Insulin-pump use in everyday practice: data from an exhaustive regional registry in France.

AIM: The aim of this study is to evaluate the effectiveness and safety of continuous subcutaneous insulin infusion (CSII) under real-life conditions among all patients treated with CSII in the south of Paris. METHODS: The 42 diabetologists practising in the region enrolled all patients treated with CSII or admitted for CSII initiation. During the study visit, the data for pump use and clinical results were recorded. RESULTS: Data were obtained for 424 patients, mean age 44.2+/-15.6 years, disease duration 18.7+/-10.6 years, including 339 treated with CSII for longer than three months (mean duration: 3.5+/-3.5 years; range: 3-258 months). Most of the patients (N=285, 84.8%) had type 1 diabetes; 44 (13.1%) had type 2 diabetes. In patients treated for more than three months, HbA1c decreased significantly between CSII initiation (9.1+/-1.9%) and the study visit (7.8+/-1.4%; P<0.0001). Patients with HbA1c >9%, using the pump, experienced a significant 0.9% improvement in their HbA1c levels with CSII versus multiple daily injections (P=0.001). The number of episodes of moderate hypoglycaemia was 2.7+/-2.5 per patient per week; of severe hypoglycaemia, 0.34 per patient per year and of ketoacidosis, 0.11 per patient per year. Factors significantly associated with HbA1c levels included amount of physical activity, pregnancy, HbA1c at CSII initiation and number of glucose self-determinations. Those associated with the number of moderate hypoglycaemia episodes were basal rate number, female gender and HbA1c level. HbA1c was negatively correlated with moderate hypoglycaemia (P<0.001), but not with severe hypoglycaemia. CONCLUSION: This 'pump' registry establishes the effectiveness of CSII in everyday practice, yet underscores the risks of severe hypoglycaemia and ketosis episodes. It could help diabetologists to improve patient training programmes and follow-up.

[Cerebral magnetic resonance imaging in iatrogenic Creutzfeldt-Jacob disease]. / Imagerie par résonance magnétique cérébrale dans la maladie de Creutzfeldt-Jakob iatrogène.

INTRODUCTION: We describe here the cerebral cerebral magnetic resonance (MRI) abnormalities observed in a case of iatrogenic Creutzfeldt-Jacob disease (CD). CASE: A 37 year-old man had been treated for pituitary dwarfism during adolescence with contaminated growth hormone. Neurological symptoms nearly two decades later suggested CJD. Cerebral MRI nine months after the onset of symptoms showed hypersignals similar to those observed in variant CJD (pulvinar sign). The diagnosis of CJD was confirmed by post-mortem examination. DISCUSSION: To our knowledge, this is the first case in which MRI revealed iatrogenic CD. The aspects are similar to those described for variant CJD.

[Chemotaxis and collagen]. / Chimiotactisme et collagène.

The authors evaluate the chemotactic properties of collagen and collagen derived fragments, according to literature datas. In experimental conditions, collagen can be chemotactic for human blood monocytes, fibroblasts and various malignant cells but not polymorphonuclear. The meaning of these facts and their possible role in the genesis of osteo-articular diseases are also discussed.

Diabetic control in 102 insulin-treated out-patients.

Haemoglobin AIc concentrations were measured in 102 insulin-treated diabetic outpatients. Only 19% had Hb AIc levels below three standard deviations above the normal mean value (5.23 +/- 0.05%). There were no correlations between Hb AIc levels, random C-peptide immunoreactivity or age. A significant correlation (r = 0.49; p < 0.001) was, however, observed between HbAIc and random plasma glucose levels. The mean random plasma glucose value was normal (89 +/- 18 mg/100 ml; 5 +/- 1 mmol/l) in the patients on insulin three times a day who had received short acting insulin 160 +/- 6 min before the sampling. --A significant inverse correlation was found (r = -0.26; p < 0.01) between the number of daily insulin injections and the HbAIc concentration. --These results suggest that the use of multiple daily insulin injections improves diabetic control. It should however be emphasised that the patients receiving multiple insulin injections were younger than those on the single injection regime and had lower plasma insulin antibody titres, different social and psychological status and a shorter duration of the disease.

[Metabolic control in 107 maturity onset diabetic out patients (author's transl)]. / Contrôle du diabète non traité par l'insuline. 107 observations.

Hemoglobin A1c concentrations were measured in 107 out patients with non insulin treated diabetes. A good correlation was observed between Hb A1c and random post-prandial plasma glucose levels. Mean Hb A1c concentrations were slightly higher in these diabetics than in controls but markedly lower than values observed in insulin treated patients. Sixty three per cent of the patients had Hb a1c levels below three standard deviations above our normal mean value. Random post-prandial plasma insulin levels were correlated to the degree of overweight but not other parameters. The best results were observed in patients treated by diet alone (31 % of the whole population) and in those on diet and sulfonylureas (30 %) who were also the less older and the less overweight subjects.