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Purpose: To evaluate the corneal sensitivity of black diabetic patients and identify factors associated with changes in corneal sensitivity., Methodology: We conducted a cross-sectional comparative case-control study at the National Obesity Center of the Yaounde Central Hospital and the Djoungolo District Hospital from March 1 to July 31, 2022. Corneal sensitivity was measured using the Cochet-Bonnet esthesiometer in all diabetic patients over 18 years of age, matched for age and sex to a clinically healthy control population. Data were analyzed using SPSS version 23.0 software. A P-value of less than 5% was considered significant., Results: A total of 111 diabetic and 111 non-diabetic patients participated in the study. The mean age was 53.46±12.74 years for diabetics and 52.85±11.77 years for non-diabetics (P=0.901). The mean duration of diabetes was 6.4±5.30 years. Corneal sensitivity in diabetics was lower (44.56±9.59mm) compared to non-diabetics (53.59±6.30mm) with a statistically significant difference (P=0.000). Factors associated with decrease in corneal sensitivity in diabetics were duration of diabetes and poor glycemic control., Conclusion: Decrease in corneal sensitivity related to diabetes is a complication to be systematically screened for during the ophthalmologic follow-up of diabetic patients., (Copyright © 2024 Elsevier Masson SAS. All rights reserved.)

Skin disorders are common in diabetes, affecting both patients with type 1 and type 2 diabetes. These cutaneous manifestations can be classified into three categories: dermatoses associated with the presence of diabetes, cutaneous complications of diabetes (acute and chronic) and dermatoses linked to antidiabetic treatments. These conditions vary considerably in terms of severity (from insignificant cosmetic problems to life-threatening) and prevalence (from relatively frequent to rare). Despite the high prevalence of diabetes and associated skin disorders, the dermatological manifestations of diabetes are generally neglected and often under-diagnosed. Failure to diagnose and treat skin disorders at an early stage can lead to clinical worsening, whereas early detection and treatment can reduce the risk of serious complications., Competing Interests: Les auteurs n’ont déclaré aucun conflit d’intérêts en relation avec cet article.

Competing Interests: L'auteur déclare participer ou avoir participé à des interventions ponctuelles (essais cliniques ou travaux scientiques, rapports d'expertise, activités de conseil, conférences, colloques et actions de formations…) pour l'entreprise Abbott.

While the prevalence of diabetes continues to rise worldwide, with 537 million adults aged 20-79-years-old having diabetes in 2021, the development of new therapeutic classes improving not only glycemic control but also kidney function and cardiovascular prevention has revolutionized patient care. Today, the treatment of diabetes is no longer just the treatment of blood sugar level. In this context, the individualized therapeutic strategy has been completely reviewed, with in particular sulfamides indicated much later in the therapeutic strategy, while SGLT2 inhibitors are indicated very early in patients with kidney disease and/or with ischemic heart disease or chronic heart failure, and GLP-1 analogues in obese patients and/or in primary or secondary cardiovascular prevention. As for lifestyle rules and metformin, they remain the cornerstone of treatment. Knowledge of antidiabetic effects in terms of efficacy and hypoglycemic risk, of cardiovascular, nephroprotective and weight effects is essential to optimize the management of diabetic patients today., (Copyright © 2023 Société Nationale Française de Médecine Interne (SNFMI). Published by Elsevier Masson SAS. All rights reserved.)

Type 2 diabetes in the elderly remains a major concern for all healthcare professionals and is itself considered a "global pandemic". Its prevalence is high and will continue to increase in years to come, becoming more and more prevalent in the elderly and very elderly. We offer a general summary of the work focusing on the links between type 2 diabetes and geriatric criteria., (Copyright © 2023 Elsevier Masson SAS. All rights reserved.)

Aim: To assess the impact of non-insulin-requiring Type 2 diabetes (T2D) on professional activity in terms of absenteeism, presenteeism, reduced productivity and daily activities., Methods: We conducted a comparative cross-sectional survey of two groups of employees in the Cap Bon textile sector: 75 diabetic and 75 workers free from any endocrinological pathology, seen in the occupational medicine group of Nabeul. The study was spread over 10 months from March 2020.A questionnaire was administered containing the Arabic version of WPAI-GH « Work Productivity and Activity Impairment Questionnaire-General Health » to assess absenteeism, presenteeism, decreased productivity and daily activity., Results: A total of 150 workers participated in our study. Diabetes was responsible for absenteeism of 5.1 ± 8.9%, presenteeism of 4.8 ± 6,4%, a decrease in productivity of 7.3 ± 7.8% and a decrease in the daily activity of 14,6 ± 10%. The rate of presenteeism, decrease in productivity and daily activity were significantly higher in T2D (p = 0.015). Absenteeism was associated with degenerative complications (p< 0,001). Presenteeism was associated with the duration of the course of diabetes (p < 0,001)., Conclusion: Diabetes has a negative impact in productivity and general activity. Early and multidisciplinary management of these patients improves their professional performance.

