Management of newly diagnosed non-insulin-dependent diabetes mellitus in the primary care setting: effects of 2 years of gliclazide treatment--the Diadem Study.

Five thousand five hundred seventy-two newly diagnosed non-insulin-dependent diabetes mellitus (NIDDM) patients (3,225 men and 2,347 women; mean age, 58.5 years) were recruited through the General Practitioners (GPs) network in France. All had persistent hyperglycemia after a preliminary 3-month period with dietary and life-style modification. Gliclazide (80 to 320 mg/d) was then prescribed as diabetic pharmacotherapy for 2 years. Additional therapy for hypertension and dyslipidemia was started if necessary. The aim of the study was mainly to determine the feasibility of a GP-directed protocol for the monitoring and treatment of newly diagnosed NIDDM patients, and to assess the effectiveness of diabetic therapy in this cohort. Diabetes was diagnosed in 78% of the cohort during routine screening. Among the women, 6.5% had a history of gestational diabetes. Eighteen percent of the patients had a parental history of diabetes, and the dominant maternal role in the genesis of NIDDM was confirmed. High blood pressure (Joint National Committee V criteria) was found at inclusion in 38.8% of the whole cohort. Hyperlipidemia was known in 44.6%. A history of stroke was present in 1.6% of the patients, and coronary heart disease (CHD) in 6.3%. These data support the relationship between the atherogenic state and development of NIDDM. Microalbuminuria defined as urinary albumin excretion (UAE) of at least 20 mg/L was found in 29.6% of the patients, and retinopathy in 9.8%. Among the included patients, 23% did not complete the study and were excluded from the efficacy analysis. Of these, 14% (808 patients) had only baseline evaluation data and 9% (499 patients) withdrew later. Comparison of mean baseline and final results in study completers uncovered a significant improvement in fasting blood glucose ([FBG] 182 +/- 48 v 137 +/- 40 mg/dL), post prandial blood glucose ([PPBG] 209 +/- 68 v 162 +/- 52 mg/dL), and hemoglobin A1c ([HbA1c] 8.7% +/- 2.5% v 7.3% +/- 2.0%). A slight improvement in total cholesterol (228 +/- 44 v 222 +/- 41 mg/dL), body mass index ([BMI] 28.5 +/- 4.7 v 27.9 +/- 4.5 kg/m2), and waist to hip ratio (0.99 +/- 0.1 v 0.98 +/- 0.1) was observed. There was a decrease in the percentage of patients with high blood pressure (38.5% v 30.7%). A mild increase in the prevalence of retinopathy (10.2% v 11.8%) was noted during the study, while the incidence of microalbuminuria remained unchanged (30.2% v 29.5%). In conclusion, the data indicate that the GPs involved in this study were able to successfully monitor and manage NIDDM patients in accordance with a standardized protocol. Gliclazide appeared to be an effective and well-tolerated treatment. The high prevalence of chronic diabetic complications at diagnosis emphasizes the delay encountered in reaching the diagnosis of NIDDM and the problems associated with this delay. In addition to the classic risk factors for NIDDM exhibited in this patient cohort, we have identified CHD and a maternal genetic component as further potential predicting factors.

[Oltipraz as brief treatment of schistosomiasis (comparison with niridazole) (author's transl)]. / Effets de l'oltipraz en traitement bref dans la bilharziose (en comparaison avec le niridazole).

161 patients affected by schistosomiasis due in most cases to S. haematobium, and less frequently to S. mansoni, received one day treatment with 4,5 g a day of oltipraz in a first group and, later on, 3 g a day in another group. A control after one year was possible for patients having received 4,5 g one day dosis. Urin control, rectal mucosa biopsy (R.M.B.) and indirect immunofluorescence test (I.I.F.) were performed in patients who did not return to infested areas during that period of time; in almost all cases, the urin control was negative; in 52 p. 100 of the cases the R.M.B. shown no live egg and I.I.F. test was significantly decreased with individual variations. -- These results are compared to those of a previous and similar study on the effects of niridazole. -- Side-effects, mostly digestive or nervous, are frequent with a 4,5 g dose and less frequent with 3 g. They rarely compel to discard the treatment and they never persist after the morning following the treatment is stopped. There is no electrocardiographic change. -- Doses below 3 g in one-day intake are presently studied in order to fix the minimal acting dosis.

[Pulmonary complications of drepanocytemia: recent advances (author's transl)]. / Complications pulmonaires de la drépanocytose: acquisitions récentes.

