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Background and Aims: Metabolic syndrome (MetS) definitions in adolescents based on the percentiles of its components are rather complicated to use in clinical practice. The aim of this study was to test the validity of artificial intelligence (AI)-based scores (AI_METS) that do not use these percentiles for MetS screening for adolescents.Methods and Results: This study included 1086 adolescents aged 12 to 18. The cohort underwent anthropometric measurements and blood tests. Mean blood pressure (MBP), and triglyceride glucose index (TyG) were calculated. Explainable AI methods are used to extract the learned function. Gini importance techniques were tested and used to build new scores for the screening of MetS. IDF, Cook, De Ferranti, Viner, and Weiss definitions of MetS were used to test the validity of these scores. MetS prevalence was 0.4%-4.7% according to these definitions. AI_METS used age, waist circumference, MBP, and TyG index. They offer area under the curves (AUCs) 0.91, 0.93, 0.89, 0.93, and 0.98; specificity 81%, 75%, 72%, 80%, and 97%; and sensitivity 90%, 100%, 90%, 100%, and 100%, respectively, for the detection of MetS according to these definitions. Considering only MBP offers a better specificity and sensitivity to detect MetS than considering only TyG index. MBP offers slightly lower performance than AI_METS.Conclusion: AI techniques have proven their ability to extract knowledge from data. They allowed us to generate new scores for MetS detection in adolescents without using specific percentiles for each component. Although these scores are less intuitive than the percentile-based definition, their accuracy is rather effective for the detection of MetS. [ABSTRACT FROM AUTHOR]

Le lénalidomide est un médicament immunomodulateur très souvent utilisé dans le traitement du myélome multiple. Plusieurs cas de néphrotoxicité ont été rapportés, mais peu ont été documentés histologiquement. Nous rapportons un cas de néphrite interstitielle aiguë au lénalidomide chez un patient âgé de 62 ans atteint de myélome multiple, après l'administration de la seconde cure de chimiothérapie selon le protocole associant bortézomib, lénalidomide et déxaméthasone. L'évolution a été rapidement favorable après l'arrêt du lénalidomide et l'introduction d'une corticothérapie. Le lénalidomide peut être responsable de néphrite interstitielle aiguë. Devant une insuffisance rénale aiguë au cours du traitement du myélome multiple, la néphrotoxicité des agents thérapeutiques doit également être évoquée en plus des causes d'atteintes rénales classiques. La chronologie des faits et les données histologiques sont essentielles et guident la prise en charge spécifique. Lenalidomide is an immunomodulatory drug widely used in the treatment of multiple myeloma. Several cases of nephrotoxicity have been reported, but few have been documented histologically. We report a case of acute interstitial nephritis to lenalidomide in a 62-year-old patient with multiple myeloma after administration of the second course of chemotherapy according to the protocol combining bortezomib, lenalidomide and dexamethasone. The outcome was quickly favorable after stopping lenalidomide, with corticosteroid therapy. Lenalidomide may be responsible for acute interstitial nephritis. When acute kidney injury occurs in myeloma, the nephrotoxicity of therapeutic agents should be considered in addition to the common causes of kidney failure. The chronology of events and the histological data are essential and guide the specific management. [ABSTRACT FROM AUTHOR]

[Figure: see text]. [ABSTRACT FROM AUTHOR]

Background and Aims: Studies of dipeptidyl peptidase inhibitors (DPP4is) report heterogeneous effects on cardiovascular targets in type 2 diabetes. This study aimed to investigate, in patients with impaired glucose tolerance (IGT), whether saxagliptin, a DPP4i, had beneficial cardiovascular effects at fasting and during the post-prandial state.Methods and Results: In this randomized, placebo-controlled, double-blind, single-center pilot exploratory study, we included obese individuals with IGT. Twenty-four individuals (BMI 36.8 ± 4.8 kg/m2) were randomized to receive for 12 weeks either saxagliptin 5 mg a day or placebo. They were explored before and after a standardized breakfast for biological markers; microcirculatory blood flow at baseline and after transcutaneous administration of acetylcholine (Periflux System 5000® PERIMED); post-occlusive digital reactive hyperhemia (Endopat2000®); pulse wave velocity, augmentation index, central pulse pressure and subendocardial viability ratio (Sphygmocor®); cardiac hemodynamic parameters and cardiovascular autonomic nervous system activity (Task force monitor®). The results of all the investigations were similar after breakfast in the two groups at Visit 1 (acute post-prandial effects, after the first tablet) and Visit 2 (long-term post-prandial effects), and at fasting at Visit 1 and 2 (long-term effects, after 12 weeks of treatment). Only at Visit 2 the decrease in cardiac vagal activity occurring after breakfast was more sustained in the saxagliptin group than in the placebo group (interaction between treatment and time effect: p = 0.016).Conclusion: In obese patients with IGT, the effects of saxagliptin on the large set of cardiovascular parameters measured are neutral, except for a more marked post-prandial depression of vagal activity.Clinical Trial Registration Number: NCT01521312. [ABSTRACT FROM AUTHOR]

