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Biomedical subjects

S Halimi

Publications and source records attributed to S Halimi.

At least 73 records · Page 4Linked to original sources
PubMed1993

[Cost of the diabetic foot].

Among the long term complications of diabetes, leg and foot problems frequently associated with chronic nonhealing wounds constitute a heavy economic cost previously evaluated in some countries. This specific cost has not yet been calculated in France. This study represents the first "estimation" of the frequency and cost of these complications in our country. Methodological obstacles must be considered related to a large variety of clinical situations all covered by the word "diabetic foot", neurotrophic or ischemic origin, and the heterogeneity of the therapeutical approach more or less expensive. We have estimated the incidence of leg and foot problems about 50,000 to 60,000 per years, 20,000 to 25,000 requiring an inpatient treatment for a neurotrophic complication and 10,000 to 15,000 for an ischemic problem (frequently followed by a limited or a large amputation). The annual total cost, direct plus indirect, calculated on this basis should be: 3,750 millions of francs/year (about 700 millions of US $). This value must be compared to the total cost of diabetes in France 12,000 to 18,000 millions of francs/year when considering 1 to 1.5 million diabetic patients. Thus leg and foot problems appear to constitute a prominent part of the economical cost of diabetes in our country as in others developed countries. Multidisciplinary and specialized structures for the care and prevention of such complications of diabetes must be developed as new therapeutical approaches to reduce this incidence, the duration of healing and the risk of relapse.

Amputation, Surgical↗
PubMed1993

Lipid peroxidation and trace element status in diabetic ketotic patients: influence of insulin therapy.

Lipid peroxidation is known to accelerate aging and microvascular lesions in diabetic patients. We studied the acute influence of improved glycemic control on the concentrations of plasma lipid peroxidation intermediates [malondialdehydes (MDA), organic hydroperoxides (OHP)] in ketotic insulin-dependent diabetic patients, as well as the interplay of enzymes such as glutathione peroxidase (GPX) and CuZn superoxide dismutase (CuZn-SOD), and trace elements (Zn, Se, Cu) postulated to be involved in free radical protection. These plasma components were measured on the first day of hospitalization (T0) and when the patient had attained a stable glycemic state after continuous insulin treatment (T1). Plasma MDA and OHP concentrations were high at the beginning of the study but approached reference values after glycemic equilibration. Plasma zinc concentrations were significantly (P < 0.05) decreased during the ketotic state, but also approached reference values with glycemic equilibration. Plasma selenium concentrations and GPX activity were relatively unchanged between T0 and T1. Erythrocyte GPX activity measured at T1 in six patients was below the reference values, whereas CuZn-SOD activity was not affected. Our results show that enhanced lipid peroxidation is associated with decreased zinc plasma concentrations in ketotic patients and underline the beneficial effects of continuous insulin infusion. The mechanisms involved are still unclear but may indicate the importance of extracellular zinc transfer secondary to glycemic disorders.

Adult↗
PubMed1992

[Diabetes education].

Diabetes is a chronic disease requiring a compelling and permanent treatment which has repercussions on the patient's daily activities, tempo of life, feeding habits and physical exercises. This treatment also carries a risk of acute metabolic complications dreaded by the patient, the main one being hypoglycaemia. These constraints and fears have important effects on the patient's state of mind and must be taken into consideration by all those who look after him. For a strict and global handling of the diabetics' medical problems, it has been found necessary to institute an educational approach aimed at informing the patient, teaching him practical actions, facilitating his autonomy and reducing his anxiety and isolation. This approach is called diabetes education. It requires special training, as well as time and means, and must be subjected to evaluation. It is now well established that diabetes education is able to reduce the constraints of the disease, the frequency of metabolic accidents and the cost of diabetes. It is usually developed in hospital structures, but it also concerns private diabetologists and other medical helpers. This should convince the State authorities to recognize this teaching activity as a genuine therapeutic activity.

Diabetes Mellitus↗
PubMed1992

Early disturbances of ambulatory blood pressure load in normotensive type I diabetic patients with microalbuminuria.