Introduction: Type 2 diabetes is associated with an increased risk of coronary disease and is the leading cause of morbidity and mortality in this population. The main objective of our work is to study the correlation of left atrial volume index with coronary disease in type 2 diabetics., Material and Methods: Cross-sectional, analytical, single-center study with prospective recruitment of 330 type 2 diabetic patients carried out at the Constantine Regional Military University Hospital over a period of 03 years (2016-2018) among which 18.8% (62 patients) are smokers. Early cardiac involvement represented by diastolic dysfunction was assessed by two-dimensional transthoracic echocardiography. Data were analyzed using Epi info 7.2.1.0 software to study the impact of smoking on the presence of left ventricular diastolic dysfunction., Results: The average age of our cohort is 52.7 ± 8.4 years, an average of 7.1 ± 1.3% of glycated hemoglobin, an average of 5.3 ± 4.3 years of diabetes duration, a sex ratio to 1.01. 34.8% of patients had left atrial volume index ≥ 34 ml/m2. The prevalence of coronary disease is 27.0%. In multivariate analysis; left atrial volume index is significantly correlated with coronary stenosis (OR = 1.75, 95% CI [1.60 - 2.05], p = 0.02)., Conclusion: The prevalence of cardiomyopathy is high in type 2 diabetes and smoking is significantly correlated with the presence of this diabetic cardiomyopathy., Competing Interests: Déclaration d'intérêts Les auteurs déclarent ne pas avoir de conflits d'intérêts en relation avec cet article., (Copyright © 2023 Elsevier Masson SAS. All rights reserved.)

NAFLD, whose prevalence keeps growing, is strongly linked with type 2 diabetes (T2D) through insulin resistance and oxidative stress. A multifactorial association with T1D has recently been found. NAFLD screening aims to identify non-alcoholic steatohepatitis (NASH) and fibrosis and to better refer to liver specialists. It is recommended for patients at higher risk, such as those with T2D. NAFLD treatment cornerstone is weight loss, obtained through lifestyle interventions, obesity pharmacotherapy, and bariatric surgery. When treating patients suffering from NAFLD and T2D, we should prioritize GLP-1 analogues and PPAR agonists, capable of regressing NASH, and SGLT2i, efficient on liver steatosis., Competing Interests: Les auteurs n’ont déclaré aucun conflit d’intérêts en relation avec cet article.

Aim of the Study: To study the predictors of knowledge level, attitudes and quality of life of type 1(T1D) and type 2 (T2D) Tunisian diabetics POPULATION AND METHODS: We undertook an analytical cross-sectional study. The questionnaire was administered in Arabic and contained a section collecting socio-demographic, clinical and diabetes-specific data. The following sections contained the Arabic-translated and validated versions of the "Simplified Diabetes Knowledge Scale", the "Diabetes Attitude Scale-3" and the "Diabetes Health Profile-18" to assess level of diabetes knowledge, attitudes towards the disease and diabetics' quality of life., Results: We collected 186 T1D (18.5%) and 821 T2D (81.5%) completed questionnaires. A good level of knowledge about diabetes was indicated in T1D patients by glycemic self-monitoring and by secondary and university education, urban housing, stable employment, insulin therapy and prior therapeutic education, while regular medical follow-up was of particular importance in T2DM patients. Smoking and diabetes complications were predictors of a negative attitude towards the disease in T1D and T2D respectively. Diabetics' Impaired quality of life was predicted by age < 40 years and a low level of knowledge about diabetes in T1D and by female sex, insulin therapy and a low level of knowledge about diabetes in T2D., Conclusion: Predictors of the level of knowledge, attitudes and quality of life of diabetics may be a basis for establishing a therapeutic education program tailored to the different populations., Competing Interests: Déclaration de liens d'intérêts Les auteurs déclarent ne pas avoir de liens d'intérêts., (Copyright © 2022 Elsevier Masson SAS. All rights reserved.)