Background and Aims: Dipeptidyl-peptidase inhibitors might be useful in type 2 diabetes prevention. ACCES (ACute and Chronic Effects of Saxagliptin) was a randomized, placebo-controlled, double-blind, controlled phase 2, pilot study aiming to examine in obese patients with impaired glucose tolerance (IGT) the acute effects and the effects after 12 weeks of treatment by saxagliptin on glucose levels at fasting and postprandially after a standard breakfast, and on glucose tolerance.Methods and Results: We included 24 obese patients with IGT. Patients were randomized to receive saxagliptin 5 mg or placebo in the morning. The treatment was taken on Visit 1 before breakfast, then continued for 12 weeks. Biochemical measurements were performed before, one, two and three hours after a standard breakfast including 75 g of carbohydrates, during Visit 1 and Visit 2 (12 weeks). Glucose variability (GV) was evaluated at Visit 1 from 24-h continuous glucose monitoring including the breakfast. A second OGTT was performed at Visit 3 (3-5 days after Visit 2). Compared with placebo-treated patients, saxagliptin-treated patients had lower 1 h and 2 h post-meal plasma glucose levels at Visit 1 and similar changes at Visit 2 (p < 0.01 to p < 0.004), with lower GV indexes after breakfast at Visit 1. At Visit 3, all patients but one in saxagliptin group and only 4 patients in placebo group turned to normal glucose tolerance. Lower glucose response to breakfast at Visit 1 was predictive of recovery of glucose tolerance.Conclusion: Saxagliptin has metabolically beneficial effects in glucose-intolerant obese patients by significantly lowering postprandial blood glucose levels.Clinical Trial Registration Number: NCT01521312: https://clinicaltrials.gov/ct2/show/NCT01521312. [ABSTRACT FROM AUTHOR]

Weighty processes took place during the Arab Spring that inter alia affected the status of the nation states in the Middle East and undermined their sovereignty. From the perspective of the ensuing decade, it appears that territorial borders and state frameworks were preserved, and sovereignty was therefore ostensibly maintained. This article proposes a more complex analysis of the term “sovereignty,” and presents the various ways in which sovereignty was manifested among countries in the region in 2010-2020. We propose reconsideration of the term with respect to what appears in the theoretical discourse of political science and international relations, in an attempt to examine the connections between the changes in the nature of sovereignty and the phenomenon of the failed state. We urge the adoption of typology reflecting the various levels and types of state sovereignty. Finally, we assess how an analysis of the region from the perspective of sovereignty is likely to help achieve a more profound understanding of countries in the Middle East and the level of their stability. [ABSTRACT FROM AUTHOR]

Our study evaluated the performance of a selective screening strategy for hyperglycaemia in pregnancy (HIP) based on the presence of risk factors (RFs; body mass index ≥ 25 kg/m2, age ≥ 35 years, family history of diabetes, personal history of HIP or macrosomic infant) to diagnose HIP and to predict HIP-related events. Women with no known diabetes who had undergone complete universal screening (early, before 22 weeks of gestation and, if normal, in the second part of pregnancy) at our department (2012–2016) were selected, resulting in four groups of women according to the presence of HIP and/or RFs, with a predefined composite endpoint (preeclampsia or large-for-gestational-age infant or shoulder dystocia). Included were 4518 women: 23.5% had HIP and 71.1% had at least one RF. The distribution among our four groups was: HIP−/RF− (n = 1144); HIP−/RF+ (n = 2313); HIP+/RF− (n = 163); and HIP+/RF+ (n = 898). HIP was more frequent when RFs were present rather than absent (33.1% vs 15.4%, respectively; P < 0.001). Incidence of the composite endpoint differed significantly (P < 0.0001) across groups [HIP−/RF− 6.3%; HIP−/RF+ 13.2%; HIP+/RF− 8.6%; and HIP+/RF+ 17.1% (HIP effect: P < 0.05; RF effect: P < 0.001; interaction HIP * RF: P = 0.94)] and significantly increased with the number of RFs (no RF: 6.3%, 1 RF: 10.8%, 2 RFs: 14.7%, 3 RFs: 28.0%, 4–5 RFs: 25.0%; P < 0.0001). RFs are predictive of HIP, although 15.4% of women with HIP have no RFs. Also, irrespective of HIP status, RFs are predictive of HIP-related events, suggesting that overweight/obesity, the only modifiable RFs, could be targets of interventions to improve pregnancy prognosis. [ABSTRACT FROM AUTHOR]

