Search PubMed⌕ Search

Biomedical subjects

V Rigalleau

Publications and source records attributed to V Rigalleau.

At least 19 recordsLinked to original sources
PubMed2007

Bone loss in diabetic patients with chronic kidney disease.

OBJECTIVE: We investigated whether loss of bone is detectable during follow-up of diabetic patients with chronic kidney disease (CKD). RESEARCH DESIGN AND METHODS: In 40 initially non-dialysed diabetic patients with CKD (isotopic glomerular filtration rate < 60 ml/min/1.73 m(2) or albumin excretion rate > 30 mg/24 h), body composition (DEXA scan) and glomerular filtration rate (GFR determined from (51)Cr-EDTA clearance) were measured at a 2-year interval, and compared by paired t-tests. RESULTS: The 40 patients, mainly with Type 2 diabetes (n = 28), were men (n = 28), aged 65 +/- 11 years, with diabetes duration 18 +/- 11 years. GFR was initially 38.0 (range 8-89) ml/min/1.73 m(2). CKD progressed during follow-up: eight started haemodialysis and GFR declined in the 32 others (P < 0.05 vs. initial). T-scores for total body (initial -0.61 +/- 1.11, final -1.11 +/- 1.40; P < 0.001) and femoral neck (initial -1.88 +/- 0.15, final -2.07 +/- 0.15; P < 0.05) declined. Ten patients were osteopaenic at baseline (no osteoporosis), whereas most were osteopaenic (n = 21, P < 0.05) and five were osteoporotic at final assessment. The 16 patients who became osteopaenic or osteoporotic during follow-up did not differ from the others for the type of diabetes, age, GFR, albumin excretion rate, HbA(1c), GFR reduction and the requirement for dialysis during follow-up. They were all men (P < 0.01 by chi-squared test), with reduced initial total body T-score (-1.20 +/- 0.82, others -0.32 +/- 1.13; P < 0.05) and a lower body mass index (24.6 +/- 4.3; others 27.7 +/- 4.3; P < 0.05). CONCLUSION: Bone loss, especially in the femoral neck, is progressive in diabetic patients with CKD.

Adult↗
PubMed2006

Air displacement plethysmography can detect moderate changes in body composition.

OBJECTIVES: To determine the sensitivity of air displacement plethysmography (APD) for evaluation of changes in body composition in normal subjects. DESIGN: Comparison of measurements with and without oil or water loads. SUBJECTS AND METHODS: Ten healthy volunteers were analyzed, without and with 1 l and 2 l of oil or water. The measured and true changes in fat mass and fat-free mass were compared by paired t-tests. A correlation study and a Bland & Altman procedure was performed on the 60 measurements of adiposity changes in 30 subjects carrying 0.5 l (n=8 x 2), 1 l (n=10 x 2) and 2 l (n=12 x 2) oil and water loads. RESULTS: Fat-free mass increased when the 10 subjects were carrying water. When they carried oil, fat mass increased, however, a approximately 0.5 kg increase of fat-free mass was also detected. Two liters loads led to distinct changes: +1.49+/-0.59 kg fat and +0.50+/-0.60 kg fat-free with oil and +0.37+/-0.57 kg fat and +1.70+/-0.56 kg fat-free with water (both P<0.001). Mixed loads (+1 l oil and 1 l water) led to detect +0.85+/-0.48 kg fat and +1.09+/-0.45 kg fat-free (both P<0.005 vs without load). For the 30 subjects analyzed thrice, measured changes in fat and fat-free mass were slightly underestimated (-15%, NS) but correlated with the true changes. Measured changes in adiposity were correlated with the true changes, with no bias as indicated by the Bland & Altman procedure. CONCLUSION: APD detects approximately 2 kg changes in fat or fat-free mass in small populations.

Adipose Tissue↗
PubMed2006

A simplified Cockcroft-Gault formula to improve the prediction of the glomerular filtration rate in diabetic patients.

