Potential Role of TRAIL in the Management of Autoimmune Diabetes Mellitus.

Type 1 diabetes mellitus (T1DM) is an autoimmune disease, due to the immune-mediated destruction of pancreatic β-cells, whose incidence has been steadily increasing during the last decades. Insulin replacement therapy can treat T1DM, which, however, is still associated with substantial morbidity and mortality. For this reason, great effort is being put into developing strategies that could eventually prevent and/or cure this disease. These strategies are mainly focused on blocking the immune system from attacking β-cells together with functional islet restoration either by regeneration or transplantation. Recent experimental evidences suggest that TNFrelated apoptosis-inducing ligand (TRAIL), which is an immune system modulator protein, could represent an interesting candidate for the cure for T1DM and/or its complications. Here we review the evidences on the potential role of TRAIL in the management of T1DM.

Blockade of the renin-angiotensin system and renal tissue oxygenation as measured with BOLD-MRI in patients with type 2 diabetes.

AIM: To assess whether blockade of the renin-angiotensin system (RAS), a recognized strategy to prevent the progression of diabetic nephropathy, affects renal tissue oxygenation in type 2 diabetes mellitus (T2DM) patients. METHODS: Prospective randomized 2-way cross over study; T2DM patients with (micro)albuminuria and/or hypertension underwent blood oxygenation level-dependent magnetic resonance imaging (BOLD-MRI) at baseline, after one month of enalapril (20mgqd), and after one month of candesartan (16mgqd). Each BOLD-MRI was performed before and after the administration of furosemide. The mean R2* (=1/T2*) values in the medulla and cortex were calculated, a low R2* indicating high tissue oxygenation. RESULTS: Twelve patients (mean age: 60±11 years, eGFR: 62±22ml/min/1.73m(2)) completed the study. Neither chronic enalapril nor candesartan intake modified renal cortical or medullary R2* levels. Furosemide significantly decreased cortical and medullary R2* levels suggesting a transient increase in renal oxygenation. Medullary R2* levels correlated positively with urinary sodium excretion and systemic blood pressure, suggesting lower renal oxygenation at higher dietary sodium intake and blood pressure; cortical R2* levels correlated positively with glycemia and HbA1c. CONCLUSION: RAS blockade does not seem to increase renal tissue oxygenation in T2DM hypertensive patients. The response to furosemide and the association with 24h urinary sodium excretion emphasize the crucial role of renal sodium handling as one of the main determinants of renal tissue oxygenation.

Circulating microRNAs as novel biomarkers for diabetes mellitus.

Diabetes mellitus is characterized by insulin secretion from pancreatic β cells that is insufficient to maintain blood glucose homeostasis. Autoimmune destruction of β cells results in type 1 diabetes mellitus, whereas conditions that reduce insulin sensitivity and negatively affect β-cell activities result in type 2 diabetes mellitus. Without proper management, patients with diabetes mellitus develop serious complications that reduce their quality of life and life expectancy. Biomarkers for early detection of the disease and identification of individuals at risk of developing complications would greatly improve the care of these patients. Small non-coding RNAs called microRNAs (miRNAs) control gene expression and participate in many physiopathological processes. Hundreds of miRNAs are actively or passively released in the circulation and can be used to evaluate health status and disease progression. Both type 1 diabetes mellitus and type 2 diabetes mellitus are associated with distinct modifications in the profile of miRNAs in the blood, which are sometimes detectable several years before the disease manifests. Moreover, circulating levels of certain miRNAs seem to be predictive of long-term complications. Technical and scientific obstacles still exist that need to be overcome, but circulating miRNAs might soon become part of the diagnostic arsenal to identify individuals at risk of developing diabetes mellitus and its devastating complications.

