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Gérard Reach,1 Laurent Benarbia,2 Pierre-Yves Benhamou,3 Brigitte Delemer,4 Séverine Dubois,5 Didier Gouet,6 Bruno Guerci,7 Nathalie Jeandidier,8 Karim Lachgar,9 Gilles Le Pape,10 Rémy Leroy,11 Jean-Hugues Masgnaux,12 Philippe Raclet,13 Yves Reznik,14 Jean-Pierre Riveline,15,16 Pauline Schaepelynck,17 Anne Vambergue,18 Bruno Vergès19 1Health Education and Promotion Laboratory (LEPS EA 3412), Sorbonne Paris Nord University, Bobigny, France; 2Marketing Studio, Paris, France; 3Department of Endocrinology, Grenoble University Hospital; Grenoble Alpes University, INSERM U1055, LBFA, Grenoble, France; 4Service d’Endocrinologie – Diabète – Nutrition, CHU de Reims - Hôpital Robert Debré, and Université de Reims Champagne Ardenne, UFR Sciences Exactes Et Naturelles, Reims, France; 5Department of Diabetology and Endocrinology, CHU Angers, Angers, France; 6Department of Diabetology and Endocrinology, Saint Louis Hospital, La Rochelle, France; 7Department of Endocrinology, Diabetology and Nutrition, CHRU of Nancy, Brabois Hospital, and ILCV Lorraine University, Vandoeuvre-les-Nancy, France; 8Department of Endocrinology, Diabetes and Nutrition, Hôpitaux Universitaires de Strasbourg, and Université de Strasbourg, Strasbourg, France; 9Department of Diabetology and Endocrinology, Centre Hospitalier Simone Veil, Eaubonne, France; 10General Practice, Penmarc’h, France; 11Private Medical Practice, Endocrinology and Diabetology, Lille, France; 12M&M Conseil, Boulogne, France; 13Association Française des Diabétiques de Bourgogne Franche-Comté, Dijon, France; 14Department oEndocrinology and Diabetology, CHU Côte de Nacre, Caen, and University of Caen Basse-Normandie, Medical School, Caen, France; 15Department of Diabetology and Endocrinology, Lariboisière Hospital, Assistance Publique - Hôpitaux de Paris, Paris, France; 16Unité INSERM U1138 Immunity and Metabolism in Diabetes, ImMeDiab Team, Centre de Recherches des Cordeliers, and Université de Paris, Paris, France; 17Department of Nutrition-Endocrinology-Metabolic Diseases, Pôle ENDO, APHM-Hôpital la Conception, Marseille, France; 18Department of Diabetology, Endocrinology, Metabolism and Nutrition, CHU Lille, and University Hospital European Genomic Institute for Diabetes, Lille, France; 19Department of Endocrinology-Diabetology,CHU Dijon, and University of Burgundy, INSERM LNC UMR1231, Dijon, FranceCorrespondence: Gérard Reach, Health Education and Promotion Laboratory (LEPS EA 3412), Sorbonne Paris Nord University, 74 Rue Marcel Cachin, Bobigny Cedex, 93017, France, Tel + 33 (0)6 60 84 53 25, Email gerardreach@icloud.comBackground: Support programs are provided to people with diabetes to help them manage their disease. However, adherence to and persistence in support programs are often low, making it difficult to demonstrate their effectiveness.Aim: To identify the determinants of patients’ perceived interest in diabetes support programs because it may be a powerful determinant of effective participation in such programs.Patients and Methods: An online study conducted in April 2021 in metropolitan France on 600 people with diabetes recruited from a consumer panel. A 64-item psychosocial questionnaire including a question asking to evaluate the helpfulness of a support program was used. Univariate, multivariate, and multiple correspondence analyses were performed.Results: The existence of a typology, known as Unsafe/Safe, was discovered, in which patients with type 2 diabetes respond in two distinct ways. Type U (unsafe) patients, who believe that a support program would be helpful, are more likely to be nonadherent to their treatment, have high hemoglobin A1c levels, have at least one diabetic complication, lack information regarding their disease and treatment, rate the burden of their disease and impairment of their quality of life as high, worry about their future, and are pessimistic. Type S (safe) patients have the opposite characteristics. Type U patients can be dichotomized into two broad classes: one in which they lack information regarding disease and treatment and the other in which alterations in the quality of life and burden of the disease predominate. Insulin-treated patients give more importance to the lack of information, whereas noninsulin-treated patients complain primarily about the burden of the disease and impairment of quality of life.Conclusion: This study describes this new U/S typology, proposes a simple method based on a nine-item questionnaire to identify type U patients by calculating a Program Helpfulness Score described herein, and clarifies the nature of the intervention to be provided to them. This novel approach could be applied to other chronic diseases.Keywords: type 2 diabetes, adherence, support programs, typology, personality traits, clinical outcomes, patients’ expectations

