[Management of diabetes during Ramadan fasting: applications of international recommendations in clinical practice]. / Prise en charge des patients diabétiques au cours du jeûne du Ramadan: application des recommandations internationales en pratique clinique.

Fasting is not without risk in diabetic patients. The aim of our study was to assess the impact of fasting on glycémic control in diabetic patients prepared for fasting as recommended by the American Diabetes Association (ADA) in 2010. We conducted a prospective cohort study in 2014, including diabetic patients wishing to fast during Ramadan, consenting to take part in this study. Were excluded patients considered at very high risk according to ADA classification. Patients included had a consultation before the month of Ramadan (D0) consisting of education and treatment adjustment. This was followed by a medical visit during Ramadan (J7), then at J30 and J60. Results analysis was done using SPSS Smartviewer15.0 Our study included 34 patients, of whom 60% were women, with a mean age of 50.4 years, an average 6.2-year diabetes history, and a mean body mass index of 27.83kg/m2. Therapeutic adjustments (D0) were: decrease dose of sulphonylurea (SH), gliptine add in patients at risk of hypoglycaemia, and a metformin dose distribution. During the first week (D7) two patients had a lower hypoglycemia 0.7g/l before breaking the fast and 38% of the sample showed hyperglycemia great than; 2g/l after breaking the fast. We noted dietary errors in 15% of patients. Adjusting at J7 was to modify the dose of SH or to add a gliptine. No patient showed major hyperglycemia, ketosis or severe hypoglycemia. One patient presented an atrial fibrillation on unknown ischemic cardiopathy with acease of fasting. Three patients gave up fasting between J15 and J20 due to an intense asthenia without hyperglycemia. Mean HbA1c in patients after the fasting was 7.10 versus 6.8% before fasting (p = 0.42). Factors significantly associated to poor glycemic control were mainly HbA1C rate at admission (p = 0.002), absence of self-monitoring (p = 0.01) and diabetes duration (p = 0.06). This study allowed us to show that a good evaluation of diabetic risk level, an education, a glycemia monitoring and an adjustment of the treatment by implementing international recommendations to allow fasting for Muslim diabetic patients with low risk of acute complications and metabolic disorders. A medical visit during the month of Ramadan (D7) would allow for correction of the dietetic mistakes and adjustment of oral agents if necessary.

Correlation between the plasma fibrinogen concentration and coronary heart disease severity in Moroccan patients with type 2 diabetes. Prospective study.

AIM: The present study aims at determining the relationship between the plasma fibrinogen concentration and the severity of coronary heart disease in type 2 diabetic patients. METHODS: Prospective analytical survey, based on a sample of 120 subjects divided in four groups: 30 non diabetic coronary patients (G1), 30 coronary diabetic patients (G2), 30 non-coronary diabetic patients (G3), and 30 healthy subjects (G4). RESULTS: The average age was 59.58±7.88 years; female gender predominated by 52.5%. The plasma fibrinogen concentration corresponded to 3.46g/L±0.86 in G1; 3.73g/L±1.11 in G2; 3.06g/L±0.98 in G3 and 2.46g/L±0.51 in G4; with a significant difference between the four groups (P=0.001). The plasma fibrinogen concentration increased in parallel with the cardiovascular risk (P=0.0001); there was also a significant correlation between the plasma fibrinogen concentration and the clinical and para-clinical coronary disease severity (respectively P=0.005 and P=0.0001). A positive correlation between the plasma fibrinogen concentration and hyperglycemia (P=0.035) was found in G4. But no correlation with the lipids parameters, except for the low density-lipoproteins in G3 (P=0.035). CONCLUSION: In the Moroccan population, the plasma fibrinogen concentration was positively and significantly correlated with the coronary heart disease severity.

Safety and effectiveness of insulin analogues in Moroccan patients with type 2 diabetes: a sub-analysis of the A1chieve study.

AIM: To determine the safety and effectiveness of insulin analogues in the Moroccan cohort of the prospective, multinational, non-interventional, 24-week A1chieve study. METHODS: Moroccan patients with type 2 diabetes (T2D) starting biphasic insulin aspart 30, insulin detemir, and insulin aspart alone or in combination were included. The primary outcome was the evaluation of serious adverse drug reactions including major hypoglycaemic events. Secondary outcomes were changes in hypoglycaemic events, glycaemic parameters (HbA1c, fasting plasma glucose [FPG], postprandial plasma glucose [PPPG]), systolic blood pressure (SBP), body weight and lipid profile. Quality of life (QoL) was evaluated using the EQ-5D questionnaire. RESULTS: In this analysis, 1641 patients (923 insulin-naive, 718 insulin-experienced) having a mean age 57.1 years, mean BMI 26.8 kg/m(2) and mean diabetes duration 10.3 years, were included. Baseline HbA1c in the entire cohort was poor (9.7%, 83 mmol/mol). Insulin analogues statistically significantly improved glucose control (HbA1c, FPG and PPPG, p < 0.001) at Week 24. The rate of hypoglycaemia decreased from 9.31 to 4.71 events/patient-year (change in proportion of patients affected, p = 0.0002). A statistically significant improvement in lipid parameters (except HDL cholesterol) was observed while body weight changed minimally. Additionally, QoL was positively impacted (mean change in visual analogue scores from EQ-5D was 15.8 points, p < 0.001). CONCLUSIONS: Insulin analogue therapy resulted in improved glycaemic control and a significant overall decrease in hypoglycaemia in Moroccan T2D patients.

Exploring insulin analogue safety and effectiveness in a Maghrebian cohort with type 2 diabetes: results from the A1chieve study.