Problematic and Objective: Masked arterial hypertension (MHTN) is a recently described entity that is associated with the same cardiovascular risk as permanent hypertension. Its prevalence is more frequent in patients with diabetes. The objective of this study is to assess the value of systematic screening for MHTN by 24-hour blood pressure monitoring in a population of type 2 diabetic patients by estimating its prevalence and looking for predictive factors of MHTN in this population., Methods: Through a prospective study, we recruited normotensive type 2 diabetics for clinical measurement, in whom we systematically searched for MHTN by performing an ambulatory blood pressure measurement (ABPM). The diagnosis of MHTN is established if: mean daytime BP ≥ 135/85 mmHg and / or, mean nighttime BP ≥ 120/70 mmHg and / or, mean 24 hour BP ≥ 130/80 mmHg. We then compared the two populations of MHTN (G1) and normotensive (G2) on clinical and laboratory parameters and we assessed end-organ damage in order to identify the predictive factors of MHTN., Results: We recruited 53 patients whose mean age was 55.3 ± 8.4 years (range 35-72 years) with a female predominance (53%). The duration of diabetes was on average 8.7 ± 3.9 years with extremes between 2 and 17 years. The average BMI of our patients was 28.2 ± 5.3 Kg/m2. Overweight was found in almost half of our patients (47.2%). Obesity was found in 32.1% of cases. Metabolic syndrome was found in 64.2% of patients. In our study, the prevalence of HTAM in type 2 diabetics was 64%. We also found that MHTN was more often nocturnal (58.5%) and occurred mainly in non-dipper patients. Left ventricular hypertrophy, microalbuminuria and arterial stiffness evidenced by pulse pressure greater than 60mmHg were more common in the MHTN group. For the predictive factors of MHTN, we were able to collect in univariate analysis the following factors: duration of diabetes, fasting blood sugar, weight and microalbuminuria. In multivariate analysis, the predictive factors that emerged in our study are poor glycemic control (HbA1c ≥7%), high BMI and duration of diabetes., Conclusion: MHTN should be sought in diabetics because it allows a better assessment of the cardiovascular risk, in particular by identifying end-organ damage., (Copyright © 2021 Elsevier Masson SAS. All rights reserved.)

Diseases related to fatty liver, independently of alcohol consumption («non-alcoholic fatty liver disease» or NAFLD), are increasing because of the epidemics of obesity and type 2 diabetes. These disorders reflect a continuum that comprises isolated steatosis, steatohepatitis (NASH) and fibrosis, with, at the end, an increased risk of cirrhosis and hepatocarcinoma. It has been recently proposed to replace the term NAFLD by MAFLD, i.e. «Metabolic (dysfunction) Associated Fatty Liver Disease», which better reflects the pathogenesis of the disease. Inflammation plays a crucial role in the aggravation of the disorder and profoundly influences the prognostic evolution. This article illustrates the natural history of this underestimated metabolic disorder, recall the diagnostic criteria used in clinical practice, emphasizes the deleterious role of inflammation and discusses some therapeutic perspectives.

The relative risk of developing MetS is higher in patients with severe mental illness (SMI) than in the general population. Similarly, the risk of developing obesity or type 2 diabetes (T2DM) is also higher in patients with SMI. GLP-1 receptor agonists, such as liraglutide, have been shown to be effective in the treatment of T2DM and, more recently, in obesity or overweight associated with at least one metabolic disease. Their psychiatric adverse effect profiles seem to be reassuring, thus not represent a limitation for prescribing in psy chiatry. We aimed to explore the therapeutic usefulness of liraglutide in patients with psychiatric disorders associated with somatic comorbidities such as obesity, T2DM or MetS., Competing Interests: Les auteurs n’ont déclaré aucun conflit d’intérêts en relation avec cet article.