AIM: The National Kidney Foundation recommends stratification of renal failure into moderate (Glomerular Filtration Rate: GFR = 30-60 mL/min/1.73 m2), severe (15-30) or terminal (<15) using the Cockcroft-Gault (CG) or the Modification of Diet in Renal Disease (MDRD) equations. We studied the biases in these methods in an attempt to improve the standard CG (MCG) and devise a strategy for stratification. METHODS: GFR was measured by 51Cr-EDTA clearance in 200 diabetic patients: 100 (Group 1: study of concordance) before 2003 and 100 thereafter (Group 2: validation of MCG). The CG was modified by replacing body weight by its mean value: 76. RESULTS: In group 1, the recommended equations only correctly stratified 50 patients. The CG, not the MDRD, underestimated GFR if BMI was normal, and overestimated it in obese patients. In group 2, the MCG was well correlated with GFR and not biased by weight. Over the whole population, the MCG and MDRD were more accurate for the diagnosis of moderate and severe renal failure. The MDRD showed the lowest differences with GFR, except if GFR > 60, where the MCG performed better. All formulae overestimated low GFR, the MDRD also underestimated high GFR. The best stratification (147/200) was obtained using the MCG if creatininemia < 120 micromol/l and the MDRD if creatininemia > or =120 micromol/l. CONCLUSION: The CG is biased by weight, the MCG corrects this. The more accurate MDRD cannot be used in all patients as it underestimates high GFR. The best stratification was obtained using the MCG at low and the MDRD at high creatininemia.

Adult↗
PubMed2006

How to better systematize the diagnosis of neuropathy?

Two attitudes can be proposed, one consisting of making a diagnosis of neuropathy, the other seeking to grade the stage that it has reached in order to give a prognosis and above all determine the right way in which to educate the patient. In order to do this, it is important for the diagnosis to be thorough. It should be based both on listening to what the patient has to say and examining him/her. It is vital to listen to the patient because the warning signs are discreet, yet very evocative, and they will be a great help in making a positive diagnosis. They should not be confused with signs of arterial damage. They should then be interpreted by means of clinical examination and the tools that are available, i.e. essentially monitoring the osteo-tendinous reflexes and sensory signs. The sensory signs can only be studied with high-quality instruments, i.e. either a monofilament of proven technical quality and that should be used with care in line with good clinical practice recommendations, or by using a graduated tuning fork, or a neuroesthesiometer which will make it possible to obtained graduated responses, not simply binary responses of the "yes/no" variety. A whole series of scores have been put forward combining both functional and physical signs, making it possible to try to quantify the stage reached and the extent of the neuropathy. It is only by using a thorough and regularly applied routine that we can progress to establishing a better prognosis and providing a better educational service for the patient.

Diabetic Neuropathies↗
PubMed2005

Body composition in diabetic subjects with chronic kidney disease: interest of bio-impedance analysis, and anthropometry.

BACKGROUND/AIMS: Lean body mass (LBM) is reduced in uremia, but this has not been reported in diabetic nephropathy. SUBJECTS AND METHODS: We compared predicted % LBM to DEXA measurements in 10 non-diabetic uremic, 10 non-uremic diabetic and 10 uremic diabetic subjects matched for age, gender and BMI. We also measured % LBM by anthropometry, bio-impedance analysis (BIA) and compared them with DEXA in 49 diabetic subjects with a wide range of renal failure. The results were compared and a Bland & Altman procedure was performed. Associations between glomerular filtration rate (GFR) and % LBM were tested. RESULTS: In matched groups, predicted % LBM values were overestimated in non-diabetic uremic subjects, and underestimated in non-uremic diabetic subjects. In uremic diabetic subjects, the error was intermediary. As compared to DEXA (% LBM: 69.0 +/- 7.1%), measurement of % LBM by anthropometry (71.4 +/- 8.0%, p < 0.05) and BIA (67.2 +/- 7.6%, p < 0.05) were biased in the 49 diabetic subjects. The mean of anthropometric and BIA (Ant+BIA) were similar to DEXA results (69.3 +/- 6.8%, p = 0.64), with best correlation coefficients and Bland & Altman plots. GFR was correlated to % LBM assessed by DEXA, BIA and Ant+BIA. CONCLUSION: In diabetic subjects with chronic kidney disease, LBM should be measured, rather than predicted. A good evaluation is possible, even without DEXA.

Anthropometry↗
PubMed2005

Lower plasma triglycerides are associated with increased need for insulin requirement in poorly controlled Type 2 diabetic patients.