• Management of type 2 diabetes before and after bariatric surgery requires the following: • Recent ophthalmoscopy and cardiac ultrasound before surgery • Monitoring of glucose capillary levels in the immediate postoperative period • Adjustment of insulin treatment made by diabetologist • Use of metformin and DPP-4 inhibitors if a non-insulin glucose lowering treatment is required • HbA 1c tested every 6 months even in case of diabetes remission Metabolic surgery is now considered as a therapeutic option in type 2 diabetes (T2D). However, few data are available regarding perioperative management of T2D. To assess current practice among bariatric teams regarding perioperative management of T2D in order to propose guidelines. A two-round Delphi method using online surveys was employed among bariatric teams experts (surgeons, diabetologists, anesthetists, nutritionists): first round, 63 questions covering 6 topics (characteristics of experts/teams, characteristics of patients, operative technique, pre/postoperative management, diabetes remission); second round, 44 items needing clarification. They were discussed within national congress of corresponding learned societies. Consensus was defined as ≥ 66% agreement. A total of 170 experts participated. Experts favored gastric bypass to achieve remission (76.7%). Screening for retinopathy, cardiac ultrasound, and reaching an HbA 1c < 8% are required in the pre-operative period for 67%, 75.3% and 56.7% of experts, respectively. After surgery, insulin pump should not be stopped, basal insulin should be halved, and bolus insulin should be stopped except if severe hyperglycemia. DPP-IV inhibitors and metformin are preferred after surgery. Patients should be seen by a diabetologist within one month if on oral antidiabetic agents (71.8% of experts), 2 weeks if on injectable treatments (77.1% of experts), and immediately after surgery if on insulin pump (93.5% of experts). Long-term monitoring of HbA1c is necessary even if diabetes remission (100%). Rapid postoperative modifications of blood glucose require a close monitoring and a prompt adjustment of diabetes medications. [ABSTRACT FROM AUTHOR]

Secondary prevention can easily be defined as referring to patients with a history of CV events although, in recently published cardiovascular outcome trials (CVOTs), inclusion criteria were slightly different, combining both patients with previous CVD events and those with established CVD. Thus, if guidelines highlight specific indications for patients in secondary prevention [3], then some patients considered as being in "primary" prevention but having a high CV risk profile, especially those with silent CAD, might also benefit from the treatment. CV risk assessment in asymptomatic patients with no history of CVD usually includes electrocardiography (ECG) and echocardiography, and often a stress test (ECG and/or myocardial scintigraphy and/or echography) as well, with subsequent coronary angiography in patients with clear evidence of silent myocardial ischaemia. Nevertheless, it should be emphasized that canagliflozin was recently found, in a subgroup of patients included in the Canagliflozin Cardiovascular Assessment Study (CANVAS), to reduce the overall risk of HF events in patients with T2D and high CVD risk whatever their EF status (preserved, reduced or unknown) [19]. [Extracted from the article]

1h-PG plasma glucose value 1h after 75-g oral glucose tolerance test 2h-PG plasma glucose value 2h after 75-g oral glucose tolerance test AGEs advanced glycation end-products BMI body mass index DIP diabetes in pregnancy eGDM early gestational diabetes mellitus FINDRISC Finnish Diabetes Risk Score FPG fasting plasma glucose GDM gestational diabetes mellitus SD standard deviation WG weeks of gestation DIP was defined as FPG>=7.0mmol/L and/or 2h-PG>=11.1mmol/L; eGDM was defined as FPG>=5.1mmol/L in early pregnancy, and regular GDM as FPG 5.1-6.9mmol/L and/or 1h-PG>=10.0mmol/L and/or 2h-PG 8.5-11.0mmol/L during OGTT performed after 22 WG. GDM: gestational diabetes mellitus; eGDM: early gestational diabetes mellitus; DIP: diabetes in pregnancy; SD: standard deviation. GDM: gestational diabetes mellitus; eGDM: early gestational diabetes mellitus; DIP: diabetes in pregnancy; BMI: body mass index; FINDRISC: Finnish Diabetes Risk Score; WG: weeks of gestation; NA: non-applicable. [Extracted from the article]

In addition to screening for hyperglycaemia during pregnancy after 24 weeks of gestation (WG), the current guidelines also suggest screening in early pregnancy and referring women with early gestational diabetes mellitus (eGDM) or overt diabetes (OD) for immediate care. Our aim was to evaluate this strategy. This study evaluated, at our hospital (2012–2016), whether the incidence of a predefined composite outcome (preeclampsia, large-for-gestational-age infant, shoulder dystocia) and secondary outcomes was different when women were screened only after 22WG ('late screening only') or before 22WG and treated for eGDM or OD if present, with repeat screening after 22WG if absent ('early ± late screening'). Early ± late screening (n = 4605, 47.0%) increased between 2012 and 2016 (P < 0.0001) and was associated with more risk factors for GDM than late screening only. Glycaemic status differed in both groups (early ± late screening: eGDM 10.3%, GDM 12.1%, OD 0.9% vs. late screening only: GDM 16.8%, OD 1.2%; P < 0.001), with a higher rate of insulin therapy (8.9% vs. 6.0%; P < 0.001) and less gestational weight gain (11.1 ± 5.4 kg vs. 11.4 ± 5.5 kg; P = 0.013) in the early ± late screening group. Rates of those meeting the composite criterion were similar in both groups [11.6% vs. 12.0%, respectively; odds ratio (OR): 1.040, 95% confidence interval (CI): 0.920–1.176; P = 0.53] and remained comparable after adjusting for Propensity Scores (OR: 1.046, 95% CI: 0.924–1.185; P = 0.4790). Rates for secondary outcomes were also similar in both groups. While a strategy including early measurement of fasting plasma glucose during pregnancy increases the incidence and care of hyperglycaemia during pregnancy, it may not significantly improve pregnancy outcomes. [ABSTRACT FROM AUTHOR]

