Functional insulin therapy in type 1 diabetics: Short-term effects on weight and nutritional intake.

INTRODUCTION-AIM: Flexible insulin therapy is currently considered the gold standard therapy of type 1 diabetes. We aimed to study the evolution of glycemic control, weight and nutritional intake of a group of patients with type 1 diabetes, three months after the initiation of functional insulin therapy (FIT). METHODS: This was a prospective longitudinal study having included 30 type 1 diabetic patients hospitalized for education to FIT. Each patient underwent an assessment of glycemic control (glycated hemoglobin (A1C) and number of hypoglycemia), weight and nutritional intake before FIT and 3 months after the initiation of this educative approach. RESULTS: The mean age of patients was 21,8 ± 7,9 years and the sex ratio was 0,5. The mean duration of diabetes was 7,2 ± 6 years. Three months after initiation of FIT, we observed a significant lowering of A1C, which went from 9,2 ± 1,6% to 8,3 ± 1,4% (p<0,001) of the number of minor hypoglycemia (p=0,001) and that of severe hypoglycemia (p= 0,021). the average weight went from 64,6 ± 13,1 kg to 65,5 ± 13,5 kg (p = 0,040) with a significant increase in BMI (p = 0,041). Weight gain was observed in 67% of patients. This weight gain contrasted with a significant decrease in caloric (p = 0,040) and in carbohydrates intakes (p = 0,027). CONCLUSION: Weight gain, associated with better glycemic control, should encourage the healthcare team to strengthen therapeutic education of patients undergoing FIT in order to limit weight gain.

Nephropathy in type 2 diabetics : predictive factors and evolving aspects.

INTRODUCTION: Diabetic nephropathy (DN) is the most common cause of end-stage renal disease. AIM: To study the evolution of nephropathy in a group of type 2 diabetics in order to determine the predictive factors of progression. METHODS: We conducted a longitudinal retrospective, descriptive study witch involved 100 type 2 diabetics patients with confirmed DN for at least 10 years. The patients were divided into 2 groups according to the evolution of their DN: stable DN (group 1) and progressive DN (group 2). RESULTS: At the time of diagnosis of DN, the majority (82%) of the patients were in the stage of incipient DN while 18% were in the stage of established DN. Univariate regression analysis showed that higher baseline values of albuminuria (p=0.038), creatinine (p=0.001), systolic blood pressure (p=0.009), uricemia (p=0.01) as well as a lower glomerular filtration rate (GFR) (p<0.001), and smoking (p=0.023) were significantly associated with an unfavorable evolution of DN.A high mean value during monitoring in albuminuria (p<0.001), creatinine (p<0.001), systolic blood pressure (p<0.001), uric acid (p<0.001) as well as a lower GFR (p<0.001), and a higher frequency of hypertriglyceridemia (p=0.004) were considered to be risk factors for an unfavorable development of DN detectable during follow-up. CONCLUSION: We have found several predictors of the progression of DN in our work whose multifactorial approach could improve the outcome of our patients as well as their quality of life.

The objective clinical evaluation in multiple stations in nutrition : Docrimological analysis.

CONTEXT: As part of its pedagogical reform, the Faculty of Medicine of Tunis integrated since 1998 the objective clinical evaluation in multiple stations (ECOSM), as sanctioning evaluation at the end of the internships. However, this method has never been evaluated in nutrition. OBJECTIVE: Carry out a docimological analysis of the ECOSM in nutrition intended for students of the 2nd year of the Second Cycle of Medical Studies (DCEM 2). METHODS: This was a transversal descriptive prospective study on the ECOSM for sanctioning purposes, students of DCEM 2 having carried out an internship at the National Institute of Nutrition in Tunis during the academic year 2017- 2018. RESULTS: The general average of the ECOSM for the population studied was 13.92 ± 1.45 out of 20. Half of the stations were of acceptable difficulty. More than a third of the questions (37%) had good or excellent discrimination. For all the stations combined, the average Cronbach's alpha coefficient was 0.62, indicating an unacceptable internal homogeneity with great heterogeneity. Likewise, the Cronbach's alpha coefficients calculated for all stations and all questions were strictly less than 0.7. The flattening coefficient was negative, equal to -0.946, and the distribution curve was platykurtic. CONCLUSIONS: At the end of this work, we recommend making students and teachers particularly aware of the importance of evaluating the various objectives during the internship before the ECOSM test in order to fill in the gaps and ensure that the internship objectives are met.