Role for JIP-1/IB1 in pancreatic β-cell and adipocyte dysfunctions in type 2 diabetes and obesity

L'insuline, produite par les cellules β du pancréas, joue un rôle central dans le contrôle de la glycémie. Un manque d'insuline entraine le diabète de type 2, une maladie répandue au stade d'épidémie au niveau mondial. L'augmentation du nombre de personnes obèses est une des causes principales du développement de la maladie. Avec l'obésité les tissus tels que le foie, le muscle, et le tissu adipeux deviennent résistants à l'insuline. En général, cette résistance est équilibrée par une augmentation de la sécrétion d'insuline. De ce fait, un grand nombre d'individus obèses ne deviennent pas diabétiques. Lorsque les cellules β ne produisent plus suffisamment d'insuline, alors le diabète se développe. Dans l'obésité, les cellules graisseuses sont résistantes à l'insuline et relâchent des lipides et autres produits qui affectent le bon fonctionnement et la vie des cellules β. «c-Jun Ν terminal Kinase» (JNK) est une enzyme qui joue un rôle important dans la résistance de l'insuline des cellules graisseuses. Cette même en2yme contribue aussi au déclin de la cellule β dans les conditions diabétogènes, et représente ainsi une cible thérapeutique potentielle du diabète. L'objectif de cette thèse a été de comprendre le mécanisme conduisant à l'activité de JNK dans les adipocytes et cellules β, dans l'obésité et le diabète de type 2. Nous montrons que les variations de JNK sont la conséquence de taux anormaux de JIP-1/EB1, une protéine qui a été impliquée dans certaines formes génétiques de diabète de type 2. En outre nous décrivons le mécanisme responsable des anomalies de JIP1/IB1 dans les adipocytes et cellules β. La restauration des taux de JIP-1/EB1 dans les deux types cellulaires pourrait être un objectif des thérapeutiques antidiabétiques actuelles et futures. - Le nombre d'individus touchés par le diabète de type 2 atteint aujourd'hui des proportions épidémiques à l'échelle mondiale. L'augmentation de la prévalence de l'obésité est la cause principale du développement de la maladie, qui, en général, survient suite à une perte de la sensibilité à l'insuline des tissus périphériques. Dans un grand nombre des cas, l'insulino-résistance est compensée par une augmentation de la sécrétion de l'insuline par les cellules β pancréatiques. Le diabète apparaît lorsque l'insuline n'est plus produite en quantité suffisante pour contrecarrer la résistance à l'insuline des tissus. Le défaut de production de l'insuline résulte du dysfonctionnement et de la réduction massive des cellules β. Les acides gras libres non estérifiés, en particulier le palmitate, provenant d'une alimentation riche en lipides et libérés par les adipocytes insulino-résistants contribuent au déclin de la cellule β en activant la voie de signalisation «cJun N-terminal kinase» (JNK). L'activation de JNK contribue aussi à la résistance à l'insuline des adipocytes dans l'obésité, soulignant ainsi l'importance de cette voie de signalisation dans la pathophysiologie du diabète. L'objectif de cette thèse a été de comprendre les mécanismes qui régulent JNK dans les cellules β et les adipocytes. Nous montrons que l'activation de JNK dans ces deux types cellulaires est la conséquence de la variation des taux de «JNK interacting protein 1» appelé aussi «islet brain 1» (JEP-1/ΓΒΙ), une protéine qui