Abstract Aim Because type 2 diabetes (T2D) is related to obesity, it is often associated with obstructive sleep apnoea syndrome (OSAS), although OSAS is also frequently diagnosed in patients with type 1 diabetes (T1D) and may promote gestational diabetes. Thus, this systematic review of the scientific evidence aimed to evaluate the epidemiological association between OSAS and all forms of diabetes, the current understanding of the pathophysiological mechanisms behind these associations, the expected benefits and limitations of OSAS treatment in patients with diabetes and, finally, to propose which patients require screening for OSAS. Methods A panel comprising French expert endocrinologists and pneumologists was convened. Two of these experts made a search of the relevant literature for each subpart of the present report; all panel experts then critically reviewed the entire report separately as well as collectively. Results There is little evidence to support the notion that OSAS treatment improves glycated haemoglobin, although it may improve nighttime blood glucose control and insulin sensitivity. However, there is robust evidence that OSAS treatment lowers 24-h blood pressure. Conclusion The high prevalence of OSAS in patients with T1D and T2D justifies screening for the syndrome, which should be based on clinical symptoms, as the benefits of OSAS treatment are mainly improvement of symptoms related to sleep apnoea. There are also several clinical situations wherein screening for OSAS seems justified in patients with diabetes even when they have no symptoms, particularly to optimalize control of blood pressure in cases of resistant hypertension and microvascular complications. [ABSTRACT FROM AUTHOR]

The territorial losses suffered by the self-proclaimed Islamic State over the past year, the fall of the stronghold Mosul, and the encirclement of the caliphate's de facto capital al-Raqqa signal the imminent military defeat of the Islamic State. However, the ideological vacuum, frustration, and alienation typical of communities in the Middle East since the so-called Arab Spring, the absence of a political alternative, and the lack of other local effective governance raise the possibility that the Islamic State will survive its military defeat. As such, it is imperative to assess how this entity is likely to evolve. Understanding the Islamic State's past evolution may help in sketching its likely future. In this context, measures can then be proposed to deal with a reincarnation of the Islamic State. [ABSTRACT FROM AUTHOR]

To explore (i) in what proportion and direction coronary artery calcium (CAC) score reclassifies coronary risk in asymptomatic diabetic patients at high a priori coronary risk, and (ii) whether screening for asymptomatic myocardial ischemia / coronary stenosis only in patients at very high coronary risk - whether a priori or combined with those reclassified at very high risk according to their CAC score - has good sensitivity to detect these conditions. We retrospectively selected 377 asymptomatic primary prevention diabetic patients at high or very high a priori coronary risk according to national guidelines. All had their CAC score measured and underwent stress myocardial scintigraphy to detect myocardial ischemia. Those identified with ischemia then had a coronary angiography to identify coronary stenoses. Of the selected patients, 242 and 135 patients had a high and very high a priori coronary risk, respectively. After taking into account their CAC score, the former were reclassified into three risk categories: moderate (n = 159, 66%), high (n = 38) and very high (45 patients) risk. Myocardial ischemia was identified in 35 patients and coronary stenoses in 14 of the latter. Had a stress scintigraphy been performed only in the 135 patients at very high risk a priori , 18 patients would have been detected with ischemia (sensitivity 51%), and 9 with coronary stenoses (sensitivity 64%). Had a scintigraphy also been performed on the 45 patients at very high risk after CAC-reclassification, an additional 7 and 5 patients with ischemia and coronary stenoses, respectively, would have been identified. Following national guidelines, 66% of our population of asymptomatic diabetic persons at high a priori coronary risk were reclassified into the moderate risk category, translating into less stringent goals for risk factor control. Eighteen percent were reclassified into the very high-risk category, leading to 100% detection sensitivity for patients with ischemia and coronary stenoses. [ABSTRACT FROM AUTHOR]

Aim This study assessed whether male fetal gender increases the risk of maternal gestational diabetes mellitus (GDM) and investigated the association with placental weight. Methods The study included 20,149 women without pregestational diabetes who delivered singletons at our hospital between January 2002 and December 2010. There was universal screening for GDM, and all placentas were weighed at delivery. Results GDM (affecting 14.2% of women) was not associated with fetal gender (male fetuses in women without and with GDM: 51.8% vs. 51.7%, respectively; P = 0.957), and remained likewise after logistic-regression analysis of risk factors for GDM (OR: 1.007, 95% CI: 0.930–1.091; P = 0.858). Placental weights were 600 ± 126 g, 596 ± 123 g, 584 ± 118 g and 587 ± 181 g in women with GDM/female, GDM/male, no GDM/female and no GDM/male fetuses, respectively (GDM effect: P = 0.017; gender effect: P = 0.41; GDM * gender effect: P = 0.16). Conclusion The present results suggest that fetal gender is not associated with GDM and, while placental weights were higher in cases of GDM, there were still no gender effects. [ABSTRACT FROM AUTHOR]

The article discusses relations between United States and Israel and mentions topics such as democracy, liberalism and human rights.

