Implementation of effective transition from pediatric to adult diabetes care: epidemiological and clinical characteristics-a pioneering experience in North Africa.

AIMS: Type 1 diabetes is increasing in children leading more T1D young adults to adult healthcare settings. This change is experienced as a tear and results in a disengagement from specialist services. This study reports on an implementation of an effective and pioneering program of transition in North Africa. METHODS: A total of 65 teenagers with T1D were recruited for a structured program of transition. They attend transitional meetings involving both pediatric and adult team and were, when ready, welcomed in specialized consultations for adolescents with a special « passport ¼. Here we study their characteristics before and after structured transition and the benefit of this program. RESULTS: 9 transition meetings took place (September 2012-December 2017). Mean age was 16.5 years. Mean age at onset of T1D was 7.5 years with average pediatric follow-up of 9 years.72% of young adults felt satisfied. After the transition meeting, 74% of patients wished to join directly adult unit. They were followed there for 28.4 ± 16.2 months. The glycaemic control improved significantly with a decrease in HbA1C of 0.93 ± 1.69% the first year of follow-up and the number of young adults achieving a HbA1C < 7.5% increased by 8%. CONCLUSION: This program was beneficial for 75% of patients who demonstrated an improvement in their metabolic control the year following transition to adult care service. To our knowledge, this study is the first one in North Africa to report on the outcome of a structured transition program from pediatric to adult diabetes care.

Change in women's eating habits during the menstrual cycle.

OBJECTIVES: During the menstrual cycle, the influence of hormonal variations on dietary habits in women has been suggested by several studies. In this context, our work aimed to assess the spontaneous food intake and the anthropometric parameters of women at different periods of their menstrual cycles. METHODS: This prospective study included 30 healthy women with regular periods (28 to 30 days), aged between 18 and 45. We assessed the spontaneous food intake and the anthropometric measurements (weight and waist circumference) of the participants, during the follicular, peri-ovulatory and luteal phases of their menstrual cycles. RESULTS: Our results showed a slight but significant increase in body weight during the luteal phase (P=0.022) and the follicular phase (P=0.017) compared with the peri-ovulatory phase, without any significant change in waist circumference. The caloric intake increased during the peri-ovulatory (P<0.001) and the luteal phases (P<0.001), compared with the follicular phase, with a significant increase in carbohydrate (P<0.001), lipid (P=0.008) and protein (P=0.008) intake. CONCLUSIONS: Our study showed a significant decrease in women's weight during the peri-ovulatory phase, with a significant increase in caloric intake during the luteal phase of the menstrual cycle. Divergent results have been reported by other authors and the physiopathology of these changes is still poorly understood.

[Continuous glucose monitoring in glimipiride plus metformin treated type 2 diabetic patients during the month of Ramadan]. / Enregistrement continu du glucose pendant Ramadan chez des diabétiques de type 2 sous glimépiride et metformine.

BACKGROUND: Fasting during Ramadan may be a cause of poor glycaemic control in diabetic patients. AIM: To assess glucose excursions during Ramadan by using a continuous glucose monitoring system (CGMS). METHODS: The interstitial glucose level was recorded over 72 hours during Ramadan and three months later, in five type 2 diabetic patients, aged 56 ± 5, treated with glimepiride and metformin. RESULTS: During Ramadan, four patients experienced at least one episode of low glucose level (<0.7 g/l) during the monitoring. The frequency of these episodes was 0.6 episode/d with an average duration of 36 mn / d. These episodes occurred in the morning in half of the cases and in the hour before breaking the fast in 37.5 % of the cases. Four patients experienced at least one episode of high glucose level (>1.8 g/l), with an average duration of 403 mn /d and with a frequency of two episodes /d. More than half episodes (53) occurred after the breaking of the fast. After Ramadan, CGM records showed at least one episode of low glucose in two patients with an average duration of 58 mn /d and a frequency of 1.3 episodes/d. Three patients experienced at least one episode of high glucose level with an average duration of 525 mn /d and a frequency of 1.46 episodes/day. CONCLUSION: The blood glucose profile of our patients during Ramadan is characterized by important glycaemic excursions.

[Renal failure in Tunisian patients with type 2 diabetes: frequency and related factors]. / L'insuffisance rénale chez des diabétiques de type 2 Tunisiens hospitalises: frequence et fateurs associés.

BACKGROUND: Frequent screening of renal failure and good glycaemic control in diabetic patients can avoid this severe complication. AIM: To evaluate the frequency of renal failure and the associated risk factors among type 2 diabetic Tunisian in-patients. Glomerular filtration rate was estimated using the Cockcroft-Gault formula. Renal failure was diagnosed on figure of glomerular filtration rate inferior than 60 ml/min. RESULTS: Six hundred eighty-nine patients were included. The sex ratio was 0.65. The mean age was 60 ± 11 years. The frequency of renal failure was 19.8% (137 patients) with dominance of a moderate form defined by a glomerular filtration rate between 30 and 59 ml/min (82.5% of patients). Patients with renal failure were older and less obese than diabetic patients without this complication (p<0.00001 and 0.02 respectively). The duration of both diabetes and hypertension was higher in presence of renal failure (p=0.0001 and p<0.001 respectively). Patients with renal failure had more often hypertension and dyslipidemia than patients with normal renal function (p<0.001 and p=0.01 respectively). A personal history of severe retinopathy treated by laser, of coronary disease or of stroke was significantly associated to renal failure (p=0.002, p<0.0001 and p=0.001 respectively). CONCLUSION: The frequency of renal failure observed in Tunisian patients diagnosed with type 2 diabetes is high. Hypertension and dyslipidemia should be carefully treated to prevent or delay the evolution to the renal failure.

[Hypothalamic-pituitary Langerhans cell histiocytosis in adults]. / Atteinte hypothalamo-hypophysaire dans l'histiocytose de l'adulte.

INTRODUCTION: Langerhans cell histiocytosis is a rare entity. Involvement of the pituitary region is frequently delayed and rarely studied. CASES: We report some clinical and paraclinical particularities of the disease in four women. Diabetes insipidus was the initial symptom in all cases, accompanied by panhypopituitarism at initial presentation in one woman. Hypopituitarism was diagnosed from 6 months to 4 years after the diabetes insipidus in the other cases, and systemic lesions appeared 3 to 6 years thereafter. Magnetic resonance imaging of the hypothalamic-pituitary axis found tumors in two patients and infundibular thickening in the other two. One patient also had a partially empty sella. DISCUSSION: In adults, pituitary involvement seems to occur predominantly in women, and panhypopituitarism is possible at initial presentation. The clinical polymorphism of Langerhans cell histiocytosis makes this disease difficult and often slow to diagnose.