attache les kinases de la signalisation de JNK et dont des variations génétiques ont été associées avec le diabète de type 2. Dans les cellules β cultivées avec du palmitate, ainsi que dans les adipocytes dans l'obésité, l'expression de JEP-l/BBl est modifiée. Les modulations de l'expression de JEP-1/ΓΒΙ sont réalisées par le facteur de transcription «inducible cAMP early repressor» (ICER). L'expression d'ICER dans les adipocytes est diminuée dans l'obésité, et corrèle avec l'augmentation des niveaux de JEP-1/IB1. A l'inverse, le niveau d'expression d'ICER est augmenté dans les cellules β cultivées avec du palmitate, et cette augmentation perturbe le bon fonctionnement des cellules en réduisant les niveaux de JEP-l/IBl. Comme le palmitate, les particules pro-athérogéniques LDL-cholesterol oxydés, sont élevées chez les personnes obèses et diabétiques et sont délétères aux cellules β. Ces particules modifiées activent JNK dans les cellules β en diminuant l'expression de JIP-1/IB1 via ICER. Tous ces résultats montrent que le dérèglement de l'expression de JIP-l/EBl par ICER joue un rôle central dans l'activation de JNK dans les adipocytes et cellules β en souffrance dans l'obésité et le diabète de type 2. La restauration appropriée des niveaux de JEPl/IBl et d'ICER pourrait être considérée comme un objectif pour mesurer l'efficacité des traitements antidiabétiques actuels et futurs. - Type 2 diabetes has reached epidemic proportions worldwide, and poses a major socio-economic burden on developed and developing societies. The disease is often accompanied by obesity, and arises when β-cells produce insufficient insulin to meet the increased hormone demand, caused by insulin resistance. In obesity, enlargement of adipocytes contribute to their dysfunction, which is characterized by the abnormal release of some bioactive products such as non-esterified free fatty acids (NEF As). Chronic plasma elevation of NEF As elicits β-cell dysfunction and death, thereby, representing a key feature for development of diabetes in obesity (diabesity). Palmitate is the most abundant circulating NEF As in obesity, which triggers adipocytes and β-cell dysfunction. The effects of palmitate rely on the induction of the cJun N-terminal kinase (JNK) pathway. Activation of JNK promotes both β-cells dysfunction and insulin resistance in adipocytes. This thesis was undertaken to investigate the mechanisms accounting for the induction of the JNK pathway caused by palmitate. JNK is regulated by the scaffold protein JNK interacting protein-1, also called islet brain 1 (JIP-1/IB1). The levels of JDM/IB1 are critical for glucose homeostasis, as genetic variations within the gene were associated with diabetes. We found that activation of JNK in both, β-cells exposed to palmitate, and in adipocytes of obese mice, results from variations in the expression of JIP-l/EBl. Modifications in the JIP-1/IB1 levels were the consequence of abnormal expression of the inducible cAMP early repressor (ICER) in the two cell types. In addition, our data show that this repressor plays a key role in abnormal production of adipocyte hormones and β-cell dysfunction evoked by the pro-atherogenic oxidized LDL. Taken together, this study proposes that fine-tuning of appropriate levels of JIP-l/EBl, and ICER could circumvent β-cell failure, adipocyte dysfunction, and thereby, development of diabesity.

