Determinants of glycaemic control in type 2 diabetes African patients monitored by physicians from 1991 to 2004 in Cote d'Ivoire.

The aim of this study was to propose determinants of glycaemic control which are useful to adequately manage the healthcare of type 2 diabetes patients attending an out-patient clinic. A retrospective, descriptive research design was implemented at the Centre AntiDiabétique d'Abidjan in 2399 African patients. Glycaemic control was calculated from the average of at least 12 fasting plasma glucose levels measured during at least three years. Logistic and multiple linear regressions were performed at the limit of the glycaemia average of 6.7mmol/l (120mg/dl). The determinants of poor glycaemic control were: long duration of monitoring (odds ratio (OR)=1.66, then 2.68), annual frequency of visits outside the 2-3 per year interval (OR=3.25) and insulin treatment (OR=4.66) in 'non-obese men'; the aforementioned frequency of visits (OR=3.69) and insulin treatment (OR=3.72) in 'non-obese women'; the duration of monitoring reaching the 10-14 year interval (OR=3.48), the aforementioned frequency of visits (OR=2.51), insulin treatment (OR=26.16) and housewife status (OR=1.94) in 'obese women'. In 'obese men', insulin treatment was the sole determinant (r(2)=0.24). Healthcare parameters (treatment, frequency of visits, and duration of monitoring) seemed to be predominant as effective predictors of glycaemic control in our study context. These findings reveal the urgent need for both more concern and further research in diabetes management to improve the quality of care and tackle this health challenge.

Prevalence of Type 2 diabetes and central adiposity in La Reunion Island, the REDIA Study.

La Reunion Island, a French overseas department in the Indian Ocean provides an example of rapid urbanisation and drastic changes in the way of life--from traditional to "westernized" lifestyle--over a few decades. To study the impact of this epidemiologic transition, a diabetes prevalence study was performed in 1999-2001. Fasting capillary blood glucose (cBG) and glycated hemoglobin (HbA1c) were systematically measured in a random sample of 3600 subjects aged 30-69 years. Weight, height, waist and hip circumferences were also measured to assess body mass index and waist-hip ratio. Diagnosis was assessed using an oral glucose tolerance test according to the World Health Organization recommendations in 363 subjects who had a cBG value > or =6.1 mmol/l, and/or a HbA1c value > or =6%. The overall diabetes prevalence rate was 17.7% for men and 17.3% for women, and the standardized diabetes prevalence rate was 20.1% (95% confidence interval: 18.7-21.4%). The most important morphological factor linked to Type 2 diabetes mellitus was waist-hip ratio, a marker of central adiposity, especially in women. This study confirms that Type 2 diabetes is increasing dramatically in societies in epidemiologic transition and is strongly linked to nutritional status.

Associations of cataract with antioxidant enzymes and other risk factors: the French Age-Related Eye Diseases (POLA) Prospective Study.

PURPOSE: To determine the association of potential risk factors, including antioxidant enzymes, with the incidence of cataract. DESIGN: Cohort study. PARTICIPANTS: At baseline, the Age-Related Eye Diseases (Pathologies Oculaires Liées à l'Age, POLA) Study included 2584 residents of Sète (southern France) aged 60 years or older. From September 1998 to May 2000, a 3-year follow-up examination was performed on 1947 of the 2436 surviving participants (79.9%). METHODS: Cataract classification was based on a standardized lens examination at the slit lamp, according to Lens Opacities Classification System III. Biologic measurements were performed at baseline from fasting blood samples. MAIN OUTCOME MEASURES: At baseline and follow-up, the presence of cataract was defined as: NC or nuclear opalescence (NO) > or = 4 for nuclear cataract, C > or = 4 for cortical cataract, and P > or = 2 for posterior cataract (PSC) opacities, using opacity grades corrected for interobserver variability. Incidence rates were assessed separately for right and left eyes and for each type of cataract. RESULTS: In the multivariate model, the incidence of cortical cataract was increased in subjects with high red blood cell superoxide dismutase activity (odds ratio [OR] 4.2 [1.5-12.1], P = 0.007). The incidence of PSC cataract was increased in subjects with a high level of plasma glutathione peroxidase (OR 1.8 [1.0-3.3], P = 0.05). In addition to age, gender, and opacities at baseline, significant risk factors for incident cataract were: long-duration diabetes (OR 5.8, P = 0.001 for cortical cataract) and lifetime heavy smoking (OR 2.9, P = 0.006 for PSC cataract). CONCLUSIONS: Consistent with the baseline analysis, the results of this prospective study suggest that antioxidant enzymes might be implicated in the etiology of cataract.

