Islet transplantation: cell therapy for type 1 diabetes

Antoine Buemi Published in the journal : September 2022 Category : Diabétologie

Islet transplantation holds great promise for the treatment of type 1 diabetes (T1DM), as it offers the potential to restore euglycaemia in a reliable manner, protects against hypoglycaemia and glycaemic lability in a way that exogenous insulin administration has thus far been unable to achieve, and is associated with far fewer risks than whole-pancreas transplantation. Moreover, for patients requiring total pancreatectomy for benign disease, isolation of islets from the diseased pancreas with intrahepatic transplantation of autologous islets can prevent or ameliorate postsurgical diabetes and improve quality of life. We, therefore, seek to add this alternative treatment to the therapeutic modalities proposed within our institution.

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Bariatric surgery: a cure for type 2 diabetes mellitus?

Jean-Paul Thissen Published in the journal : September 2022 Category : Diabétologie

Obesity surgery or bariatric surgery has significantly grown over recent years. Given that obesity plays a key role in the pathophysiology of type 2 diabetes mellitus, it is no surprise that bariatric surgery, along with its impressive weight loss, has been shown to dramatically improve diabetes mellitus. The observation that numerous diabetic patients remain poorly controlled despite recent advances in drug therapy has been associated with an increased interest in this surgical approach to the treatment of diabetes mellitus. The primary purpose of this review has been to summarize the place of bariatric surgery within the therapeutic arsenal for type 2 diabetes mellitus.

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Are F. Banting and Ch. Best really the "discoverers" of insulin 100 years ago? Synthesis of a rereading of history

Martin Buysschaert (1), Alberto de Leiva-Hidalgo (2) Published in the journal : September 2022 Category : Diabétologie

The aim of this article has been to revisit the history of the discovery of insulin, "officially" attributed to F.G. Banting and Ch. Best. The first administration of their pancreatic extract to humans was performed in January 1922 in Toronto. In reality, history has made these two names sacred, whereas others, in Canada and Europe, have also contributed in a decisive way to this discovery. Given this context, we wish to untangle the skeins by describing the essential role and major impact of other researchers from both Canada (J. Macleod and J.B. Collip) and Europe (M. Gley in France, G. Zuelzer in Germany, and N. Paulescu in France and Romania). This article thus primarily seeks to "render to Caesar what belongs to Caesar".

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New indications of SGLT2-inhibitors

Michel Jadoul Published in the journal : September 2022 Category : Diabétologie

Inhibitors of the sodium-glucose cotransporter 2 (SGLT2) are dramatically changing the management of heart failure and, especially, chronic kidney disease. Indeed, this class of drugs, which was initially developed to improve glycemia control in Type 2 diabetics, is now widely recommended by global/international guidelines as part of the standard care for both diabetics and non-diabetics presenting with heart failure and/or albuminuric chronic kidney disease. Indeed, large outcome trials have conclusively demonstrated their efficacy and safety, with some undesirable effects that are easily manageable in clinical practice, such as mycotic genital infection. The key challenge for the coming years is to ensure that the broad population of patients susceptible to benefit from SGLT2-i is actually treated by these drugs. In the near future, additional trials may further enlarge the population targeted by this drug class.

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Lyumjev®: a new rapid insulin formulation

Michel P. Hermans Published in the journal : February 2021 Category : Diabétologie

Insulin URLi (Lyumjev®) is a novel formulation of insulin lispro that was developed to more closely mimic the physiological secretion of prandial insulin, owing to its faster action and shortened duration of effect. URLi was recently marketed in Belgium and is intended for adult diabetics. Compared to lispro, its use is associated with decreased postprandial glycemic excursions in both Type 1 and Type 2 diabetic patients. When used in multiple injection regimens, URLi was demonstrated to increase diurnal time in range compared to lispro, in addition to reducing the time spent in hypoglyaemia in patients using insulin pumps.

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Insulinotherapy in 2021

Martin Buysschaert, Vanessa Preumont, Dominique Maiter Published in the journal : January 2021 Category : Diabétologie

The aim of this paper is to propose a current state of the art in the field of insulin treatment. We describe human insulin and analogs available in Belgium, as well as the current recommendations in terms of insulin strategies in type 1 and type 2 diabetes.