Aim This study retrospectively evaluated the complications associated with prepregnancy overweight (OW) or obesity (OB) and gestational weight gain (GWG) in women with or without universally screened and treated gestational diabetes mellitus (GDM). Methods A total of 15,551 non-Asian women without pregravid diabetes or hypertension who delivered singleton babies (2002–2010) were classified according to GDM (13.5%), pregestational body mass index (BMI; normal range: 18.5–24.9 kg/m 2 ), OW (26.2%), OB (13.9%; BMI ≥ 30 kg/m 2 ) and GWG (< 7 kg: 32%; 7–11.5 kg: 37%; 11.6–16 kg: 23%; > 16 kg: 8%). Main outcome measures were large/small for gestational age (LGA/SGA), caesarean section, preeclampsia, preterm delivery and shoulder dystocia. Results GDM was associated with more LGA babies [Odds Ratio (OR): 2.12, 95% confidence interval (CI): 1.85–2.43], caesarean section (OR: 1.49, 95% CI: 1.34–1.65) and preeclampsia (OR: 1.59, 95% CI: 1.21–2.09). OW/OB and GWG were associated with LGA infants whatever the GDM status, and with SGA babies only in women without GDM. LGA status was independently associated with GWG in women with GDM (11.6–16 kg: OR: 1.74, 95% CI: 1.49–2.03 and > 16 kg OR: 3.42, 95% CI: 2.83–4.13 vs 7–11.5 kg) and in women without GDM (OR: 2.14, 95% CI: 1.54–2.97 or OR: 2.65, 95% CI: 1.68–4.17, respectively), and with BMI only in women without GDM (OR: 1.12, 95% CI: 1.00–1.24, per 10 kg/m 2 ). SGA status was independently associated with OW (OR: 0.86, 95% CI: 0.77–0.98), OB (OR: 0.84, 95% CI: 0.72–0.98) and GWG < 7 kg (1.14, 95% CI: 1.01–1.29) only in women without GDM. Conclusion In our European cohort and considering the triumvirate of GDM, BMI and GWG, GDM was the main contributor to caesarean section and preeclampsia. OW/OB and GWG contributed to LGA and SGA infants mainly in women without GDM. [ABSTRACT FROM AUTHOR]

Prediabetes is a very prevalent condition associated with an increased risk of developing diabetes and/or other chronic complications, in particular cardiovascular disorders. Early detection is therefore mandatory since therapeutic interventions may limit the development of these complications. Diagnosis of prediabetes is currently based on glycemic criteria (fasting plasma glucose (PG), and/or glycemia at 120 min during a 75 g oral glucose tolerance test (OGTT) and/or glycated hemoglobin (HbA1c). Accumulating longitudinal evidence suggests that a 1-hour PG ≥155 mg/dl (8.6 mmol/l) during the OGTT is an earlier marker of prediabetes than fasting PG, 2-h post-load PG, or HbA1c. There is substantial evidence demonstrating that the 1-h post-load PG is a more sensitive predictor of type 2 diabetes, cardiovascular disease, microangiopathy and mortality compared with conventional glucose criteria. The aim of this review is to highlight the paramount importance of detecting prediabetes early in its pathophysiological course. Accordingly, as recommended by an international panel in a recent petition, 1-h post-load PG could replace current criteria for diagnosing early stages of "prediabetes" before prediabetes evolves as conventionally defined. [ABSTRACT FROM AUTHOR]

Background and Aims: Arterial stiffness, a measure of macrovascular damage predictive of poor cardio-vascular outcomes, is strongly related to age and hypertension (HT). In diabetic patients peripheral neuropathy (PN) has been found to be associated with increased arterial stiffness, which might be due to the concomitant presence of HT. The aim of this study was to examine in type-2 diabetic patients, the relationship between arterial stiffness and presence or absence of PN and HT separately.Methods and Results: Arterial stiffness was measured with the gold standard carotid-femoral pulse wave velocity (PWV) in 447 type-2 diabetic subjects of whom 66% were hypertensive, 53% had PN, and 40% had both. Patients with PN were older, more often hypertensive and had higher PWV than those free of PN. Patients were separated according to the presence or absence of PN and HT. PWV values above the 90th percentile age- and blood pressure-adjusted reference range (PWV+) were different across these groups (p < 0.005) with the following respective prevalences: 27.2%, 53.4%, 33.3% and 30.6%. Only PWV+ was significantly associated with PN and hypertension in the interaction analysis.Conclusion: Well controlled hypertensive patients did not have elevated arterial stiffness compared to normotensive patients. This might be due to anti-hypertensive treatment although our study design does not allow us to confirm it. A strong association between PN and arterial stiffness was only present in normotensive patients, suggesting that normotensive type 2 diabetic patients with PN and elevated arterial stiffness should be carefully managed to prevent future macrovascular complications. [ABSTRACT FROM AUTHOR]

