment to avoid cerebral damage. Chronic hyponatremia, on the other hand, needs a slow correction to avoid the "Osmotic Demyelinating Syndrome". In addition to the intensive care of severe hyponatremia, the actual etiology of the disorder must be sought for and therapy adapted to the underlying pathology.

[Mucosal immunity in elite athletes]. / Influence de l'effort physique sur le système immunitaire muqueux.

It is now generally accepted that strenuous exhausting exercise can increase susceptibility to viral infection during the following days or weeks. This review addresses the role of mucosal immunity in respiratory illness and associations with the intensity, volume and duration of exercise. Indeed habitual exercise at an intense level can cause suppression of mucosal immune parameters.