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COVID-19 and diabetes

Laura Orioli, Michel P. Hermans, Vanessa Preumont, Audrey Loumaye, Jean-Paul Thissen, Orsalia Alexopoulou, Raluca Furnica, Maria-Cristina Burlacu, Dominique Maiter, Jean-Cyr Yombi, Bernard Vandeleene Published in the journal : May 2020 Category : Diabétologie

Diabetes is one of the most commonly reported comorbidities in COVID-19-infected patients. According to current data, diabetic patients do not appear to be at increased risk of contracting SARS-CoV-2 compared to the general population. However, diabetes is a risk factor for developing severe and critical COVID-19 forms, which often require intensive care unit admission and, eventually, invasive mechanical ventilation, which are associated with high mortality rates. The characteristics of COVID-19 diabetic patients and prognostic impact of diabetes on SARS-CoV-2 infection are currently under investigation. Obesity, the main risk factor for incident Type 2 diabetes, appears to be more common in patients with critical COVID-19 forms that require mechanical invasive ventilation. In diabetic patients, COVID-19 is associated with poor glycemic control and acute metabolic complications like ketoacidosis. At present, there are no recommendations in favor of discontinuing antihypertensive medications that interact with the renin-angiotensin-aldosterone system. Owing to the risks of lactic acidosis and ketoacidosis, metformin and SGLT2 inhibitors should be discontinued in patients with severe COVID-19 forms. Finally, we advise a systematic screening for (pre)diabetes in patients with proven SARS-CoV-2 infection.

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Hyperglycemia in type 2 diabetes: a synthesis of the new therapeutic recommendations

Martin Buysschaert Published in the journal : April 2020 Category : Diabétologie

This paper sought to describe and discuss the new guidelines for the treatment of hyperglycemia in patients with Type 2 diabetes, published in 2020 by the American Diabetes Association (ADA) and European Association for the Study of Diabetes (EASD). Besides lifestyle measures, metformin remains the first-line treatment. Additional antihyperglycemic agents are now selected depending of a past history of cardiovascular or renal diseases. Antidiabetic agents with proven cardiac and renal protection should be privileged, particularly in secondary prevention. These recommendations define a structured strategy, which must be implemented in each country, according to internal rules.

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New Type 2 diabetes treatments: cardiovascular safety/benefit and neproprotection

Martin Buysschaert, Benoit Buysschaert, Isabelle Paris, José Luis Medina, Michael Bergman, Vanessa Preumont Published in the journal : January 2020 Category : Diabétologie

Diabetic nephropathy is currently the leading cause of chronic end-stage renal disease, along with its clinical consequences. Its prevention implies multidisciplinary management based on strict control of blood glucose from diabetes onset, in addition to blood pressure control, primarily using ACE-I inhibitors or sartans. Recent clinical trials have demonstrated the cardiovascular security/benefits as well as nephroprotective effects of new classes of antihyperglycemic agents (DDP-4 inhibitors, GLP-1 agonists and SGLT-2 inhibitors), in addition to their well-established antihyperglycemic effects.

This paper aims to review the state of the art of diabetes-related cardiovascular and renal complication management.




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Impact of Freestyle Libre flash glucose monitoring system on glycemic control and quality of life

Margarita Goula, Marie Strivay, Vincianne Thielen Published in the journal : December 2019 Category : Diabétologie

The self-monitoring of glucose values is deemed necessary in diabetic patients to achieve a better glycemic control while avoiding hypoglycemias. New technologies have been devel-oped, such as the Freestyle Libre (sFL), a flash glucose monitoring system whose impact on better glycemic control and improved quality of life must still be assessed. This study confirmed the significant rise in the frequency of self-monitored glucose tests performed when using the sFL, in comparison with baseline, thereby resulting in an improvement in glycemic control and various quality of life features. Larger studies are required to elucidate the potential benefits gained by using sFL in blood glucose self-monitoring by diabetic in a larger scale.

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