[Insulin sensitivity, blood pressure and cardiovascular diseases]. / Insulinosensibilité, pression artérielle et maladies cardiovasculaires.

Essential hypertension is one of the main components of the insulin resistance syndrome. Blood pressure levels are especially critical for the cardiovascular prognosis of patients with diabetes. However, whether the relationship between blood pressure levels and insulin sensitivity is causal, or just an association, remains debatable. In this study, this relationship is explored through the data of currently available clinical trials.

[Management of diabetic nephropathy before and during pregnancy]. / Prise en charge de la néphropathie diabétique avant et pendant la grossesse.

Congenital malformations represent the major risk of pregnancy in diabetic women. Prevention needs strict glycemic control before and during pregnancy. The risk of maternal and foetal complications is particularly high among patients with diabetic nephropathy, and a multidisciplinary approach is necessary. Before pregnancy, nephropathy is evaluated on serum creatinine and 24 hour urinary albumin and protein excretions. We discuss the interactions between diabetic nephropathy and pregnancy: the care of the other diabetic complications, the course of renal function during and after pregnancy, the influence of nephropathy on maternal and foetal complications and prevention of the latter by strict control of blood pressure and glycaemia before and during pregnancy. All these elements should be taken into account when discussing pregnancy with diabetic women with nephropathy wishing to become pregnant. The need to take preventive measures should be emphasised but the practice of systematically discouraging pregnancy without careful evaluation should be avoided.