Relationships between hormonal status and cataract in french postmenopausal women: the POLA study.

PURPOSE: Prevalence rate of cataract is higher in women than in men. Sex hormones have been hypothesized to be linked with this gender difference. Our aim is to study the relationships between hormonal status and cataract in postmenopausal women. METHODS: The Pathologies Oculaires Liées à l'Age (POLA) study is a population-based study on age-related eye diseases and their risk factors, in 2584 residents of Sète (France). Cataract classification was based on a standardized lens examination, according to Lens Opacities Classification System III. Biological measurements were performed from fasting blood samples. We conducted a cross-sectional study in the female participants (n=1451) aged over 60 years. RESULTS: No association of hormone replacement therapy (HRT) with any type of cataract was found, but an increased risk of cataract surgery was observed in women with a long duration of hormone therapy >/=5 years) (multivariate-adjusted odds ratio (OR)=3.80; 95% CI: 1.45-9.94). Globally, the risk for cataract (any type) was not associated with a long duration of HRT use (OR=1.06; 95% CI: 0.64-1.74). After multivariate adjustment, oophorectomy was associated with a reduced risk of cataract (OR=0.60; 95% CI=0.38-0.94). In the multivariate model, no association was found between estradiol, total testosterone or sex-hormone-binding globulin and cataract. However, high levels of dehydroepiandrosterone sulfate (DHEAS) were associated with a reduced risk of cataract (OR=0.79; 95% CI: 0.63-0.99). CONCLUSION: HRT use was not associated with cataract. A reduced risk of cataract was found in oophorectomized women and in women with high DHEAS levels.

Convective and diffusive losses of vitamin C during haemodiafiltration session: a contributive factor to oxidative stress in haemodialysis patients.

BACKGROUND: Enhanced oxidative stress in haemodialysis (HD) patients may be considered as a risk factor for accelerated atherosclerosis. Reduced antioxidant defences include impairment in enzyme activities and decreased plasma levels of hydrophilic vitamin C (vit C), and cellular levels of lipophilic vitamin E (vit E). METHODS: We investigated plasma levels of vit C in 19 patients undergoing regular haemodiafiltration (HDF) (mean age 62+/-7 years) and in 1846 healthy elderly subjects (HS) (mean age 69+/-5 years). The contribution of convection and diffusion was determined using paired filtration dialysis (PFD), a modified HDF technique which physically separates convective from diffusive fluxes. Blood samples were collected before and after the HDF session; in addition at 60 min of HDF, samples were drawn from arterial lines (AL) and venous lines (VL), dialysate (D) and ultrafiltrate (UF). Blood levels of total vit C were determined using an HPLC fluorescence method. Markers of oxidative stress were also assessed in both populations as follows: levels of malondialdehyde (MDA) were determined by fluorometric assay, measurements of advanced oxidation protein products (AOPP) and glutathione peroxidase (GSH-Px) activity were performed by spectrophotometric assay, and plasma vit E content was obtained by an HPLC procedure. RESULTS: A significant reduction in plasma vit C level was observed in HDF patients when compared with HS (1.6+/-1.4 microg/ml in HDF vs 6.6+/-3.7 microg/ml in HS; P<0.01). The HDF session was associated with a dramatic reduction in vit C levels (1.87+/-1.57 microg/ml before HDF and 0.98+/-0.68 microg/ml after HDF); at 60 min of HDF, concentrations were as follows: AL=1.35+/-1.27 microg/ml; VL=0.37+/-0.31 microg/ml, D=0.40+/-0.34 microg/ml, UF=1.24+/-1.18 microg/ml; corresponding to a diffusive flux of 271 microg/min and a convective flux of 126 microg/min. Total loss of vit C could be assessed at 66 mg/session (8--230 mg/session). According to this loss of vit C, presence of an oxidative stress was demonstrated in HD population as shown by a significant increase in MDA (1.66+/-0.27 microM in HD vs 0.89+/-0.25 microM in HS; P<0.01) and AOPP (77.5+/-29.3 microM in HD vs 23.5+/-13.2 microM in HS; P<0.01) levels, and a decrease in GSH-Px activity (259.2+/-106.3 U/l in HD vs 661.2+/-92.2 U/l in HS; P<0.01). No change in plasma vit E between both populations (30.7+/-9.1 microM in HD vs 35.3+/-7.34 microM in HS) was observed. CONCLUSIONS: These results suggest that HDF with highly permeable membranes is associated with a significant loss of vit C. Diffusive transport is responsible for two-thirds whereas convective phenomenon accounts for only one-third of this loss.