AIMS: To identify factors associated with insulin requirement in Type 2 diabetic patients, and to examine the significance of a normal plasma triglyceride level. METHODS: One hundred and three poorly controlled (HbA1c = 9.4 +/- 1.9%) Type 2 diabetic patients initially not treated with insulin were followed up for 5 years. Insulin was administered if HbA1c > 8% despite maximal oral anti-diabetic treatment and bodyweight control. Variables were compared between insulin requiring and non-insulin-treated patients using unpaired t-tests. The outcomes of initially normotriglyceridaemic (< 1.7 mmol/l) and hypertriglyceridaemic patients were compared using unpaired t-tests, and a survival analysis (Cox proportional hazards model). RESULTS: Sixty-three patients were transferred to insulin. They were 5 years older (P = 0.004), with a 3-year longer duration of their diabetes (P = 0.03), a 1.2% higher HbA1c (P = 0.002), and 50% lower triglyceride levels (P = 0.02) than the others. The survival analysis showed that a long duration of diabetes, a high HbA1c, and a normal triglyceride level were associated with the need for insulin; the effect of normotriglyceridaemia was significant in the most poorly controlled (HbA1c > 9.5%) patients (relative risk: 2.35, 95% confidence interval: 1.16-5.52, P = 0.016). The 46 normotriglyceridaemic patients were leaner (P = 0.0004) and had lower C-peptide levels (P = 0.0008) than the others. Despite similar diabetes duration and HBA1c, more were transferred to insulin (normotriglyceridaemic: 71%, hypertriglyceridaemic: 52%, P = 0.03). CONCLUSION: A normal triglyceride level is associated with a need for insulin in poorly controlled Type 2 diabetes.

Body Mass Index↗
PubMed2004

Emphysematous cystitis.

We present a case of emphysematous cystitis in a diabetic patient with a poor glycemic control in the context of alcoholic chronic pancreatitis. A 62-year-old woman was admitted to the emergency department after being found on floor with confusion and vomiting. The clinical examination was unremarkable except she was undernourished, agitated and presented an hepatomegaly. Urine contained 5.104 leukocytes/mm3 and culture grew Escherichia coli, 10(7) Colony Forming Unit/ml. Abdominal plain film showed gas shadows along the wall of urinary bladder. CT scan of the pelvis confirmed the presence of gas, and diffuse thickening of the urinary bladder wall. A Foley catheter was placed and the patient was treated with antibiotics for 6 weeks. She was also treated with insulin, rehydratation, vitamin B1 and B6, and pancreatic enzyme replacement. Emphysematous cystitis is defined by the presence of gas in the urinary bladder wall. It complicates urinary tract infections especially in diabetic patients but other disabled general medical conditions may be present. Because this relatively uncommon disease may present with fairly nonspecific findings, the diagnosis is often made incidentally on X-rays. However, as early diagnosis and treatment improve the outcome, a high index of suspicion for unusual presentations is warranted. Every diabetic patient with a urinary tract infection who seems to be severely ill should have an abdominal X-ray as a minimal screening tool to detect emphysematous complications.

Anti-Bacterial Agents↗
PubMed2004

Comparison of the diet of self-declared diabetics with non-diabetic patients in the SU.VI.MAX study: did the diabetics modify their nutritional behavior?

OBJECTIVE: Dietary recommendations, a pillar in the treatment of diabetes, form part of official guidelines. However, it is not known how well these recommendations are followed in the diabetic population in France. The purpose of this study was to compare the habitual diet of self-declared diabetics with non-diabetics and to evaluate whether recommendations are being followed. METHODS: The intakes of several nutrients and foods of 67 self-declared diabetic patients were compared to those of 4658 non-diabetics in the SU.VI.MAX study (a primary prevention trial evaluating the impact of antioxidant supplementation on chronic disease). All patients (aged 45 to 60 years) who had completed at least five 24-hr dietary records over the first 18 months of the SU.VI.MAX study were included. We excluded patients who had not declared a diagnosis of diabetes and those with plasma fasting glucose levels over 7 mmol/l. RESULTS: The diabetic patients who declared being diabetic reported lower carbohydrate intakes (185 +/- 10.4 vs 219 +/- 1.4 g/d for men [p=0.001], 137 +/- 9.6 vs 165 +/- 1.0 g/d for women [0.005]), with a 50% reduction in consumption of oligosaccharides. Lipid intakes were unchanged for men, but reduced for women (61 +/- 4.1 g/d vs 72 +/- 0.4 g/d [p=0.01] with a 20% reduction in saturated fatty acids. Protein consumption was higher in the diabetic than in the non-diabetic men, but comparable for the women. Energy intakes were only lower in the diabetic women (1458 +/- 81 vs 1665 +/- 9 Kcal/d for women [p=0.01]). Micronutrient intakes were similar to those of non-diabetics, but appeared to be inadequate, particularly for anti-oxidants. Diabetic men consumed more margarine and less alcohol than did the non-diabetics. CONCLUSION: Diabetic patients who declared being diabetic did modify their nutritional behaviour, as they reduced their carbohydrate intake (both men and women), increased their protein intake (men only), and decreased their lipid and energy intakes (women only). However, carbohydrate intakes were unbalanced and there was excess protein intake. So patients who declared being diabetic are not as non-compliant in nutrition as commonly thought; they try to modify their diet, but often inappropriately. This may be explained by the fact that dietary advice stems from different sources and may be contradictory. A diabetic education program requires standardised training of health professionals and the provision of unequivocal information to the mass media and the general public.