Alexia Rouland,1 Benjamin Bouillet,1,2 Pauline Legris,1 Isabelle Simoneau,2 Jean-Michel Petit,1,2 Bruno Vergès1,2 1Endocrinology Diabetics and Metabolic Disorders Department, Dijon University Hospital, Dijon, France; 2French National Health and Medical Research Body Unit, Lipid-Nutrition-Cancer-1231, University of Burgundy, Dijon, 21000, FranceCorrespondence: Alexia RoulandEndocrinology Diabetics and Metabolic Disorders Department, Dijon University Hospital, 14 Rue Paul Gaffarel, Dijon, 21000, FranceEmail alexia.rouland@chu-dijon.frIntroduction: Inappropriate insulin secretion could be due to several diseases. Nesidioblastosis is characterized by diffuse hyperplasia of pancreatic beta cells, causing organic hypoglycemia. No pancreatic lesions are found on the imaging of patients with this condition. Diazoxide is used as a first-line treatment but can be poorly tolerated because of its side effects, and therapeutic failure is possible. Somatostatin analogues have limited efficacy because of their poor affinity to somatostatin (SST) receptors. Pasireotide is a somatostatin analogue with a much higher affinity to SST receptors, especially SST5, and it could thus be more efficient for treating nesidioblastosis-related hypoglycemia.Observation: A 56 years-old diabetic woman had symptoms of hypoglycemia, persistent after treatment’s withdrawal. A fasting test authentify an organic hypoglycemia, at 34mg/dL, a plasma insulin level at 6mUI/L above the 5 mU/L threshold, a C-peptide level at 1.9 ng/mL above the threshold of 0.6, and an insulin/C-peptide ratio 0.066, below the threshold of 1. No lesions were found on CT-scan or endoscopic ultrasound. Somatostatin receptor scintigraphy was also negative. Diazoxide and octreotide failed to improve the recurrence of hypoglycemia episodes. With pasireotide LAR, hypoglycemia disappeared and glycemia increased. Hyperglycemia was controlled with sitagliptin. The patient has now been treated with pasireotide LAR for two years, with no more episode of hypoglycemia until now.Discussion: We present the first case of nesidioblastosis treatment with pasireotide LAR, with success. Patients diagnosed with nesidioblastosis and diazoxide-resistant hypoglycemia, or who experience difficulties with other treatments, could use pasireotide LAR in conjunction with glycemia monitoring, particularly if they are diabetic.Keywords: nesidioblastosis, hypoglycemia, pasireotide LAR, diazoxide

Origin of the great inter-individual variability of the fatty taste perception found in obese subjects is challenging. The fact that recent studies suggest interrelations between taste perception and oral microbiota composition, prompt us to explore the putative impact of such a connection in the context of obesity. To check this hypothesis, the oro-sensory perception thresholds of linoleic acid and the composition of oral microbiota surrounding the gustatory circumvallate papillae (CVPs) were analyzed in obese adult men (BMI ≥ 30 kg/m2, n = 42). A specific microbial signature (higher diversity, pro-inflammatory bacterial profile, lower methanogenesis activity) discriminated subjects with a degraded fatty taste sensitivity (perception threshold ≥ 0.05% LA = Low-LA tasters, n = 22) from high-LA tasters (n = 20). Collectively, these data substantiate the association between the microbial microenvironment surrounding CVPs and the fatty taste sensitivity and provide a plausible explanation about the variability of the fatty taste sensitivity in obesity.

Récemment, l’ANSES a rendu un avis prudent sur la consommation des phytostérols/stanols dans le but de réduire le risque cardiovasculaire. Parmi les principales raisons justifiant la prudence de l’ANSES figurent notamment, d’une part la variabilité inter-individuelle de la réponse à la consommation de phytostérols/stanols, et, d’autre part, les relations entre phytostérolémie plasmatique et risque cardiovasculaire. Ces deux points font l’objet de la présente revue. Il existe une variabilité de la réponse individuelle à l’apport de stérols/stanols végétaux, avec une absence de réponse (baisse LDLC) chez 20 à 42 % des sujets. Parmi les sujets non-répondeurs, certains augmentent le LDLC. La diminution du cholestérol LDLC est proportionnelle à sa concentration initiale en valeur absolue, et constante en pourcentage. La réponse est corrélée négativement au taux de synthèse du cholestérol et positivement au niveau d’absorption. L’effet des facteurs génétiques sur la réponse reste encore à démontrer. Il existe un manque de puissance statistique générale dans toutes les études génétiques publiées à ce jour. Concernant la relation entre phytostérolémie et le risque cardiovasculaire, de nombreux résultats contradictoires ont été publiés. Une méta-analyse montre globalement une absence de relation, mais l’hétérogénéité significative entre ces études ne permet pas de conclure. D’autre part, des études génétiques montrent que les variants qui augmentent la phytostérolémie sont associés à une augmentation du risque. La phytostérolémie est liée à l’absorption du cholestérol. L’absorption pourrait être le facteur causal de la relation entre phytostérolémie et risque cardiovasculaire, mais il n’est pas exclu que les phytostérols circulants aient aussi un effet délétère. L’ANSES estime que des études cliniques sont nécessaires pour conclure sur l’impact cardiovasculaire de la consommation des produits contenant des phytostérols/stanols.

Abstract Aims to investigate the association between admission hyperglycemia and myocardial damage in patients with ST-segment elevation myocardial infarction (STEMI) using Cardiac Magnetic Resonance (CMR). Methods We analyzed 113 patients with STEMI treated with successful primary percutaneous coronary intervention. Admission hyperglycemia was defined as a glucose level ≥ 7.8 mmol/l. Contrast-enhanced CMR was performed between 3 and 7 days after reperfusion to evaluate left ventricular function and perfusion data after injection of gadolinium-DTPA. First-pass images (FP), providing assessment of microvascular obstruction and Late Gadolinium Enhanced images (DE), reflecting the extent of infarction, were investigated and the extent of transmural tissue damage was determined by visual scores. Results Patients with a supramedian FP and DE scores more frequently had left anterior descending culprit artery (p = 0.02 and 1c (p = 0.01 and 0.04), peak plasma Creatine Kinase (p < 0.001), left ventricular end-systolic volume (p = 0.005 and In a multivariate model, admission hyperglycemia remains independently associated with increased FP and DE scores. Conclusion Our results show the existence of a strong relationship between glucose metabolism impairment and myocardial damage in patients with STEMI. Further studies are needed to show if aggressive glucose control improves myocardial perfusion, which could be assessed using CMR.