OBJECTIVE: To compare 24-h ABP in normotensive type 1 diabetic patients with and without microalbuminuria. RESEARCH DESIGN AND METHODS: The study was a retrospective comparison of cases and matched control subjects. The first phase included 35 type 1 diabetic patients, normotensive by OMS criteria. The 23 patients with normoalbuminuria (< 15 micrograms/min) were compared with 12 patients with microalbuminuria (> or = 15 micrograms/min). In the second phase, the 12 microalbuminuric patients were paired by sex- and age-matched with 12 normoalbuminuric patients and 12 nondiabetic healthy control subjects. We measured casual systolic and diastolic BP and HR, 24-h ABP and AHR (recorded with a Spacelabs automatic recorder), and microalbuminuria. RESULTS: No correlation between microalbuminuria and casual BP was observed. Microalbuminuria was correlated significantly with diastolic 24-h APR and nocturnal systolic and diastolic ABP (r = 0.35, 0.38, and 0.33, respectively; P < 0.05) and with AHR during all time periods (24-h, r = 0.46; day, r = 0.39; night, r = 0.39; P < 0.05). Normo- and microalbuminuric patients did not differ in casual BP and HR. However, microalbuminuric patients had a significant increase in systolic 24-h ABP (119.1 +/- 8.2 vs. 113.1 +/- 8.1, P = 0.05), diastolic 24-h ABP (74.9 +/- 7.5 vs. 70.2 +/- 5.7, P = 0.04), nocturnal systolic ABP (112.8 +/- 7.1 vs. 105.8 +/- 7.9, P = 0.01), and AHR during all time periods. The same results were observed when patients were paired by age and sex. CONCLUSIONS: Normotensive microalbuminuric type 1 patients, although strictly comparable with normoalbuminuric patients for casual BP and HR, have an increased ABP and HR, especially during the night. This difference might reflect dysautonomia. Ambulatory measurement of BP and HR is more appropriate than casual measurements in hemodynamic studies of incipient diabetic nephropathies and could be proposed as an interesting tool for an early prediction of diabetic nephropathy.

Adult↗
PubMed1992

Diabetes mellitus prevalence among dialysed patients in France (UREMIDIAB study).

The prevalence of diabetes mellitus among patients treated for end-stage renal failure was studied using a questionnaire mailed to all dialysis units of mainland France in 1989. With a response rate of 80.8%, the study population amounted to 12,903 dialysed patients of whom 884 were declared diabetic (6.9%). In a second phase, the study focused on the diabetic patients treated in the 63 largest units (those with at least four diabetic patients). Seven specially trained physicians completed questionnaires after having interviewed the patients and checked their medical records. All this material was reviewed by the same diabetologist. The conflict of diabetes type declared by both sources of information (the nephrologists and the diabetologist) showed a misclassification rate of 31.2%. Using these new data, the prevalence of type 1 diabetes mellitus was estimated at 1.4% of patients on dialysis therapy in mainland France, and 5.5% for type 2 diabetes mellitus. A north-south declining trend was suggested for type 2 diabetes mellitus. Diabetic nephropathy was the only primary renal diagnosis among 93.9% of type 1 diabetic patients, but only for 36.8% of type 2 diabetic patients. Of the latter, 51.6% had a non-diabetic cause of renal failure. These data show that the proportion of diabetics among patients receiving dialysis, while steadily increasing in France, remains lower than in other countries in Europe and in North America. However, the validity of international comparisons depends on diabetes ascertainment. Heterogeneity in selection of patients and in diabetes type classification by dialysis units may account to a considerable degree for the differences between diabetes mellitus prevalence across countries.

Adult↗
PubMed1992

Classification of diabetes in patients with end-stage renal disease. Validation of clinical criteria according to fasting plasma C-peptide.

An epidemiologic study of end-stage diabetic nephropathy in France (Uremidiab) was performed, aiming to establish the prevalence of both types of diabetes in dialysis patients. Because discrimination between type I and type II diabetes remains mostly clinical, our aim was to evaluate what the most fitted clinical criteria were. We studied 494 hemodialyzed diabetic patients. A first classification (Cn) was offered by the nephrologist. Clinical data of 472 patients (22 patients of the 494 have been excluded) were then collected with a standardized questionnaire, allowing one diabetologist of us to establish the diagnosis of type of diabetes (classification Cd). Plasma C-peptide at this stage of the disease was expected to be very discriminative, measured in 88 patients and defined classification Ccp (< or = 0.6 ng/ml = "negative C-peptide" = type I, > 0.6 ng/ml = "positive C-peptide" = type II). Classification Cd observed 98 type I and 374 type II diabetes. Cn overestimated type I diabetes, 37% of type II diabetes being misclassified because insulin-treated. Classification Ccp observed 74 positive C-peptide patients, classified as type II, among whom 45 were insulin-treated. Only 3 patients were discordant for classification Cd and Ccp. Predictive value of "negative C-peptide" and "positive C-peptide" were 100% and 96% respectively. Multiple regression analysis of the Ccp classification was performed with the clinical criteria and showed very significant correlation with: age at the time of diagnosis of diabetes (AGE), maximal body mass index ever reached (BMI MAX) and delay between diagnosis and consistent insulin use (DI).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1992

[Methods of computerized approach of dysautonomia from a non-invasive pressure signal].

