Quarterly individual outpatients lifestyle counseling after initial inpatients education on type 2 diabetes: the REDIA Prev-2 randomized controlled trial in Reunion Island.

AIMS: This study aimed to describe the 1-year evolution of type 2 diabetes (T2D) patients who attended inpatients education, and to assess whether quarterly outpatients counseling visits by nurses and dietitians can improve metabolic control and health-related behaviours. METHODS: Following in-hospital educational sessions, 398 adult T2D patients were randomized to either attend quarterly individual lifestyle counseling visits by a nurse and a dietitian (intervention group), or receive the usual care (control group). Primary (HbA(1c)) and secondary endpoints (fasting blood glucose, lipids, body mass index, waist circumference, fat mass, blood pressure, diet, physical activity) were assessed at baseline and at 12 months. RESULTS: HbA(1c) changes from baseline to 12 months were -1.74±2.64% (P<0.0001) for the intervention group and -2.02±2.57% (P<0.0001) for the control group. There was no statistically significant difference between the intervention group (n=153) and the controls (n=166) for any of the clinical and biological outcomes. In both groups, total energy and fat intakes decreased significantly from baseline levels. Also, no difference was found between the groups for any dietary outcome. A slight enhancement in sports activity was observed in the intervention group, but the difference between the two groups did not reach statistical significance, and no difference was found concerning any other physical activity scores. CONCLUSION: In this study of adults with T2D, patients significantly improved their metabolic control, and dietary and exercise habits, 1 year after receiving intensive inpatients education, whereas subsequent quarterly outpatients counseling visits with nurses and dietitians have not demonstrated any superiority compared with the usual care.

Health perceptions of diabetic patients in the REDIA study.

AIM: To explore the beliefs and perceptions of type 2 diabetic patients in La Réunion where the disease is highly prevalent (17.5% among 30-69 yr old subjects) with a strong link to the metabolic syndrome and nutritional habits. METHODS: Two sets of data were analysed. An 80-item questionnaire explored the perceptions of causal factors, knowledge of complications and therapeutic issues in 331 known diabetic patients included in the REDIA study. The data were completed by semi-structured interviews of 40 diabetic patients in a hospital setting. RESULTS: Perceived causal factors of diabetes are mainly sugar excess, heredity and stress or life events. Weight excess and lack of physical activity are virtually never mentioned as causes. Diabetes is predominantly perceived as potentially acute, with risk of coma and death. Its chronic and progressive nature is not appreciated, and chronic complications are not well understood, especially in poorly educated people. Only 33% of males and 42% of females are willing to change their nutritional habits and the role of fats is largely underestimated (30.2%) although 90% consider physical activity as an effective course of action. Most patients are tardy in the way that they adopt medical recommendations and treatment in the course of the disease. CONCLUSION: These results highlight the discrepancy between medical knowledge and patients' perceptions, especially concerning etiological issues and complications. Lifestyle and therapeutic recommendations are not well understood. Educational activities need to consider the knowledge issues and understanding by patients early in the course of chronic diseases like diabetes.

Diabetic ketoacidosis revealing glucose-6-phosphate dehydrogenase deficiency: description of an adult case.

The discovery of an haemolytic anemia after a diabetic ketoacidosis led us to diagnose glucose-6-phosphate dehydrogenase (G6PD) deficiency in a 38-year old male patient. After a favorable course, we reviewed the links between this genetically transmitted enzymatic defect and diabetes mellitus, a public health concern in La Réunion. This description is a rare case of G6PD deficiency revealed after diabetic ketoacidosis in an adult.

[Clinical, biological and developmental aspects of alcoholic ketoacidosis]. / Aspects cliniques, biologiques et évolutifs de l'acidocétose alcoolique.

OBJECTIVES: To review cases of alcoholic ketoacidosis in order to better ascertain therapeutic management. METHODS: The medical files of 32 alcoholic patients with ketoacidosis hospitalized in the Saint-Pierre general hospital of the Reunion island from January 1, 1991 through 31 August 1994 were analyzed. RESULTS: There were 18 women and 14 men, mean age 47 years. The first clinical signs were predominated by digestive (n = 22) or neurological disorders (n = 10). Acidosis was severe (mean pH = 7.12) and always associated with a wide anion gap (mean anion gap = 35). There were 3 types of glycemic status: hypoglycemia 10 cases, normal or subnormal glycemia in 19 cases (mean glycemia = 9.3 mmol/l) and hyperglycemia above 20 mmol/l in 3 cases. Hypophosphatemia, elevated serum lactate levels and cytolytic hepatitis were the main abnormalities associated. CONCLUSION: Short-term outcome was favorable in all cases after rehydration. The use of insulin may be dangerous and needs to be avoided.

Increase in thiobarbituric acid-reactive substances and vascular complications in type 2 diabetes mellitus.

Lipid peroxidation was assessed by measuring the concentrations of thiobarbituric acid-reactive substances in plasma from 204 Type 2 diabetic patients, relative to 107 controls. The concentrations obtained in diabetic patients (3.08 +/- 0.37 mumol/l) were significantly higher than in controls (2.80 +/- 0.34 mumol/l) (p < 0.0001). Values were also significantly increased in patients with macroangiopathy and/or microangiopathy (3.17 +/- 0.41 mumol/l), relative to patients void of vascular complications (2.92 +/- 0.34 mumol/l) (p < 0.001). Elevated concentrations were independent of the type of vascular complication and their possible associations. In patients without vascular affection, thiobarbituric acid-reactive substances were in significantly higher concentrations in hypertensive (3.07 +/- 0.36 mumol/l) than in normotensive (2.87 +/- 0.29 mumol/l) (p < 0.01) patients. There was a correlation between these values and those of total cholesterol (r = 0.46, p < 0.0001) and triglyceride (r = 0.45, p < 0.0001). Statistical analysis by multivariate logistical regression revealed that among the independent factors (TBARS, APO A1, hypertension, age), thiobarbituric acid-reactive substances constituted the parameter most strongly linked to the existence of vascular complications. This study has evidenced a lipid peroxidation disorder in non insulin- dependent diabetes mellitus, more marked in patients with vascular affection. Thiobarbituric acid-reactive substances appear to be an independent marker of vascular complications in Type 2 diabetes.