ABSTRACT
The aim of this study was to determine which candidates were suitable for immunotherapy among adult insulin dependent diabetic patients of recent onset. A statistical analysis was performed using the results of a multicentre randomized trial of cyclosporine versus placebo after nine months of treatment. When the baseline characteristics of the patients in remission were compared with those not in remission, there was no difference observed either in initial residual beta-cell function (glucagon stimulated C-peptide level), or in immunological markers (T4 and T8 lymphocytes counts, Interleukin 2). The parameters showing the most difference were, in addition to treatment group, the duration of diabetes symptoms and body mass index at inclusion, and the HLA-DR phenotype. This was confirmed using a logistic regression analysis, in which these variables were found to be significantly related to remission. The probability of remission in each individual patient was then calculated using these variables in the mathematical function provided by the logistic model. Ninety eight out of 110 patients were correctly classified using this method. In addition, it must be noted that only subjects adequately treated by cyclosporine were still in complete remission after a one year follow-up. Conversely, it appeared that immunosuppression in subjects having a predicted probability of remission lower than 0.35 using the mathematical function, and being non-DR3, non-DR4 has to be avoided. These results will be useful in optimizing the recruitment of patients in on-going or future trials of immunotherapy in early diabetes.
Subject(s)
Cyclosporins/therapeutic use , Diabetes Mellitus, Type 1/drug therapy , Adolescent , Adult , C-Peptide/blood , Diabetes Mellitus, Type 1/blood , Diabetes Mellitus, Type 1/immunology , Glycated Hemoglobin/metabolism , HLA-DR3 Antigen/analysis , HLA-DR4 Antigen/analysis , Humans , Immunosuppression Therapy , Insulin/therapeutic use , Random Allocation , Remission InductionABSTRACT
Art. R.24-1 of the Code governing distribution of beverages and preventive measures against alcoholism: "If the verifications are performed following a traffic accident having occurred under the conditions provided at article L.88 of the present code or in application of articles L.1 and L.3 of the traffic code, the requesting authority keeps a copy of form A and sends: 1. The first blood specimen samples, along with four copies of forms A, B and C, to a laboratory of an establishment part of the public hospital system as defined at article 3 of law n. 70-1318 of December 31 1970 or to an expert biologist registered on the list held by the court of appeals as provided by article R.32 of the code governing distribution of beverages and preventive measures against alcoholism; 2. The second sample, along with one copy of forms A, B and C, to another expert biologist registered on the same list and in charge of eventually performing a control analysis. The laboratory or the expert biologist having performed the analysis reports the results on forms C and forwards one copy of forms A, B and C directly, under separate cover and stamped confidential to the competent Procureur de la Republique, to the region in which the misdemeanor or the accident occurred. The results reported on the form are immediately transmitted to the requesting authority.