BENEFITS OF BARIATRIC SURGERY ON WEIGHT LOSS, DEVELOPMENT OF COMORBIDITIES AND MORTALITY Bariatric surgery, mainly sleeve gastrectomy (SG) and gastric bypass (GBP) in France, induces a greater and more durable weight loss than current treatments in cases of morbid or severe obesity with co-morbidity. Bariatric surgery can also improve, or even put into remission, most of the pathologies associated with obesity, such as type 2 diabetes, sleep apnea, arterial hypertension, dyslipidemia... An improvement in the quality of life and life expectancy of patients after bariatric surgery has been observed, even considering the operative risk and the discomfort generated by these procedures. The differences in efficacy, risk and discomfort at short and long term between SG and GPB do not allow to define a procedure of choice at the present time. The great effectiveness of bariatric surgery on diabetes associated with obesity, corresponding to the metabolic surgery concept, will probably lead to an extension of the operative indications., Competing Interests: T. Bège, P. Duconseil et A. Lasbleiz déclarent n’avoir aucun lien d’intérêts. A. Dutour déclare avoir été prise en charge à l’occasion de déplacements pour congrès, par Sanofi, Lilly, Astra Zeneca et Novo Nordisk.

Diabetes is a rapidly evolving discipline ; numerous new molecules are available and recommendations regarding treatment change. However, these rapid changes are sometimes difficult to follow for general practitioners. Metformin remains the cornerstone of type 2 diabetes treatment after lifestyle modifications, which should always be encouraged before medications. Currently, the best classes to add after metformin are SGLT2 inhibitors and GLP-1 receptor agonists, as these molecules showed some cardiovascular and renal beneficial effects in dedicated studies. The aim of this article is to guide the general practitioner in choosing the most suitable pharmacological treatment for each patient, in light of the novelties in the field of diabetes that appeared during the year 2021., Competing Interests: Les auteurs n’ont déclaré aucun conflit d’intérêts en relation avec cet article.

Competing Interests: N. Foussard déclare avoir été invitée à des congrès par Lilly, Novo Nordisk, Sanofi-Aventis, Sandoz, Servier.K. Mohammedi déclare avoir reçu, à titre personnel ou pour des associations de recherche dont il est membre, des soutiens financiers, sous forme d’honoraires pour communication ou expertise, ou d’invitations à des congrès d’AstraZeneca, Boehringer Ingelheim, Novo Nordisk, Sanofi-Aventis, Eli Lilly et Abbott.

Competing Interests: N. Foussard déclare avoir été invitée à des congrès par Lilly, Novo Nordisk, Sanofi-Aventis, Sandoz, Servier.K. Mohammedi déclare avoir reçu, à titre personnel ou pour des associations de recherche dont il est membre, des soutiens financiers, sous forme d’honoraires pour communication ou expertise, ou d’invitations à des congrès d’AstraZeneca, Boehringer Ingelheim, Novo Nordisk, Sanofi-Aventis, Eli Lilly et Abbott.

Type 2 diabetes in the elderly remains a major concern for all healthcare professionals, this disease being considered a real global «pandemic». Its prevalence is high and will continue to increase in the years to come, becoming significant in the elderly and the very old. We offer you a general summary and a focus on diabetes in the elderly with the GERODIAB study.

The transition from hospital to ambulatory care is a high-risk period for patients with diabetes mellitus and is a challenge for health care professionals. Various interprofessional collaborative interventions have shown a positive impact on continuity of care at discharge. Communication and transmission of information between the hospital and ambulatory settings as well as coordination between healthcare professionals are key points to explore and to improve to ensure optimal continuity of care., Competing Interests: Les auteurs n’ont déclaré aucun conflit d’intérêts en relation avec cet article.

MODY diabetes, for Maturity Onset Diabetes of the Young, is a form of monogenic diabetes characterized by a typical onset before the age of 25 years, the lack of autoimmunity against the b cells of the pancreas, a preserved β cells function and an autosomal dominant mode of inheritance. This type of diabetes constitutes 2 to 5% of all cases of diabetes but remains often undiagnosed. Nearly 15 MODY subtypes have been identified to date. The 3 most common subtypes are caused by mutations in the genes encoding glucokinase, HNF1a and HNF4a, and account for approximately 80% of all MODY cases. Carrying out a genetic test can thus make it possible to make the diagnosis of MODY diabetes and to set up an appropriate treatment. In this article we will discuss these 3 main MODY sub-type, although there are other forms, which may be characterized by associated specific organ damage., Competing Interests: Les auteurs n’ont déclaré aucun conflit d’intérêts en relation avec cet article.

Competing Interests: L’auteur déclare n'avoir aucun lien d’intérêts.