A role for the transcriptional repressor ICER in the molecular pathogenesis of type 2 diabetes

AbstractType 2 diabetes (T2D) is a metabolic disease which affects more than 200 millions people worldwide. The progression of this affection reaches nowadays epidemic proportions, owing to the constant augmentation in the frequency of overweight, obesity and sedentary. The pathogenesis of T2D is characterized by reduction in the action of insulin on its target tissues - an alteration referred as insulin resistance - and pancreatic β-cell dysfunction. This latter deterioration is defined by impairment in insulin biosynthesis and secretion, and a loss of β-cell mass by apoptosis. Environmental factors related to T2D, such as chronic elevation in glucose and free fatty acids levels, inflammatory cytokines and pro-atherogenic oxidized low- density lipoproteins (LDL), contribute to the loss of pancreatic β-cell function.In this study, we have demonstrated that the transcription factor Inducible Cyclic AMP Early Repressor (ICER) participates to the progression of both β-cell dysfunction and insulin resistance. The expression of this factor is driven by an alternative promoter and ICER protein represents therefore a truncated product of the Cyclic AMP Response Element Modulator (CREM) family which lacks transactivation domain. Consequently, the transcription factor ICER acts as a passive repressor which reduces expression of genes controlled by the cyclic AMP and Cyclic AMP Response Element Binding protein (CREB) pathway.In insulin-secreting cells, the accumulation of reactive oxygen species caused by environmental factors and notably oxidized LDL - a process known as oxidative stress - induces the transcription factor ICER. This transcriptional repressor hampers the secretory capacity of β-cells by silencing key genes of the exocytotic machinery. In addition, the factor ICER reduces the expression of the scaffold protein Islet Brain 1 (IB 1 ), thereby favouring the activation of the c-Jun N-terminal Kinase (JNK) pathway. This triggering alters in turn insulin biosynthesis and survival capacities of pancreatic β-cells.In the adipose tissue of mice and human subjects suffering from obesity, the transcription factor ICER contributes to the alteration in insulin action. The loss in ICER protein in these tissues induces a constant activation of the CREB pathway and the subsequent expression of the Activating Transcription Factor 3 (ATF3). In turn, this repressor reduces the transcript levels of the glucose transporter GLUT4 and the insulin-sensitizer peptide adiponectin, thereby contributing to the diminution in insulin action.In conclusion, these data shed light on the important role of the transcriptional repressor ICER in the pathogenesis of T2D, which contributes to both alteration in β-cell function and aggravation of insulin resistance. Consequently, a better understanding of the molecular mechanisms responsible for the alterations in ICER levels is required and could lead to develop new therapeutic strategies for the treatment of T2D.RésuméLe diabète de type 2 (DT2) est une maladie métabolique qui affecte plus de 200 millions de personnes dans le monde. La progression de cette affection atteint aujourd'hui des proportions épidémiques imputables à l'augmentation rapide dans les fréquences du surpoids, de l'obésité et de la sédentarité. La pathogenèse du DT2 se caractérise par une diminution de l'action de l'insuline sur ses tissus cibles - un processus nommé insulino-résistance - ainsi qu'une dysfonction des cellules β pancréatiques sécrétrices d'insuline. Cette dernière détérioration se définit par une réduction de la capacité de synthèse et de sécrétion de l'insuline et mène finalement à une perte de la masse de cellules β par apoptose. Des facteurs environnementaux fréquemment associés au DT2, tels l'élévation chronique des taux plasmatiques de glucose et d'acides gras libres, les cytokines pro-inflammatoires et les lipoprotéines de faible densité (LDL) oxydées, contribuent à la perte de fonction des cellules β pancréatiques.Dans cette étude, nous avons démontré que le facteur de transcription « Inducible Cyclic AMP Early Repressor » (ICER) participe à la progression de la dysfonction des cellules β pancréatiques et au développement de Pinsulino-résistance. Son expression étant gouvernée par un promoteur alternatif, la protéine d'ICER représente un produit tronqué de la famille des «Cyclic AMP Response Element Modulator » (CREM), sans domaine de transactivation. Par conséquent, le facteur ICER agit comme un répresseur passif qui réduit l'expression des gènes contrôlés