The International Association of Diabetes and Pregnancy Study Group (IADPSG) has proposed that blood glucose levels for the diagnosis of gestational diabetes mellitus (GDM) be the values associated with a 1.75-fold increase in the risk of neonatal complications in the Hyperglycaemia and Adverse Pregnancy Outcomes (HAPO) study. However, this recommendation was not adopted by the US National Institutes of Health (NIH) panel as it would have been responsible for a huge increase in the prevalence of GDM with no clear evidence of a reduction of events at such blood glucose values. Considering this aspect, we now propose the use of a blood glucose threshold combination associated with an odds-ratio of 2.0 for neonatal disorders [fasting plasma glucose (FPG) ≥ 95 mg/dL, or a 1-h glucose value after a 75-g oral glucose tolerance test (OGTT) ≥ 191 mg/dL or a 2-h glucose value ≥ 162 mg/dL] for GDM diagnosis. This would lead to a lower prevalence of GDM and concentrate medical resources on those with the highest risk of complications. This would also allow the use of a similar FPG value for both the diagnosis and therapeutic target of GDM. The IADPSG also proposed screening for dysglycaemia during early pregnancy, using FPG measurement with a similar threshold after 24 weeks of gestation. We propose the same strategy considering an FPG value ≥ 95 mg/dL as abnormal, but only after confirmatory measurements. We also believe that an OGTT should not be used before 24 weeks of gestation as normal values during that time are as yet unknown. [ABSTRACT FROM AUTHOR]

Aim The study compared the duration of maintenance of treatment in patients with type 2 diabetes (T2D) using dual therapy with either metformin and sitagliptin (M-Sita) or metformin and a sulphonylurea (M-SU). Materials and methods This observational study included adult patients with T2D who had responded inadequately to metformin monotherapy and therefore had started de-novo treatment with Met-Sita or Met-SU within the previous eight weeks. Patient follow-up and changes to treatment were performed according to their general practitioner's usual clinical practice. The primary outcome was time to change in treatment for whatever cause. HbA 1c and symptomatic hypoglycaemia were also documented. Results The median treatment duration for patients in the M-Sita group (43.2 months) was significantly longer ( P < 0.0001) than in the M-SU group (20.2 months). This difference persisted after adjusting for baseline differences and confounders. A similar reduction in HbA 1c was noted in both arms (–0.6%), and the incidence of hypoglycaemia prior to treatment modification was lower with M-Sita (9.7%) than with M-SU (21.0%). Adverse events potentially related to treatment were reported in 2.8% ( n = 52) and 2.7% ( n = 20) of patients in the M-Sita and M-SU arms, respectively. Conclusion Under everyday conditions of primary diabetes care, dual therapy with M-Sita can be maintained for longer than M-SU. In addition, while efficacy, as measured by changes in HbA 1c , was similar between treatments, the incidence of hypoglycaemia was lower in patients taking M-Sita. [ABSTRACT FROM AUTHOR]

Objectives This study aimed to estimate, in a large group of Algerian adolescents, the prevalence of the metabolic syndrome (MetS), using four definitions (by Cook, De Ferranti, Viner and the IDF), and to test the validity of unique thresholds of waist circumference, waist/height ratio and BMI in screening for the MetS regardless of the definition used. Subjects and methods A total of 1100 adolescent students, aged 12–18 y, were randomly selected from schools and classrooms in the city of Constantine; all had anthropometric measurements taken and 989 had blood tests. Results Prevalences of the MetS were: 2.6% for boys and 0.6% for girls by the Cook definition; 4.0% for boys and 2.0% for girls by the De Ferranti definition; 0.7% for boys and 0% for girls by the Viner definition; and 1.3% for boys and 0.5% for girls by the 2007 IDF definition. Prevalences ranged from 3.7% to 13.0% in obese adolescents. Unique thresholds, independent of gender, age and height, of 80 cm for waist circumference, 0.50 for waist/height ratio and 25 kg/m 2 for BMI had sensitivities of 72–100%, 67–100% and 72–100%, respectively, and specificities of 74–78%, 74–86% and 74–78%, respectively, depending on the MetS definition used. Conclusion The MetS is present in Algerian adolescents and the prevalence is especially high in obese young people. Our thresholds for waist circumference, waist/height ratio and BMI for screening for the MetS should now be tested in other adolescent populations. [ABSTRACT FROM AUTHOR]