Anthropometric profile of children and adolescents from diabetic pregnancies.

BACKGROUND: Exposure in utero to maternal diabetes is a risk factor for obesity and type 2 diabetes. It may contribute to the current epidemic outbreak of these diseases. AIM: to evaluate the impact of the exposure to maternal diabetes on the anthropometric profile of the offspring. METHODS: This cross-sectional study was conducted in the department "A" of the National Institute of Nutrition. It involved 120 children and adolescents who were from 5 to 19 years old and recruited between October 2008 and November 2009. They were divided into two groups : • A first group of 80 children from diabetic mothers ; • A second control group of 40 children from non-diabetic pregnancies. They have had a clinical examination. Data about diabetic pregnancies were collected from the mothers'medical records. RESULTS: body mass index and waist circumference of children from both groups were comparable. In both groups, two thirds of children had a normal weight (62.5 % in the first group versus 65% in the control group). Obesity is more common in children exposed to maternal hyperglycemia (31.3% versus 25% in the control group), but the difference is not statistically significant. The majority of obese children (88%) are those from diabetic mothers with type 2 or gestational diabetes. CONCLUSION: our results underline the need for early screening for gestational diabetes and an optimal management of diabetic pregnancy to reduce the metabolic risk in the offspring.

Metabolic syndrome in Tunisian obese children and adolescents.

AIM: To determine the frequency of cardiovascular risk factors and the prevalence of metabolic syndrome (MS) in obese children and adolescents. METHODS: This cross-sectional study concerned 186 obese children and adolescents (137 girls and 49 boys), between the ages of 6 and 18 years, recruited in the research unit on human obesity of the National Institute of Nutrition between December 2007 and October 2008. Metabolic syndrome was defined with the International Diabetes Federation (IDF) criteria. RESULTS: The frequency of MS was 34.4%. It was higher in males (40.8%) than in females (32.1%) but without statistical significance (p=0.27). Body mass index and waist circumference were significantly higher in subjects with metabolic syndrome than that of subjects without metabolic syndrome. The frequency of MS increases with age. Family history of obesity, birth weight and breastfeeding did not influence the prevalence of MS. The most common component, associated with abdominal obesity, was Glucose tolerance abnormalities observed in 51 % of the sample. 65.6% of subjects with MS had 3 criteria of the five proposed by the IDF. CONCLUSION: Metabolic syndrome is prevalent in our young obese population. Early identification of young at risk is crucial to the prevention of early cardiovascular diseases.

Clinical and anatomic features of acardiac twins.

OBJECTIVE: To report 6 cases of acardiac twins, and to investigate prognostic factors that would lead to survival of the normal twin. SUBJECTS AND METHODS: During a 9-year period from 1993 to 2001, 6 cases of acardiac twins out of 109,000 deliveries at the Maternity Center, Tunis, Tunisia were studied. Detailed inspection, X-rays, ultrasound and autopsies were performed. RESULTS: Prenatal diagnosis was made in only 1 case at 33 weeks of gestation. Rudimentary cardiac tissue was observed in 2 of the 6 perfused twins, and the cephalic pole was less developed than other parts of the body. Severe agenesis or hypoplasia of the thoracoabdominal organs was commonly observed. Many limb malformations were observed, with arms the most affected. One of the pump twins was stillborn, 3 died between days 1 and 3 from respiratory distress, and 2 developed cardiac failure after birth and were treated with diuretics and digoxin, which led to a favorable outcome in only 1. The ratio of the weight of the acardiac to pump twin (TWR) ranged from 50 to 142%. CONCLUSION: The findings of this study indicate that acardia can be diagnosed by means of ultrasound in front of a monochorial twin pregnancy when one of the fetuses is deformed and has no cardiac activity. Heart failure and polyhydramnios, as well as a TWR greater than 50% are prognostic factors for the pump twin.