par la voie de l'AMP cyclique et des « Cyclic AMP Response Element Binding protein » (CREB).Dans les cellules sécrétrices d'insuline, l'accumulation de radicaux d'oxygène libres, soutenue par les facteurs environnementaux et notamment les LDL oxydées - un processus appelé stress oxydatif- induit de manière ininterrompue le facteur de transcription ICER. Ainsi activé, ce répresseur transcriptionnel altère la capacité sécrétoire des cellules β en bloquant l'expression de gènes clés de la machinerie d'exocytose. En outre, le facteur ICER favorise l'activation de la cascade de signalisation « c-Jun N- terminal Kinase » (JNK) en réduisant l'expression de la protéine « Islet Brain 1 » (IB1), altérant ainsi les fonctions de biosynthèse de l'insuline et de survie des cellules β pancréatiques.Dans le tissu adipeux des souris et des sujets humains souffrant d'obésité, le facteur de transcription ICER contribue à l'altération de la réponse à l'insuline. La disparition de la protéine ICER dans ces tissus entraîne une activation persistante de la voie de signalisation des CREB et une induction du facteur de transcription « Activating Transcription Factor 3 » (ATF3). A son tour, le répresseur ATF3 inhibe l'expression du transporteur de glucose GLUT4 et du peptide adipocytaire insulino-sensibilisateur adiponectine, contribuant ainsi à la diminution de l'action de l'insuline en conditions d'obésité.En conclusion, à la lumière de ces résultats, le répresseur transcriptionnel ICER apparaît comme un facteur important dans la pathogenèse du DT2, en participant à la perte de fonction des cellules β pancréatiques et à l'aggravation de l'insulino-résistance. Par conséquent, l'étude des mécanismes moléculaires responsables de l'altération des niveaux du facteur ICER pourrait permettre le développement de nouvelles stratégies de traitement du DT2.Résumé didactiqueL'énergie nécessaire au bon fonctionnement de l'organisme est fournie par l'alimentation, notamment sous forme de sucres (glucides). Ceux-ci sont dégradés en glucose, lequel sera distribué aux différents organes par la circulation sanguine. Après un repas, le niveau de glucose sanguin, nommé glycémie, s'élève et favorise la sécrétion d'une hormone appelée insuline par les cellules β du pancréas. L'insuline permet, à son tour, aux organes, tels le foie, les muscles et le tissu adipeux de capter et d'utiliser le glucose ; la glycémie retrouve ainsi son niveau basai.Le diabète de type 2 (DT2) est une maladie métabolique qui affecte plus de 200 millions de personnes dans le monde. Le développement de cette affection est causée par deux processus pathologiques. D'une part, les quantités d'insuline secrétée par les cellules β pancréatiques, ainsi que la survie de ces cellules sont réduites, un phénomène connu sous le nom de dysfonction des cellules β. D'autre part, la sensibilité des tissus à l'insuline se trouve diminuée. Cette dernière altération, l'insulino-résistance, empêche le transport et l'utilisation du glucose par les tissus et mène à une accumulation de ce sucre dans le sang. Cette stagnation de glucose dans le compartiment sanguin est appelée hyperglycémie et favorise l'apparition des complications secondaires du diabète, telles que les maladies cardiovasculaires, l'insuffisance rénale, la cécité et la perte de sensibilité des extrémités.Dans cette étude, nous avons démontré que le facteur ICER qui contrôle spécifiquement l'expression de certains gènes, contribue non seulement à la dysfonction des cellules β, mais aussi au développement de l'insulino-résistance. En effet, dans les cellules β pancréatiques en conditions diabétiques, l'activation du facteur ICER altère la capacité de synthèse et de sécrétion d'insuline et réduit la survie ces cellules.Dans le tissu adipeux des souris et des sujets humains souffrant d'obésité, le facteur ICER contribue à la perte de sensibilité à l'insuline. La disparition d'ICER altère l'expression de la protéine qui capte le glucose, le transoprteur GLUT4, et l'hormone adipocytaire favorisant la sensibilité à l'insuline, nommée adiponectine. Ainsi, la perte d'ICER participe à la réduction de la captation de glucose par le tissue adipeux et au développement de l'insulino-résistance au cours de l'obésité.En conclusion, à la lumière de ces résultats, le facteur ICER apparaît comme un contributeur important à la progression du DT2, en soutenant la dysfonction des cellules β pancréatiques et l'aggravation de l'insulino-résistance. Par conséquent, l'étude des mécanismes responsables de la dérégulation du facteur ICER pourrait permettre le développement de nouvelles stratégies de traitement du DT2.