Medico-economic data of patients suffering from chronic nausea and vomiting are lacking. In these patients, gastric electrical stimulation (GES) is an effective, but costly treatment. The aim of this study was to assess the efficacy, safety and medico-economic impact of Enterra therapy in patients with chronic medically refractory nausea and vomiting. Data were collected prospectively from patients with medically refractory nausea and/or vomiting, implanted with an Enterra device and followed for two years. Gastrointestinal quality of life index (GIQLI) score, vomiting frequency, nutritional status and safety were evaluated. Direct and indirect expenditure data were prospectively collected in diaries. Complete clinical data were available for142 patients (60 diabetic, 82 non-diabetic) and medico-economic data were available for 96 patients (36 diabetic, 60 non-diabetic), 24 months after implantation. GIQLI score increased by 12.1 ± 25.0 points (p <.001), with a more significant improvement in non-diabetic than in diabetic patients (+15.8 ± 25.0 points, p <.001 versus 7.3 ± 24.5 points, p =.027, respectively). The proportion of patients vomiting less than once per month increased by 25.5% (p <.001). Hospitalisations, time off work and transport were the main sources of costs. Enterra therapy decreased mean overall healthcare costs from 8873 US$ to 5525 US$ /patient/year (p =.001), representing a saving of 3348 US$ per patient and per year. Savings were greater for diabetic patients (4096 US$ /patient/year) than for non-diabetic patients (2900 US$ /patient/year). Enterra therapy is an effective, safe and cost-effective option for patients with refractory nausea and vomiting. ClinicalTrials.gov Identifier: NCT00903799 [ABSTRACT FROM AUTHOR]

Objective The contribution of postprandial glycemia (PPG) to hyperglycemia has been shown to decrease as HbA1c increased in type 2 diabetic patients. This study aimed at examining, in a series of overweight/obese patients without known glycemic disorder, the contribution of PPG to a “relative” hyperglycemia (glucose values ≥ 5.5 mmol/L) and the presence of glycemic variability according to HbA1c levels. Methods Seventy overweight/obese inpatients (body mass index 35.2 ± 6.8 kg/m 2 ) without known glycemic disorder were included. Participants were classified according to an oral glucose tolerance test (according to the American Diabetes Association criteria) as patients with normoglycemia (n = 33), with intermediate hyperglycemia (n = 24) or diabetes (n = 13). They were separated into HbA1c quartiles (Q1 to Q4). A 24 hour continuous glucose monitoring was used under a 1800 kcal diet and minimal physical activity. We assessed PPG contribution (3 hour period after each meal) to the “relative” 24 hour hyperglycemia (glucose values ≥ 5.5 mmol/L); the remaining time was considered as the fasting/post-absorptive period. Results HbA1c range was from 5.1% to 7.4% (32 to 57 mmol/mmol). From the lowest to the highest HbA1c quartile, the area under the curve (AUC) for the “relative” hyperglycemia presented a 17-fold increase for the fasting/post-absorptive (p < 0.001) period and a 7-fold increase postprandially (p < 0.001). The percent of PPG contribution to the “relative” hyperglycemia was calculated with the following formula [100 × (postprandial 3 hour AUC − 3 h AUC for a constant 5.5 mmol/L glycemia)/(total 24 h AUC − 24 h AUC for constant 5.5 mmol/L glycemia)] and decreased from Q1 to Q4 of HbA1c (81.2%, 66%, 65.8%, 57%; p < 0.001). Increasing HbA1c quartiles were associated with higher daily mean blood glucose level (p < 0.001) and higher levels of daily glucose variability indices, including mean amplitude of glycemic excursions (p < 0.01). Conclusions In overweight/obese patients, HbA1c was associated with lower PPG contribution to “relative” hyperglycemia and greater glycemic variability. The present findings support the importance of postprandial period in glycemic exposure even before the appearance of diabetes. [ABSTRACT FROM AUTHOR]

Abstract: Introduction: Although it is important to screen women who have had gestational diabetes mellitus (GDM) for abnormal post-partum glucose levels, such testing is rarely performed. The aim of this study was to use data from the first observational phase of the IMPACT study to determine rates of screening within 6 months of delivery in a multiethnic cohort, focusing in particular on the effects of social deprivation and the risk of future diabetes. Patients and methods: To investigate the frequency of post-partum screening, charts were analyzed, and all women attending four centres located in a deprived area who had had GDM between January 2009 and December 2010 were contacted by phone. The Evaluation of Precarity and Inequalities in Health Examination Centres (EPICES) deprivation index and Finnish Diabetes Risk Score (FINDRISK) questionnaire were also evaluated. Results: Data were evaluable for 589 of the 719 women contacted (mean age: 33.4±5.2years; mean body mass index: 27.6±5.4kg/m2), and 196 (33.3%) reported having been screened. On multivariate analysis, factors associated with a lack of screening were smoking [odds ratio (OR): 0.42 (0.20–0.90), P <0.05], low consumption of fruit and vegetables [OR: 0.58 (0.39–0.82), P <0.01] and heavier offspring birth weight (P <0.05), although there were no differences in FINDRISK and EPICES scores between screened and unscreened women. Conclusion: One-third of women who had had GDM reported having been screened for dysglycaemia at 6 months post-partum. However, it is expected that the interventional phase of the IMPACT study will increase screening rates, especially in women with the risk factors associated with lower screening rates during this observational phase. [Copyright &y& Elsevier]