Introduction: Type 2 diabetes is associated with an increased risk of coronary disease and is the leading cause of morbidity and mortality in this population. The main objective of our work is to study the correlation of diastolic function of the left ventricle with coronary disease in type 2 diabetics., Material and Methods: Analytical cross-sectional, monocentric prospective-looking study of 703 type 2 diabetic patients performed at the Military Regional Hospital of Constantine over a period of 04 years (2016-2019). We excluded 338 patients who did not receive coronary angiography; thus 365 patients are ultimately analyzed. Evaluation of diastolic function was performed by two-dimensional transthoracic echocardiography with the search of coronary disease. The data was analyzed using the Epi Info 7.2.1.0 with study of the relationship of the diastolic function to coronary disease by multiple logistic regression., Results: The average age of our final cohort is 57,7±6,5 years, an average of 7.4±1.8% of glycated hemoglobin, an average of 5,8±4,1 years of diabetes, a sex ratio to 1.27. 49.3% had diastolic dysfunction. The prevalence of coronary disease is 32,9%. In multivariate analysis; diastolic dysfunction is correlated with coronary involvement significantly (OR=2.02, 95% CI [1.50 - 2.90], p=0.02)., Conclusion: The prevalence of diastolic dysfunction is high in type 2 diabetics and is significantly correlated with coronary heart disease., (Copyright © 2020 Elsevier Masson SAS. All rights reserved.)

Endocrine disruptors are chemicals or natural molecules able to interfere with the hormonal system of living organisms. These pollutants can promote the emergence of diseases of the endocrine system in humans or animals. In this publication, we will focus on certain families of endocrine disrupting chemicals that may contribute to the development of type 2 diabetes, a disease whose prevalence is increasing strongly in the world.

Diabetes is a rapidly evolving discipline, numerous new molecules and recommendations are available. However, these rapid changes are sometimes difficult to follow for general practitioners. Metformin remains the cornerstone of type 2 diabetes treatment after lifestyle modifications, which should always be encouraged before medications. Currently, the best classes to add after metformin seem to be SGLT2 inhibitors and GLP-1 receptor agonists, as these molecules showed some cardiovascular and renal beneficial effects in dedicated studies. Nevertheless, the current pharmacological plethora is paradoxically associated with clinical inertia as general practitioners may be in trouble finding the right medication. This article will highlight novelties in the field of diabetes during the year 2020., Competing Interests: Les auteurs n’ont déclaré aucun conflit d’intérêts en relation avec cet article.

Introduction: The main objective of this study was to investigate the rate of ophthalmological screening for diabetic retinopathy in diabetic individuals in the Centre-Val de Loire (CVDL) region. This study secondarily aimed to identify factors associated with regular ophthalmological screening., Material and Methods: Data were extracted from the French national healthcare database (SNDS). Individuals were identified on the basis of reimbursements for antidiabetic medications. Patients who were identified as having at least one reimbursed eye examination between 2015 and 2016 were considered as having regular follow-up., Results: In total, 118,181 diabetic individuals residing in CVDL were identified in the SNDS, and 74,048 had undergone ophthalmological screening. The rate of eye examination was 62.7% between 2015 and 2016 and was highly variable within the region (from 65.6% in Loiret to 54.0% in Cher). The main factors associated with regular eye screening were: follow-up with an established primary care physician (OR=2.88), regular follow-up with a diabetologist (OR=2.14), and regular follow-up with an internist (OR=1.57)., Conclusion: This study suggests that ophthalmological screening for diabetic retinopathy in individuals with diabetes in the CVDL region could be significantly improved, particularly in rural areas. Factors influencing compliance with follow-up are multiple but appear mainly related to the patients' quality of overall medical management. These findings highlight the need for public health policies to improve detection and prevention of diabetic retinopathy by promoting comprehensive medical care for diabetic individuals., (Copyright © 2020 Elsevier Masson SAS. All rights reserved.)

Background: Through various research lead in the past, it has been made evident that Quebec is home to higher rates of acute myocardial infarction (AMI) and higher prevalence of cardiovascular risk factors than other Canadian provinces. This proposed study will perform a retrospective analysis on Caucasian populations in order to analyze the cardiovascular risk factors in partially francophone populations in comparison to French and Non-French Canadians. Furthermore, we will closely analyze both genders of aforementioned populations., Methods: This population-based retrospective cohort study was achieved using the University of Ottawa Heart Institute CCTA registry. Included are Caucasian patients of all ages who came to UOHI for a CCTA between 2006 and 2018 and provided written informed consent. SPSS was used to compare the different populations (French Canadian, partially French Canadian and non-French Canadian) and sex., Results: The PFC population more closely resembles FC, having higher incidence of cardiovascular risk factors such as smoking, dyslipidemia and type 2 diabetes., Interpretation: Our results suggest that PFC, like FC, may benefit from more intensive education and lifestyle modification techniques., (Copyright © 2020 Elsevier Masson SAS. All rights reserved.)