TBS (Trabecular Bone Score) is More Sensitive Than BMD to Diabetes-Related Fracture Risk

Background:Type 2 diabetes (T2D) is associated with increased fracture risk but paradoxically greater BMD. TBS (trabecular bone score), a novel grey-level texture measurement extracted from DXA images, correlates with 3D parameters of bone micro-architecture. We evaluated the ability of lumbar spine (LS) TBS to account for the increased fracture risk in diabetes. Methods:29,407 women ≥50 years at the time of baseline hip and spine DXA were identified from a database containing all clinical BMD results for the Province of Manitoba, Canada. 2,356 of the women satisfied a well-validated definition for diabetes, the vast majority of whom (>90%) would have T2D. LS L14 TBS was derived for each spine DXA examination blinded to clinical parameters and outcomes. Health service records were assessed for incident non-traumatic major osteoporotic fracture codes (mean follow-up 4.7 years). Results:In linear regression adjusted for FRAX risk factors (age,BMI, glucocorticoids, prior major fracture, rheumatoid arthritis, COPD as a smoking proxy, alcohol abuse) and osteoporosis therapy, diabetes was associated with higher BMD for LS, femoral neck and total hip but lower LS TBS (all p<0.001). Similar results were seen after excluding obese subjects withBMI>30. In logistic regression (Figure), the adjusted odds ratio (OR) for a skeletal measurement in the lowest vs highest tertile was less than 1 for all BMD measurements but increased for LS TBS (adjusted OR 2.61, 95%CI 2.30-2.97). Major osteoporotic fractures were identified in 175 (7.4%) with and 1,493 (5.5%) without diabetes (p < 0.001). LS TBS predicted fractures in those with diabetes (adjusted HR 1.27, 95%CI 1.10-1.46) and without diabetes (HR 1.31, 95%CI 1.24-1.38). LS TBS was an independent predictor of fracture (p<0.05) when further adjusted for BMD (LS, femoral neck or total hip). The explanatory effect of diabetes in the fracture prediction model was greatly reduced when LS TBS was added to the model (indicating that TBS captured a large portion of the diabetes-associated risk), but was paradoxically increased from adding any of the BMD measurements. Conclusions:Lumbar spine TBS is sensitive to skeletal deterioration in postmenopausal women with diabetes, whereas BMD is paradoxically greater. LS TBS predicts osteoporotic fractures in those with diabetes, and captures a large portion of the diabetes-associated fracture risk. Combining LS TBS with BMD incrementally improves fracture prediction.

Patients' sibling history was sensitive for hypertension and specific for diabetes.

OBJECTIVE: We examined the analytic validity of reported family history of hypertension and diabetes among siblings in the Seychelles. STUDY DESIGN AND SETTING: Four hundred four siblings from 73 families with at least two hypertensive persons were identified through a national hypertension register. Two gold standards were used prospectively. Sensitivity was the proportion of respondents who indicated the presence of disease in a sibling, given that the sibling reported to be affected (personal history gold standard) or was clinically affected (clinical status gold standard). Specificity was the proportion of respondents who reported an unaffected sibling, given that the sibling reported to be unaffected or was clinically unaffected. Respondents gave information on the disease status in their siblings in approximately two-thirds of instances. RESULTS: When sibling history could be obtained (n=348 for hypertension, n=404 for diabetes), the sensitivity and the specificity of the sibling history were, respectively, 90 and 55% for hypertension, and 61 and 98% for diabetes, using clinical status and, respectively, 89 and 78% for hypertension, and 53 and 98% for diabetes, using personal history. CONCLUSION: The sibling history, when available, is a useful screening test to detect hypertension, but it is less useful to detect diabetes.

Diabetes and immune thrombocytopenic purpura: a new association with good response to anti-CD20 therapy.