• In previous studies, women with pregnancies complicated by hyperglycaemia in pregnancy (HIP) and insulin resistance (IR), but not those without IR, had a greater risk of adverse pregnancy outcomes than those with normoglycaemic pregnancies. • Considering only women with HIP, we found that HOMA-IR index was positively associated with insulin therapy, gestational hypertension, preeclampsia, large-for-gestational-age infants and neonatal hypoglycaemia. • The association between a high HOMA-IR and insulin therapy, hypertensive disorders and large-for-gestational-age infants remained after adjustment for confounders, including body mass index. • On clinical practice, HIP stratification according to presence of IR might help decision makers adapt care to prevent adverse pregnancy outcomes. Aim. Recent studies have shown that women with hyperglycaemia in pregnancy and insulin resistance have a greater risk of adverse pregnancy outcomes than women with normoglycaemic pregnancies. This study aimed to determine adverse pregnancy outcomes of women with hyperglycaemia in pregnancy only as a function of insulin resistance. Methods. From a prospective cohort study, we included 1,423 women with hyperglycaemia in pregnancy whose insulin resistance was evaluated using homoeostatic model assessment for insulin resistance (HOMA-IR) when care was first provided for this condition. We compared the adverse pregnancy outcomes for different tertiles of HOMA-IR (intertertile range 1.9 and 3.3). Results. Increasing HOMA-IR tertiles were positively associated with the rate of insulin therapy (tertile 1, 2 and 3: 32.7, 47.0 and 58.7%, P < 0.0001), caesarean section (23.7, 26.0 and 32.2%, respectively, P < 0.01), gestational hypertension (1.3, 2.8 and 5.4% respectively, P < 0.01), preeclampsia (1.5, 2.8 and 4.5% respectively, P < 0.05), large-for-gestational-age infant (13.3, 10.4 and 17.6% respectively, P < 0.05), and neonatal hypoglycaemia (0.8, 1.5 and 3.2% respectively, P < 0.05). Women in the 3rd HOMA-IR tertile were more likely to have insulin therapy (odds ratio 2.09 (95% interval confidence 1.61–2.71)), hypertensive disorders (2.26 (1.42–3.36)), and large-for-gestational-age infant (1.42 (1.01–1.99)) than those in the 1st and 2nd tertiles combined in multivariable logistic regression analyses adjusted for gestational age at HOMA-IR measurement, glycaemic status, age, body mass index, family history of diabetes, parity and ethnicity. Conclusion. Despite suitable care and increased rates of insulin therapy during pregnancy, higher insulin resistance in women with hyperglycaemia in pregnancy was associated with a greater risk of adverse pregnancy outcomes. [ABSTRACT FROM AUTHOR]

Background and Aims: To document the stroke volume to pulse pressure ratio (SV/PP, an index of total arterial compliance) and its correlates in patients with type 2 diabetes (T2DM) aged over 50 years whose peripheral neuropathy and silent myocardial ischemic (SMI) status were known. Methods and Results: A total of 360 patients with T2DM aged ≥ 50 years, without cardiac history or symptom, left ventricular systolic dysfunction, dilatation and hypokinesia, were retrospectively enrolled. The SV/PP was calculated from echocardiographic left ventricular measurements and brachial blood pressure at rest. Peripheral neuropathy was defined as the presence of any two or more of the following: neuropathic symptoms, decreased distal sensation, or decreased or absent ankle reflexes. SMI was defined as an abnormal stress myocardial scintigraphy and/or stress echocardiography. A low SV/PP ratio (<0.53 ml/m²/mmHg, first tertile) was associated with age, creatinine clearance, 24 h urinary albumin excretion rate, peripheral neuropathy, hypertension, serum total cholesterol and triglycerides levels (p < 0.05-0.0001). In multivariate analysis, age (OR 1.1 [1.0-1.2], p < 0.01), triglycerides (OR 1.5 [1.2-2.0], p = 0.01) and peripheral neuropathy (OR 2.2 [1.2-3.9], p = 0.009) were independently associated with a low SV/PP. The patients with peripheral neuropathy had lower SV (p < 0.01) and higher PP (p < 0.05) than those without, and only lower SV after adjustment for age and nephropathy. Similar results were obtained in the patients with and without SMI. Conclusion: Peripheral neuropathy was independently associated with decreased SV/PP, mainly through decreased SV, in patients with T2DM over 50 years. [ABSTRACT FROM AUTHOR]