Purpose: To study the effect of type 2 diabetes on pupil diameter., Patients and Methods: We carried out a case-control study at the Douala Obstetrics, Gynecology and Pediatric Hospital over a 5-month period. The cases were type 2 diabetic patients, and the controls were non-diabetic patients paired for age and gender. We studied the correlation between the duration of diabetes, fasting blood sugar and the horizontal pupil diameter., Results: We included 35 patients in each group. The mean age was 56.6±10.01 years. Both groups included 17 males and 18 females. The mean duration of diabetes was 2.72±4.31 years, and the mean fasting blood sugar was 2.02±0.69g/L. The mean pupil diameter was similar in the two groups. On the right side, it was 4.75±0.73mm for controls and 4.52±0.69mm for cases (P=0.179). On the left side, it was 4.70±0.68mm and 4.42±0.73mm respectively for each group (P=0.101). The duration of diabetes was correlated to pupil diameter in the right eye (r=-0.43; P=0.01) and left eye (r=-0.45; P<0.01). No additional risk was found to be associated with diabetes for right pupil diameters (OR=0.79; P=0.33), or for left ones (OR=0.76; P=0.24)., Conclusion: Pupil diameter is similar in diabetic and non-diabetic patients. However, the duration of diabetes appears to affect pupil diameter., (Copyright © 2020 Elsevier Masson SAS. All rights reserved.)

Background: There is a global rise in the prevalence of diabetes mellitus and pre-diabetes is a fore-runner to type-2 diabetes. Pre-diabetes is reversible, therefore, measures should be taken to halt or slow down its progression to frank diabetes., Aim: The study aimed to evaluate the prevalence of pre-diabetes and diabetes amongst staff of ABUTH, Zaria and identify some cardiovascular risks associated with them., Methods: A cross-sectional analytical study carried out on 377 healthcare workers who presented at the Medical out-patient department of ABUTH, Zaria in response to an invitation for the 2017 World Diabetes Day free medical screening. HbA1c was assessed via Immunofluorescence method. The difference in HbA1c amongst healthcare workers was determined by One-way Analysis of Variance with Post-hoc Bonferroni test. Cardiovascular risk associations were assessed via Multiple Binary Logistic Regression., Results: Pre-diabetes and diabetes prevalence were 19.4% and 6.5% respectively. There were 28.6% undiagnosed diabetic healthcare workers. There was no significant (p=0.35) difference in HbA1c between different categories of healthcare workers, however, random blood glucose was significantly (p=0.042) higher in other healthcare workers than doctors. There was a significant (p<0.01) association between systolic hypertension and risk of developing pre-diabetes and diabetes (OR, 4.11, CI 0.98-17.30)., Conclusion: There is a high prevalence of pre-diabetes and diabetes amongst healthcare workers in Zaria. The odds of hypertensive healthcare workers developing pre-diabetes and diabetes is high. Efforts should be geared at intensifying health education, increased work physical activity and proper diet.

Introduction: Sodium-glucose cotransporter type 2 inhibitors (SGLT2i) are new therapeutic agents that improves the management of type 2 diabetes. Clinical trial results for SGLT2i have shown a reduction in blood glucose levels and a decrease in significant cardiovascular and renal complications related to diabetes. However, rare adverse events such as diabetic ketoacidosis have been reported in these clinical trials and in "real life". These ketoacidosis were atypical because the hyperglycemia was less severe than in traditional acute diabetes, hence the name of "euglycemic" ketoacidosis. We detail a series of local cases associated with the use of SGLT2i in type 2 diabetic patients., Methods: This was a retrospective consecutive case study, with a review of medical records from 2016 to 2019. We identified 7 single episodes of "euglycemic" ketoacidosis associated with SGLT2i use in individuals with type 2 diabetes., Results: Seven cases of type 2 diabetic individuals (M/F: 5/2) aged from 51 to 74years old were analysed. All had symptoms of hyperketonemia (fruity smelling breath, nausea or lack of appetite) and an increase level of capillary β-hydroxybutyric acid despite a glycaemia between 112 and 280mg/dL. The risk factors for ketoacidosis identified in these patients were: prolonged fasting, infection, dehydration and significantly decreased in insulin secretory function (according to the HOMA model), revealing endogenous insulinopenia before ketoacidosis., Conclusion: The increasing use of SGLT2i in individuals with type 2 diabetes is likely to increase the number of ketoacidosis cases. It is essential to recognise this complication and prevent it according to each patient's risk factors., (Copyright © 2019 Société Nationale Française de Médecine Interne (SNFMI). Published by Elsevier Masson SAS. All rights reserved.)