Type 1 diabetes (T1D) is rarely a component of primary immune dysregulation disorders. We report two cases in which T1D was associated with thrombocytopenia. The first patient, a 13-year-old boy, presented with immune thrombocytopenia (ITP), thyroiditis, and, 3 wk later, T1D. Because of severe thrombocytopenia resistant to immunoglobulins, high-dose steroids, and cyclosporine treatment, anti-cluster of differentiation (CD20) therapy was introduced, with consequent normalization of thrombocytes and weaning off of steroids. Three and 5 months after anti-CD20 therapy, levothyroxin and insulin therapy, respectively, were stopped. Ten months after stopping insulin treatment, normal C-peptide and hemoglobin A1c (HbA1c) levels and markedly reduced anti-glutamic acid decarboxylase (GAD) antibodies were measured. A second anti-CD20 trial for relapse of ITP was initiated 2 yr after the first trial. Anti-GAD antibody levels decreased again, but HbA1c stayed elevated and glucose monitoring showed elevated postprandial glycemia, demanding insulin therapy. To our knowledge, this is the first case in which insulin treatment could be interrupted for 28 months after anti-CD20 treatment. In patient two, thrombocytopenia followed a diagnosis of T1D 6 yr previously. Treatment with anti-CD20 led to normalization of thrombocytes, but no effect on T1D was observed. Concerning the origin of the boys' conditions, several primary immune dysregulation disorders were considered. Thrombocytopenia associated with T1D is unusual and could represent a new entity. The diabetes manifestation in patient one was probably triggered by corticosteroid treatment; regardless, anti-CD20 therapy appeared to be efficacious early in the course of T1D, but not long after the initial diagnosis of T1D, as shown for patient two.

Subclinical coronary and aortic atherosclerosis detected by magnetic resonance imaging in type 1 diabetes with and without diabetic nephropathy.

BACKGROUND: Patients with type 1 diabetes and nephropathy maintain an excess cardiovascular mortality compared with diabetic patients with normoalbuminuria. We sought to evaluate coronary and aortic atherosclerosis in a cohort of asymptomatic type 1 diabetic patients with and without diabetic nephropathy using cardiovascular magnetic resonance imaging. METHODS AND RESULTS: In a cross-sectional study, 136 subjects with long-standing type 1 diabetes without symptoms or history of cardiovascular disease, including 63 patients (46%) with nephropathy and 73 patients with normoalbuminuria, underwent cardiovascular magnetic resonance imaging. All subjects underwent cardiac exercise testing and noninvasive tests for peripheral artery disease and autonomic neuropathy. Coronary artery stenoses were identified in 10% of subjects with nephropathy (versus 0% with normoalbuminuria; P=0.007). Coronary plaque burden, expressed as right coronary artery mean wall thickness (1.7+/-0.3 versus 1.3+/-0.2 mm; P<0.001) and maximum right coronary artery wall thickness (2.2+/-0.5 versus 1.6+/-0.3 mm; P<0.001), was greater in subjects with nephropathy. The prevalence of thoracic (3% versus 0%; P=0.28) and abdominal aortic plaque (22% versus 16%; P=0.7) was similar in both groups. Subjects with and without abdominal aortic plaques had similar coronary plaque burden. CONCLUSIONS: In asymptomatic type 1 diabetes, cardiovascular magnetic resonance imaging reveals greater coronary plaque burden in subjects with nephropathy compared with those with normoalbuminuria.

Quette place pour l'automesure glycémique dans la prise en charge du diabète de type 2 [Which role for self-monitoring of blood glucose in type 2 diabetes?]

There is a sustained controversy in the literature about the role and utility of self-monitoring of blood glucose (SMBG) in type 2 diabetes. The study results in this field do not provide really useful clues for the integration of SMBG in the follow-up of the individual patient, because they are based on a misconception of SMBG. It is studied as if it was a medical treatment whose effect on glycemic control is to be isolated. However, SMBG has no such intrinsic effect. It gains its purpose only as an inseparable component of a comprehensive and structured educational strategy. To be appropriate this strategy cannot be based on the health care professionals' view on diabetes only. It rather has to be tailored to the individual patient's needs through an ongoing process of shared reflection with him.

Diabetic neuropathy is a more important determinant of baroreflex sensitivity than carotid elasticity in type 2 diabetes.

