Expanding the clinical use of standard OGTT: the percentage increment of 2 h with respect to fasting glucose as an index of ß-cell dysfunction.

AIMS: Since glucose levels during oral glucose tolerance test (OGTT) are determined both by insulin sensitivity and insulin secretion, we investigated whether the percentage increment (PG%) of 2-h plasma glucose (2hPG) over fasting plasma glucose (FPG) is related to validated indexes of insulin sensitivity and insulin secretion. METHODS: Using Stumvoll's formulas we calculated estimated insulin sensitivity index and first-phase insulin secretion in 1281 subjects who underwent a standard OGTT. The ratio first-phase insulin secretion/(1/estimated insulin sensitivity index) was considered a surrogate index of ß-cell function. For each subject we calculated PG% using the formula: [(2hPG - FPG)/FPG] × 100. For each glucose tolerance group we formed tertiles based on PG% values. RESULTS: In each glucose tolerance group, ß-cell function was better preserved in lower PG% tertiles, demonstrating a correlation between PG% and insulin resistance. CONCLUSIONS: By a simple calculation, our study allows, expansion of the clinical use of OGTT to recognize subjects liable to further worsening of glucose homeostasis, independent from glucose tolerance groupings.

[Prerequisites to the administration and prevention of adverse effects of chemotherapy in colorectal cancer]. / Prérequis avant l'administration et prévention des effets secondaires d'une chimiothérapie pour cancer colorectal.

Some general and specific, statutory, clinical and biological parameters have to be taken into account before beginning chemotherapy in colorectal cancer to ensure maximal safety. Statutorily the prescription is reserved to specialised or competent physicians in oncology in some accredited institutions. It is essential to conform to indications, contraindications and posology, and to have a good knowledge of safety measures, drug interactions and side effects. Patients, family members and general practitioners should be informed about side effects, without forgetting some thematics (sexuality, fertility, contraception, vaccines, driving). This information should be simple, adapted and "reassuring", but should focus on symptoms indicating a serious toxic side effect. The message can be optimized by nurse consultation, transmission of the individualized care plan and linkage notebook, such as oral chemotherapies (capecitabine, UFT). The computerized and standardized prescription is done after infusion line inspection, clinical examination (global health status, nutritional status and buccodental status) and review of relevant pathological, radiological and biological data. Management of side effects includes patient education, appropriate premedication and prescription of prophylactic supportive care. Some specific preventive measures can attenuate the cutaneous side effects of EGFR inhibitors and the oxaliplatine-induced sensory neurotoxicity. Life expectancy, comorbidities, level of dependence, and if possible the comprehensive geriatric assessment should be taken into account for elderly patients. Prescription should be individualized and adapted to liver biology (irinotecan), kidney function (capecitabine and raltitrexed) and cardiovascular status (bevacizumab, 5-FU, capecitabin). Some molecular biologic prerequisites are indicated: detection of tumor KRAS-BRAF mutation before anti-EGFR and tumor microsatelliteinstability status before 5-FU in stage II cancers. Clinical relevance of others pretherapeutic molecularparameters are still being evaluated: UGT1A1 genotyping before irinotecan and detection of dihydropyrimidine dehydrogenase deficiency before fluoropyrimidines.