Purpose: The goal of this study was to investigate the safety and efficacy of the intravitreal dexamethasone implant (DI) for patients with diabetic macular edema (DME) in real life., Methods: We conducted a monocentric retrospective analysis of the change in visual acuity and central macular thickness (CMT) after intravitreal injection of the DI at peak efficacy (2 months after injection) as well as the timing of reinjections and complications in patients with a loss of vision due to DME., Results: Forty eyes of 33 patients were included, with a mean follow-up of 12.6 months. Thirty percent of the eyes experienced an increase in best corrected visual acuity (BCVA)>15 letters at peak efficacy (P<0.05) after each ID injection. Treatment-naive patients had a sustained response after Ozurdex injection, with better visual acuity at 3 months (P=0.02) and 4 months (P=0.04) than non-naïve patients and better visual acuity at 6 months despite identical baseline visual acuity (P<0.05). Anatomical efficacy was good, with approximately 60% of patients with CMT<300 microns at peak efficacy after each injection of ID. Thirty percent of eyes demonstrated ocular hypertension (OHT)>25mmHg at peak efficacy, and 12.5% of eyes required cataract surgery during follow-up., Conclusion: The DI has good functional and anatomic efficacy in these patients, with a good safety profile. Treatment-naïve patients with more recent DME had a more sustained increase in visual acuity after the injections and better visual recovery at 6 months. This encourages us to initiate DI therapy early if there is no response to anti-vascular endothelial growth factor (anti-VEGF) treatment., (Copyright © 2020 Elsevier Masson SAS. All rights reserved.)

Diabetes is one of the most important comorbidities linked to the severity of infection caused by severe acute respiratory syndrome coronavirus (SARS-CoV-2). The prevalence of diabetic patients hospitalized in intensive care units for COVID-19 is two-to-threefold higher than that observed in non-diabetic patients and a risk of progressing to critical or fatal disease is increased by a factor of 3 to 4 in patients with diabetes. Multiple mechanisms link diabetes as a risk factor of severe COVID-19, including both diabetes-related (such as hyperglycaemia) and diabetes-associated (such as immune dysfunction, obesity and hypertension) components. Optimising glycaemic control to reduce the risk of severe COVID-19 appears important but challenging and the best choice of antidiabetic treatment remains to be established, even if an early introduction of insulin in type 2 diabetes patients with COVID-19 is encouraged upon admission to the hospital. Future investigations are necessary to improve both the management and the prognosis in these very high risk patients.

Background: Non-adherence in patients with type 2 diabetes is a frequent phenomenon with important impact in terms of management of this disease. The aim of this study was to assess the level of medication adherence and to identify the factors associated with non-adherence in type 2 diabetic patients., Methods: A cross-sectional study was conducted in type 2 diabetic patients at the endocrinology and diabetology department of University Medical Center of Sidi Bel Abbes (Algeria) in 2017. Medication adherence was determined using a morisky 8-Item medication adherence questionnaire. A logistic regression was used to identify factors associated with non-adherence., Results: The study enrolled 403 type 2 diabetic patients. The mean age was 60 years and sex-ratio was 0.8. Medication non-adherence rate was 31.3% (95% CI: 26.8-35.8%). The factors significantly associated with non-adherence in multivariate analysis were: health insurance status, self-monitoring of blood glucose, disease duration, education level and need for information on diabetes., Conclusion: Our study had demonstrated a low adherence in patients with type 2 diabetes. The results suggest that implementation of a therapeutic education program could be important in management of diabetes., (Copyright © 2019 Académie Nationale de Pharmacie. Published by Elsevier Masson SAS. All rights reserved.)