The object of this study was to evaluate the contribution of carotid distensibilty on baroreflex sensitivity in patients with type 2 diabetes mellitus with at least 2 additional cardiovascular risk factors. Carotid distensibility was measured bilaterally at the common carotid artery in 79 consecutive diabetic patients and 60 matched subjects without diabetes. Spontaneous baroreflex sensitivity assessment was obtained using time and frequency methods. Baroreflex sensitivity was lower in diabetic subjects as compared with nondiabetic control subjects (5.25+/-2.80 ms/mm Hg versus 7.55+/-3.79 ms/mm Hg; P<0.01, respectively). Contrary to nondiabetic subjects, diabetic subjects showed no significant correlation between carotid distensibility and baroreflex sensitivity (r2=0.08, P=0.04 and r2=0.04, P=0.13, respectively). In diabetic subjects, baroreflex sensitivity was significantly lower in subjects with peripheral neuropathy than in those with preserved vibration sensation (4.1+/-0.5 versus 6.1+/-0.4 ms/mm Hg, respectively; P=0.005). Age in nondiabetic subjects, diabetes duration, systolic blood pressure, peripheral or sensitive neuropathy, and carotid distensibility were introduced in a stepwise multivariate analysis to identify the determinants of baroreflex sensitivity. In diabetic patients, neuropathy is a more sensitive determinant of baroreflex sensitivity than the reduced carotid distensibility (stepwise analysis; F ratio=5.1, P=0.028 versus F ratio=1.9, P=0.16, respectively). In diabetic subjects with 2 additional cardiovascular risk factors, spontaneous baroreflex sensitivity is not related to carotid distensibility. Diabetic subjects represent a particular population within the spectrum of cardiovascular risk situations because of the marked neuropathy associated with their metabolic disorder. Therefore, neuropathy is a more significant determinant of baroreflex sensitivity than carotid artery elasticity in patients with type 2 diabetes.

Prédire la survenue d'un diabète: la place de scores cliniques et/ou génétiques [Genetic and/or clinical scores to anticipate the onset of diabetes]

Diabetes represents an important health burden on our society: for example in Lausanne (Switzerland) 16% of the adult population have abnormal glucose homeostasis and 6% have diabetes, of which about a third is not aware. Some guidelines identify the "at risk" population for which screening seems indicated. Simple clinical scores have been developed at allow to better estimate the risk of diabetes and hence to potentially better target screening of the disease. The recent discovery of more that 18 genetic variants associated with an increased risk to develop the diseased has allowed to include individual genotype into genetic risk scores. We will discuss in this article the usefulness of these genetic score, how they compare to clinical score, their implication for clinical practice as well as their potential ethical or economical consequences.

Mortality associated with diabetes and cardiovascular disease in older women.

BACKGROUND: Current guidelines for the prevention of cardiovascular disease (CVD) recommend diabetes as a CVD risk equivalent. However, reports that have examined the risk of diabetes in comparison to pre-existing CVD are lacking among older women. We aimed to assess whether diabetes was associated with a similar risk of total and cause-specific mortality as a history of CVD in older women. METHODOLOGY/PRINCIPAL FINDINGS: We studied 9218 women aged 68 years or older enrolled in a prospective cohort study (Study of Osteoporotic Fracture) during a mean follow-up period of 11.7 years and compared all-cause, cardiovascular and coronary heart disease mortality among 4 groups: non-diabetic women with and without existing CVD, diabetic women with and without existing CVD. Mean (SD) age of the participants was 75.2 (5.3) years, 3.5% reported diabetes and 6.8% reported existing CVD. During follow-up, 5117 women died with 36% from CVD. The multivariate adjusted risk of cardiovascular mortality was increased among both non-diabetic women with CVD (hazard ratio (HR) 2.32, 95% CI: 1.97-2.74, P<0.001) and diabetic women without CVD (HR 2.06, CI: 1.62-2.64, P<0.001) compared to non-diabetic women without existing CVD. All-cause, cardiovascular and coronary mortality of non-diabetic women with CVD were not significantly different from diabetic women without CVD. CONCLUSIONS/SIGNIFICANCE: Older diabetic women without CVD have a similar risk of cardiovascular mortality compared to non-diabetic women with pre-existing CVD. The equivalence of diabetes and CVD seems to extend to older women, supporting current guidelines for cardiovascular prevention.