OBJECTIVE: examination of an automated exploration of autonomic neuropathy using the Ewing score and evaluation of sympatho-vagal tone. MATERIAL: continuous non-invasive collection of blood pressure (BP) data by means of Finapress fingerprobe. The signal was analysed after digitization at 500Hz, sampled and computerised. Values of systolic BP (SBP), diastolic BP (DBP) and heart rate (HR) are analysed by Anapres (Notochord). PROTOCOL: the pressure monitor is placed on the finger and the reading calibrated to the BP value recorded by auscultatory method on the contralateral arm to give a gap of less than 10 mmHg. BP and HR response to five different manoeuvres are recorded, namely: at rest over 7 minutes, after lying decubitus for 15 minutes; on rising suddenly over 3 seconds, and then over 9 minutes standing still; during 2 respiratory manoeuvres (a) deep breathing over 6 cycles per minute, (b) Valsalva pressure at 40 mmHg sustained over 20 seconds; isometric exercise with sustained handgrip at 30% maximal force sustained over 3 minutes. ANALYSIS: a dedicated computer programme displays in graphic form BP and HR over each manoeuvre and allows the operator to locate the exact cut-off of normality for each test of the Ewing score and also measure the balance of sympatho-vagal tone by Fourier transformation of the interval data of HR or BP peaks. APPLICATION: this approach allows evaluation of autonomic function and sympatho-vagal tone by means of 40 minutes of clinical testing and two minutes of automated analysis. This approach seems useful in the assessment of the autonomic nervous system in diabetes.

Autonomic Nervous System Diseases↗
PubMed1992

Assessment of handicap in chronic dialysis diabetic patients (Uremidiab section study).

As part of a large epidemiological study concerning 494 diabetic patients undergoing dialysis throughout France--the so-called Uremidiab section study--we collected data with the aim of describing objective as well as subjective aspects of quality of survival. Questionnaires were completed from medical records and from direct interviews by trained collectors. The data included: (a) medical status and impairments; (b) functional status with the Barthel index for basic activities of daily living; (c) subjective aspects through self-estimation of fatigue, pain, care burden, quality of life and working capacity. Only 21% of the patients had type 1 diabetes and more than 71% were currently insulin-treated. Among the various long-term complications registered, visual impairment was a prominent feature: 25% of the patients were blind and the best eye vision scored 0.8 or more for only 20%. The differences found between the two types of diabetes are discussed. As a result of these impairments, functional status was poor even when considering basic activities, with a mean Barthel index (BI) of 80 +/- 19. Type 2 patients and those patients undergoing continuous ambulatory peritoneal dialysis had significantly lower BI. The results are discussed in the light of the literature. Compared with a group of 121 non-dialyzed diabetics, patients scored higher for fatigue and pain, but not for care burden and quality of life.

Activities of Daily Living↗
PubMed1991

Inhibition of gluconeogenesis in isolated rat hepatocytes after chronic treatment with phenobarbital.

Gluconeogenesis was studied in hepatocytes isolated from phenobarbital-pretreated rats fasted for 24 h. In closed vial incubations, glucose production from lactate (20 mmol/l) and pyruvate (2 mmol/l), alanine (20 mmol/l) or glutamine (20 mmol/l) was suppressed by about 30-45%, although glycerol metabolism was not affected. In hepatocytes perifused with lactate and pyruvate (ratio 10:1), glucose production was inhibited by 50%, even at low gluconeogenic flux. From the determination of gluconeogenic intermediates at several steady states of gluconeogenic flux, we have found a single relationship between phosphoenolpyruvate and the rate of glucose production (Jglucose), and two different curves between cytosolic oxaloacetate and Jglucose in controls and in phenobarbital-pretreated hepatocytes. By using 3-mercaptopicolinate to determine the flux control coefficient of phosphoenolpyruvate carboxykinase we found that phenobarbital pretreatment led to an increase in this coefficient from 0.3 (controls) to 0.8 (phenobarbital group). These observations were confirmed by the finding that the activity of phosphoenolpyruvate carboxykinase was decreased by 50% after phenobarbital treatment. Hence we conclude that the inhibitory effect of phenobarbital on gluconeogenesis is due, at least partly, to a decrease in the flux through phosphoenolpyruvate carboxykinase.