Pulmonary complications are non very frequent in drepanocytemia (3 to 7 p. 100) but they are often severe and sometimes dramatic. They happen in the homozygotic forms or in the double heterozygotic ones (SC and Sbeta Tahal). Infections, most often due to pneumococcus, are specially frequent in children, though infractions are generally observed in youth and grown-ups. All these patients suffer of an impairement of their respiratory function and of their immunological capacity.

[Diagnostic value of parasitologic examinations and of indirect immunofluorescence test in S. haematobium schistosomiasis (author's transl)]. / Valeur diagnostique des examens parasitologiques et de la réaction d'immunofluorescence indirecte dans la schistosomose à S. haematobium.

A study has been carried out in 690 patients admitted in a Paris hospital and from Mali, Senegal and Mauretania origin, in order to compare the three available techniques for the diagnosis of infection with S. haematobium: urine centrifugation deposit control, biopsy of rectal mucosa and indirect immunofluorescence test. The prognostic value of each of these three techniques has been reevaluated. (Formula: see text), Living eggs have been detected in 55 p. 100 of the patients by direct examinations and a prevalence of 75 p. 100 has been computaned for S. haematobium.

[Cardiovascular risk factors in type 2 diabetes]. / Les facteurs de risque cardiovasculaire dans le diabète de type 2.

Morbidity and mortality through coronary atherosclerosis are higher in Type 2 diabetic patients than in nondiabetic subjects, roughly by a factor of 2 in males and 3 in females. Methodological problems in attempting to weigh the relative effects of each factor make it difficult to accurately interpret the numerous epidemiological data already available. Three issues are discussed here:--Do diabetics have more "classic" risk factors than nondiabetics? The incidence of hypertension, lipid disorders, and even smoking is practically consistently higher in diabetics, with "diabetic" lipid disorders (decreased HDL cholesterol and hypertriglyceridemia) topping the list.--Do diabetics have specific risk factors which could explain the observed increase in coronary morbidity and mortality? The answer would appear to be yes, as patent microalbuminuria--between 30 and 300 mg/24 hours--is found, as well as retinopathy and an increase in fibrinogen and PAI1 plasminogen activator inhibitor. Recent genetic studies have highlighted the role of Lp (a), and particularly that of angiotensin converting-enzyme gene polymorphism (DD allele).--What are the respective roles of hyperglycalmia and elevated levels of circulating insulin? In contrast to the importance of insulin in nondiabetics as demonstrated in longitudinal studies, insulin appears to play a marginal or even nil role in diabetics once the disease is established. It is probably glycaemia itself which remains the fundamental factor, even though the mechanisms leading from hyperglycemia to macrovascular complications remain unknown.

[Hypoglycemic and microvascular properties of gliclazide: a review of the latest international studies]. / Propriétés hypoglycémiantes et microvasculaires du gliclazide: une synthèse des dernières études internationales.

The effects of gliclazide on blood sugar levels and the micro-vascular system have been specified by the latest international studies of this antidiabetic agent presented at the 11th World Congress on Diabetes Mellitus. The potency of gliclazide is similar to that of the most effective reference agents. However, the mode of action of gliclazide, which induces an insulin release resembling physiologic conditions, explains why hypoglycemia is uncommon. Pharmacokinetic studies in the elderly have shown that gliclazide can be given to these more susceptible patients. Lastly, a number of trials, each of which was carried out against reference agents, have shown that gliclazide is valuable in delaying the course of non-proliferative diabetic retinopathy.

[Recent aspects of tuberculous peritonitis (22 cases in the adult) (author's transl)]. / Aspects actuels de la tuberculose péritonéale. A propos de vingt-deux cas chez l'adulte.

The authors show in this work the principal features of 22 tuberculous peritonitis cases seen between 1967 and 1977 affecting 17 Black Africans, 2 West Indians and 3 French (metropolitan) Caucasians cirrhotic or alcoholic. The 9 ascitic forms are not in the majority but it is worthwhile to consider a laparoscopy with peritoneal and/or hépatic biopsy where there is abdominal pain or unexplained fever. In most cases there exists one or several other tuberculous sites particularly pleural, pulmonary, hepatic, or in the cases of the Africans mediastinal lymphadénopathy. The means of diagnosis are commented upon with stress on the importance of peritoneoscopy and biopsies. The prognosis is good provided that antituberculous treatment is employed over a period of one year, with or without the temporary conjunction of corticosteroids.