Antioxidants↗
PubMed2003

Effect of metformin on fibrinolytic parameters in insulin-treated, type 2 diabetic patients.

OBJECTIVE: In the present study, we measured fibrinolytic parameters, including PAI-1 antigen and activity in a group of type 2 diabetic patients in secondary oral anti-diabetic failure treated with insulin alone or with insulin plus metformin. RESEARCH DESIGN AND METHODS: 12 type 2 diabetic patients in secondary oral anti-diabetic failure were randomly allocated into two groups receiving insulin alone or insulin plus metformin 1000 mg twice a day; six weeks later, the treatments were swapped over. At the end of each treatment period, blood samples were withdrawn for metabolic and fibrinolytic analysis. RESULTS: There were no significant differences in fasting blood glucose, fructosamine or fibrinogen; LDL cholesterol, PAI-1 antigen and activity, insulin needs were reduced by the inulin plus metformin regimen (LDL cholesterol: 1.59 +/- 0.62 versus 1.28 +/- 0.5 mmol/l, PAI-1 antigen: 28.3 +/- 17.4 versus 23.9 +/- 18 ng/ml, PAI-1 activity: 23.8 +/- 9.6 versus 21.9 +/- 10 IU/ml, insulin needs: 64 +/- 18 versus 52 +/- 15 U/day (p<0.05). CONCLUSION: In type 2 diabetic patients with secondary oral treatment failure, insulin alone controlled blood glucose but had no effect on the levels of PAI-1; addition of metformin improved the fibrinolytic parameters.

Aged↗
PubMed2002

Atrial fibrillation can cause major hyperglycemia.

We report the case of a 66 years old woman with a well controlled, insulin-treated, type 2 diabetes, who experienced a ten-fold increase of her daily insulin needs (from 21 to 215 U/day) after the onset of a symptomatic atrial fibrillation. Check-up for another cause of insulin resistance was negative, and insulin doses could be decreased to preceding values only after electric cardioversion. Symptomatic atrial fibrillation should be considered as a potential cause of hyperglycemia.

Aged↗
PubMed2002

[Screening for peripheral neuropathy: which tools?].

Peripheral diabetic neuropathy is asymptomatic as other diabetic complications. However it can have potentially serious consequences such as the development of foot ulcerations and foot amputation. Early identification of high-risk diabetic patients is needed but one must keep in mind that peripheral neuropathy always begin at the extreme distality of the lower limbs and that it may be detected at the toe level and not at the ankle level; moreover, diabetic peripheral neuropathy can affect different type of fibers and different explorations are needed for an early diagnosis. There are different tools such as monofilament, tune fork, or vibration bioesthesiometer but each has its limits and must be used with caution for being valid; some are qualitative, others are quantitative. The early detection of the high-risk patient can focus the attention of the medical and nurse team on those patients which will benefit from self foot care.

Diabetic Neuropathies↗
PubMed2002

Oral anti diabetic polychemotherapy in type 2 diabetes mellitus.