Alanine↗
PubMed1991

[Diabetic glomerulopathy].

Detecting a microalbuminuria in a diabetic patient is enough to diagnose a diabetic glomerulopathy (which is more properly termed diabetic nephropathy). To appreciate exactly means to know what are the lesions of mesangium matrix and interstitial tissue; therefore, a renal biopsy is useful, (but needs to be examined by quantitative histo-morphometry). Numerous factors facilitate the progression of renal insufficiency in these patients: high blood pressure, poor glycemie control, high protein diet. Avoiding each of these factors allows to delay the time of dialysis and renal transplantation. Now diabetics represent the large group of patients in renal replacement therapy world-wide. These therapies are twice to thrice as expensive as they are for non diabetic patients.

Diabetic Nephropathies↗
PubMed1990

[Familial form of hypoglycemia due to leucine hypersensitivity].

The authors report on a boy and his mother showing signs of hypoglycemia due to hypersensitivity to leucine that is related to a that dominant autosomal. The cyclic inheritance glycemia test shows hyperinsulism; oral as well as intravenous loading dose of leucine tests showed that this hyperinsulism is due to hypersensitivity to leucine. The clinical picture, outcome of the disease dietary and medical treatment with diazoxide, and the role of GIP in insulin secretion is discussed.

Adult↗
PubMed1987

Differential effect of steady-state hyperinsulinaemia and hyperglycaemia on hepatic glycogenolysis and glycolysis in rats.

The action of glucose and of insulin on hepatic glucose production and metabolism has been studied in fed anaesthetized rats during hyperinsulinaemic clamp combined with various steady state levels of glycaemia (6.8 +/- 0.1, 9.3 +/- 0.1, 11.8 +/- 0.1 mmol/l). Hepatic glucose production was measured using constant infusion of D-[6-3H] glucose. At the end of each clamp the liver was freeze clamped, and enzyme activities and metabolites were measured. Hepatic glucose production was totally suppressed in all the groups receiving insulin. In the group with steady-state normoglycaemia, the suppression of hepatic glucose production was accompanied by a decrease in the levels of glucose-6-phosphate, an increase in those of fructose 2,6-bisphosphate and glycolytic intermediates, but without change in glycogen level or glycogen synthase and phosphorylase. In contrast, in the groups with steady-state hyperglycaemia, phosphorylase a was inactivated, and glycogen synthase activated. Under these conditions, glucose-6-phosphate levels were also decreased and those of fructose 2,6-bisphosphate and glycolytic intermediates were higher than in the group with steady-state normoglycaemia. A slight drop in the level of cAMP was also observed which may contribute, with hyperglycaemia, to the inactivation of phosphorylase. Incorporation of tritiated water into liver glycogen paralleled the activation of glycogen synthase and the accumulation of glycogen. The data indicate that, at normoglycaemia, insulin may suppress hepatic glucose production by channeling glucose-6-phosphate into the glycolytic pathway.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMed1987

Acromegaly due to a growth hormone-releasing hormone-secreting bronchial carcinoid tumor: further information on the abnormal responsiveness of the somatotroph cells and their recovery after successful treatment.

UNLABELLED: We studied GH secretion in a patient with acromegaly and a bronchial carcinoid tumor before and again after surgical removal of this tumor. Before removal of the carcinoid tumor, plasma GH increased slightly after glucose loading (OGTT) and markedly after TRH (650%) and insulin (440%) treatment. Plasma GH did not change after GH-releasing hormone (GHRH), LHRH, or L-dopa administration. Somatostatin (SRIH) infusion lowered plasma GH. No change in plasma immunoreactive GHRH (IR-GHRH) occurred after TRH, glucose, insulin, or SRIH administration. Two weeks after removal of the carcinoid tumor, TRH induced GH secretion (250%) when the IR-GHRH level was undetectable and somatomedin-C was within normal limits. Fifteen weeks after surgery, the patient had normal GH secretion. IN CONCLUSION: no pattern of GH secretion is diagnostic of acromegaly due to ectopic GHRH secretion, but the lack of GH response to exogenous GHRH and a large response during hypoglycemia may be features of this condition. When acromegaly and abnormal GH responsiveness are induced by a GHRH-secreting tumor, the increases in plasma GH after TRH, glucose, and insulin administration are not mediated by GHRH. After removal of the GHRH-secreting tumor, persistent paradoxical GH response to TRH does not require abnormally high IR-GHRH levels and does not preclude complete recovery.

Acromegaly↗