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C Levy-Marchal

Publications and source records attributed to C Levy-Marchal.

40 records · Page 3Linked to original sources
PubMedDate not supplied

[Respective weight of genotypes DQA1 and DQB1 associated with insulin-dependent diabetes in French children].

Genetic susceptibility alleles have been identified at the DQ HLA region. The aim of the present study was to confirm the value of these markers, and to evaluate the respective weight in the risk of the different alleles at the DQA1 and DQB1 levels, identified by restriction mapping after polymerase chain reaction on exon 2. A significant enrichment in DQB1 alleles encoding for an aminoacid different from Aspartic acid at position 57 (NA) was observed in diabetic (n = 213) in comparison to control (n = 93) children (94% vs 52%; p < 10(-8)). Not all the given NA/NA allelic combinations were equally and positively associated to the disease. Homozygous "Ala/Ala" combinations carried the highest relative risk (OR = 12.3; p < 10(-8)), and among them, the *0201/*0302 genotype was more positively associated to type 1 diabetes (OR = 66; p < 10(-8)). A significant enrichment in DQA1 alleles encoding for Arginine at position 52 in diabetic children was also observed (82% vs 40%; p < 10(-8)). The *0301/*0501 (Arg/Arg) genotype was significantly associated to Type 1 diabetes (OR = 16.2; p < 10(-4)). The highest risk was carried by the whole genotype, a result which could be expected from the known linkage desequilibrium between HLA-DQA1 and DQB1, DRB1 loci. The frequency of Ala DQB1 alleles was low in the background non-at-risk population, although the incidence of the disease is low in our country.

Adolescent↗
PubMedDate not supplied

Feasibility of continuous subcutaneous insulin infusion in young diabetic patients.

Seven diabetic children (age: 8-12 y.) participated in a study comparing CSII and conventional treatment (CT) under the same monitoring and supervision for a year. The aim of the study was to explore the feasibility, the risks and the results on the glycemic control of CSII. Mean HbAlC fell from 9.3 +/- 2.1% to 7.3 +/- 1.4% (p less than 0.001) after the first month of CSII, remaining stable thereafter and with marginally lower, daily insulin requirements. There was a trend for HbAlc to increase, (HbAlC = 8.6 +/- 1.8%) under conventional treatment. The individual means of premeal capillary blood glucose concentrations were lower under CSII than under CT, but exhibited large variability under both treatments. Symptomatic hypoglycemia was as frequent under CSII as under CT. Ketonuria occurred frequently after the night basal infusion, but was of moderate clinical relevance and mainly due to technical problems. All seven children completed the trial; 4 of them chose to return to pump treatment. No psychologically adverse effects were noted. They all liked the flexibility of lifestyle afforded by CSII, and were generally compliant with the guidelines of this regimen. The pump itself was a valuable educational tool for the children and their families. However, CSII was recognized as individually demanding. This study demonstrates the feasibility of CSII in prepubertal children, and its impact on the glycemic control. The risks of this form of intensified treatment were limited by the strict monitoring and medical supervision provided by a specialized team.

Child↗
PubMedDate not supplied

Heterogeneity of type 1 diabetes at onset in children: results from the French Incidence Study.

OBJECTIVE: The aim of this survey was to identify specific relationships between clinical and biological features and immunogenetic markers at presentation in a large cohort of newly diagnosed Type 1 diabetic children recruited from the French incidence registry, in which country the incidence rate of the disease is low. RESEARCH DESIGN AND METHODS: A prospective study of the incidence of Type 1 diabetes has been set up in four regions of France since 1988 (2.3 million inhabitants under 20 years of age) where the epidemiological characteristics of the children have been studied as well as presentation at diagnosis. RESULTS: Five hundred and twenty one cases of newly diagnosed Type 1 diabetes were identified over the 3 years of the study in subjects aged 0-19 yr. The mean incidence rate was 7.6/10(5) per year. Eighty-two percent of the children had a symptomatic period shorter than or equal to 2 months. The mean weight loss was -9.2 +/- 7% of body weight. Forty-eight percent of the children demonstrated plasma total CO2 values < or = 18 mmol/l. Islet cell antibodies and insulin auto-antibodies were found in 86% and 41% of the children, respectively. Insulin auto-antibody positivity was significantly more frequent in the younger age group (0-4 yr: 78%, p = 0.0001) but not so for islet cell antibodies. HLA-DR3/DR4 phenotype was found in 32% of the children, and 11% carried none of these antigens, irrespectively of age. DR3 phenotype was significantly associated with a lesser frequency of islet cell antibodies (p < 0.001), but no other immunogenetic marker was associated to any clinical feature studied at presentation. CONCLUSIONS: France is a country with a low incidence rate of Type 1 diabetes within Europe. The heterogeneity of the risk for Type 1 diabetes across this continent has recently been confirmed. The variability of the risk according to age has also been shown in many parts of the world. Young age is an important factor for severity at presentation, but immunogenetics do not seem to play a major role in the heterogeneity of the picture at diagnosis.

Adolescent↗