The therapeutic guidelines of the seventies for type 2 diabetic patients was a monotherapy which choice was based on the BMI of the patient and a bitherapy in case of a blood glucose increase. The pathophysiologic knowledge on type 2 diabetes has moved and the disease is nowadays more complex with a loss of the beta cell mass and an insulin resistance state of the liver, muscle and adipocyte tissue associated with a defect in gastro-intestinal hormones in the postprandial state. The pathophysiologic knowledge and the existence of new therapeutic agents led us to discuss oral antidiabetic polychemotherapy at the first drug prescription. This intuitive proposition has no evidence-based arguments with prospective long-term studies that would demonstrate the benefit of such a proposition. Moreover, if nowadays we can imagine a tritherapy proposition, progress in chemistry research will conduct to a quadri- and penta-therapy with expected difficulties in therapeutic compliance of the patient.

Administration, Oral↗
PubMed2002

Comparison between monofilament, tuning fork and vibration perception tests for screening patients at risk of foot complication.

OBJECTIVE: To compare normal and pathologic values of three different tests for screening patients at risk of foot complications: mono-filament, tuning fork and vibration threshold perception (VTP). METHODS: Two hundred and fifty consecutive patients followed-up in a diabetic clinic were screened for sensitive polyneuropathy by three different tests in three different examinations in a blind design. The 10 g mono-filament, tuning fork and Horwell neuro-esthesiometer were applied to different sites on the patients' legs and feet. RESULTS: Thirty eight patients were identified having abnormal tests and being at risk of foot complications using the mono-filament test; 33 of them and 9 more (42 patients (33 + 9)) were identified using the tuning fork applied to the malleolus and eight more (50 patients (33 + 9 + 8)) when the tuning fork was applied to the big toe; twenty more patients (70 (33 + 9 + 8 + 20)) were identified as being at risk using the VTP at a cut-off of 25 V. CONCLUSION: The mono-filament test identified patient with the highest risk of foot complications, but 37 more patients were identified to be at risk from a VTP > 25 V. These patients were not detected using the mono-filament test. The VTP test provides numerical values that can help to follow the course of the risk for foot insensitivity by allowing the care team to grade the education and follow-up of the at-risk group.

Adolescent↗
PubMed2001

Energy expenditure following oral glucose load in ten uremic patients before and after three months on a ketoacid-supplemented very-low-protein diet.

We have previously shown that a ketoacid-supplemented very-low-protein diet (KSVLPD), which has been proposed to slow down the rate of progression of chronic renal failure (CRF), improves tissue insulin sensitivity and decreases hyperinsulinemia in predialytic uremic patients. However, this diet may interfere with nutritional status. The aim of this study was to study basal energy expenditure (EE) and EE after an oral glucose load in patients with CRF before and during a KSVLPD (0.3 cal x kg wt(-1) x d(-1) supplemented with aminoacid and ketoanalogs) using oral glucose loading in combination with indirect calorimetry. We also monitored body weight and analyzed body composition by dual-energy x-ray (DEXA) during KSVLPD. In the third month of KSVLPD, no significant change in total body weight was observed, but DEXA showed a decrease in lean tissue mass (LTM; 46.2 +/- 3.6 kg before v 44 +/- 3.4 kg in the third month; P <.01) and an increase in body fat mass (20.1 +/- 2.4 kg before v 21.3 +/- 2.4 kg on KSVLPD; P <.05). Postabsorptive plasma glucose level was significantly lower, and glucose oxidation and energy expenditure per LTM were significantly increased (EE, 20 +/- 0.8 cal x kg LTM(-1) x min(-1) before diet v 21.9 +/- 1.1 cal x kg LTM(-1) x min(-1) after 3 months on KSVLPD; P <.01). Plasma glucose and serum insulin levels were significantly lower after glucose loading, and glucose oxidation increased. EE values were significantly higher after the oral glucose load, and cumulative EE after oral load increased from 20.7 +/- 0.7 cal x kg LTM(-1) x min(-1) before the diet to 22.9 +/- 1.1 cal x kg LTM(-1) x min(-1) in the third month of KSVLPD; P <.001). Glucose oxidation was higher and cumulative glucose storage was decreased after diet (29.6 +/- 4.2 g v 20.9 +/- 3.4 g on KSVLPD; P <.01). We conclude that KSVLPD increases EE in the postabsorptive state and after an oral glucose load with an adaptation of lean tissue mass in the third month of the diet. Therefore, during KSVLPD, strict monitoring of dietetic management is necessary to maintain energy requirements at high levels appropriate to the new EE.

Administration, Oral↗