AIM: To evaluate the safety and effectiveness of insulin analogues in patients with type 2 diabetes (T2D) from Morocco, Algeria and Tunisia that formed the Maghrebian cohort of the 24-week, non-interventional A1chieve study. METHODS: Patients starting biphasic insulin aspart, insulin detemir and insulin aspart, alone or in combination, were included. The primary outcome was the incidence of serious adverse drug reactions (SADRs), including major hypoglycaemic events. Secondary outcomes included hypoglycaemia, glycated haemoglobin A1c (HbA1c), fasting plasma glucose (FPG), postprandial plasma glucose (PPPG), systolic blood pressure (SBP), body weight and lipids. Quality of life (QoL) was evaluated using the EQ-5D questionnaire. RESULTS: Overall, 3720 patients with a mean age of 58.6 years, body mass index of 27.7 kg/m(2) and diabetes duration of 11.5 years were enrolled. Pre-study, insulin-experienced patients had a mean ± SD dose of 0.54 ± 0.27 U/kg. In the entire cohort, the mean dose was 0.42 ± 0.27 U/kg at baseline, titrated to 0.55 ± 0.30 U/kg by Week 24. Twenty-six SADRs were reported during the study. There was a significant decrease in the proportion of patients reporting overall hypoglycaemia from baseline to Week 24 (18.3% to 13.8%, p < 0.0001). The mean HbA1c improved significantly from 9.5 ± 1.8% to 7.9 ± 1.4% (p < 0.001). The mean FPG, PPPG, SBP, total cholesterol and QoL also improved significantly (all p < 0.001), while the mean body weight increased by 0.9 ± 3.9 kg (p < 0.001). CONCLUSION: Insulin analogue therapy was well-tolerated and was associated with improved glycaemic control.

Malignant insulinoma misdiagnosed and treated as epilepsy.

Pancreatic neuroendocrine tumors (PNET) are extremely rare, and although insulinomas are the commonest, less than 10% of insulinomas are malignant. Most patients with insulinomas present neuroglycopenic symptoms. Because of the rarity of the condition, we report the case of a 56-year-old man with malignant insulinoma, which was misdiagnosed as epilepsy. Timely diagnosis of this disease is of paramount importance to prevent neurologic sequelae of hypoglycemia. Insulinomas should be regarded from the beginning as potentially malignant, although the majority of malignant insulinomas progresses slowly.

Clinical experience with insulin detemir, biphasic insulin aspart and insulin aspart in people with type 2 diabetes: Results from the Casablanca cohort of the A1chieve study.

BACKGROUND: The A1chieve, a multicentric (28 countries), 24-week, non-interventional study evaluated the safety and effectiveness of insulin detemir, biphasic insulin aspart and insulin aspart in people with T2DM (n = 66,726) in routine clinical care across four continents. MATERIALS AND METHODS: Data was collected at baseline, at 12 weeks and at 24 weeks. This short communication presents the results for patients enrolled from Casablanca, Morocco. RESULTS: A total of 495 patients were enrolled in the study. Four different insulin analogue regimens were used in the study. Study patients had started on or were switched to biphasic insulin aspart (n = 231), insulin detemir (n = 151), insulin aspart (n = 19), basal insulin plus insulin aspart (n = 53) and other insulin combinations (n = 41). At baseline glycaemic control was poor for both insulin naïve (mean HbA1c: 10.2%) and insulin user (mean HbA1c: 9.4%) groups. After 24 weeks of treatment, both groups showed improvement in HbA1c (insulin naïve: -2.3%, insulin users: -1.8%). Major hypoglycaemia was observed in the insulin naïve group after 24 weeks. SADRs were reported in 1.2% of insulin naïve and 2.1% of insulin user groups. CONCLUSION: Starting or switching to insulin analogues was associated with improvement in glycaemic control with a low rate of hypoglycaemia.

Pulmonary epidermoid carcinoma in a patient with acromegaly: a rare entity.

A 56-years-old woman was referred to our unit for partially treated acromegaly. She had a high level of insulin growth factor. She did not complain of any pulmonary symptoms and was a non-smoker. Physical examination revealed clinical features of acromegaly. She had a 13 mm pituitary adenoma and was proposed for surgical intervention. Her chest X-ray showed a right paracardiac tumor. Computed tomography scan revealed a large right-sided fowler tumor. Pituitary surgery was cancelled and lobectomy after biopsy with lymph nodes excision was performed through thoracotomy. Histological study of the tumor revealed a medium differentiated epidermoid carcinoma with positive lymph nodes and extension to pleura. She was referred to chemotherapy protocol. Association between carcinoma and acromegaly has previously been reported. Most common tumors are colorectal and thyroid neoplasia. As we see in this case report, we need to consider other carcinomas in acromegalic patients like pulmonary carcinoma, despite their rarity in women.

Autosomal recessive hypercholesterolaemia in a Morrocan family due to a mutation of the G266C LDL receptor.

Familial hypercholesterolaemia (FH) is quite common genetic disorder resulting in high low-density lipoprotein (LDL) cholesterol levels, but homozygous FH is rare. The authors describe a Moroccan family where a 24-year-old man and his 13-year-old brother, born from a consanguineous union, showed characteristics of FH with large tendon, tuberous and planar xanthomas. They had already five deaths in the sibship before the age of 15 years. Blood analysis found high LDL cholesterol levels. Arterial assessment showed diffuse atherosis. Genetic study found that patients are homozygous for the mutation of G266C LDL receptor. Treatment with high doses of statins and ezetimibe was introduced reducing cholesterol up to 70%. Large xanthomas were removed surgically. The G266C mutation has been previously identified in Morocco. Early identification and adequate treatment of individuals with hypercholesterolaemia and their relatives are essential for prevention of early death in these populations.