Introduction and Objectives: Elderly patients with diabetes have been shown to have more diabetes-related complications, and they are more likely to develop somatic and psychiatric comorbidities including cognitive dysfunction and depression. Several studies have shown a close association between diabetes and depression. This comorbidity may lead to functional disability and quality of life deterioration. Thus, the elderly will face various constraints through the coping strategies. In this context, we conducted our study to assess the prevalence of depressive symptoms in elderly patients with diabetes as well as its associated factors, and to investigate their coping strategies., Methods: We conducted a cross-sectional, descriptive and analytic study among 50 elderly patients (age≥65 years) being followed for type 2 diabetes at the outpatient department for chronic diseases of the Regional Hospital of Aguereb, Sfax, Tunisia. We used the "Activity of Daily Living" to assess the dependence level, the "Geriatric Depression Scale" to screen for depressive symptoms, and the "Brief Coping with Problems Experienced" to investigate the coping strategies., Results: The mean age of patients was 73.3 years, with a sex-ratio (M/F) of 0.62. Smoking and alcohol consumption were reported respectively in 20% and 4% of participants. The mean duration of diabetes was 7.7 years. Diabetes complications were noted in 70% of participants. Somatic comorbidities were noted in 94% of cases (hypertension 84%; dyslipidemia 34%). Psychiatric histories were reported in 18% of patients who suffered from anxio-depressive symptoms. No patient among those with mental disorder histories benefited from any psychiatric management prior to the study. Three patients (6%) had previously presented suicidal ideations but none of them had attempted suicide. The mean "Activity of Daily Living" score was 4.9 points. Patients were autonomous in 28%, and dependent in 4% of cases. The mean "Geriatric Depression Scale" score was 9.8 points. According to this scale, the prevalence of depressive symptoms was 34%. They were correlated with: smoking (P=0.04), psychiatric histories (P=0.031), absence of leisure activity (P=0.035), "Activity of Daily Living" score (P=0.028), long duration of diabetes (P=0.04) and the presence of suicidal ideation (P=0.013). According to the « Brief Coping with Problems Experienced », the problem-focused coping strategies were the most frequently used (44%), followed by emotion-focused (38%) and passive strategies (18%). Participants with depressive symptoms are significantly more likely to adopt emotion-focused coping strategies (P=0.01)., Conclusion: Our study highlighted a high prevalence of depressive symptoms among elderly patients with diabetes. This relationship seems to be bi-directional and may increase somatic complications and alter the quality of life, and then darken the prognosis. Thus, besides pharmacological treatment, regular depression screening and psychological support are essential to ensure a better control of diabetes and to improve well-being., (Copyright © 2019 L'Encéphale, Paris. Published by Elsevier Masson SAS. All rights reserved.)

Introduction: Diabetic ketoacidosis (DKA) is a severe metabolic complication of diabetes. Recent years have seen a marked increase in prevalence of diabetic ketoacidosis, but mortality is low. This study aimed to describe the epidemiological, clinical, therapeutic and prognostic features of patients with severe or moderate DKA admitted to the Emergency Department., Methods: He conducted a prospective, descriptive study including patients with moderate or severe DKA. Standardized care protocol. We studied the epidemiological, clinical, therapeutic and prognostic features of these patients., Results: The study involved 185 patients with moderate or severe DKA. The average age of patients was 38+/-18 years, with a sex ratio of 0.94. Known diabetes was reported in 159 patients (85%) of whom 116 had type 1 diabetes. The most common factors of decompensation were treatment discontinuation in 42% and infection in 32%. Average blood glucose was 32.7+/-12 mmol/L, pH =7.14+/-0.13, HCO3- =7.2+/-3.56 mmol/L. The mean duration of intravenous insulin was 17.3 +/- 16 hours. Hypoglycaemia was reported in 26 patients (14%), hypokalemia in 80 (43%) patients and hyperchloraemic mineral acidosis in 43 patients (23%). Intrahospital mortality was 2.1%., Conclusion: Diabetic ketoacidosis occurs in young subjects treated with insulin therapy. Treatment is based on intravenous insulin associated with correction of fluid deficit. Complications mainly include hypokalemia and hypoglycemia and mortality is low., Competing Interests: Les auteurs ne déclarent aucun conflit d’intérêts., (© Sarra Jouini et al.)

Background: The combination of schizophrenia and diabetes mellitus presents a public health problem in the world. Several studies have been carried out for the analysis of this comorbidity, including prognostic factors., Objective: The objective of our study is to determine the risk factors associated with the comorbidity schizophrenia and diabetes mellitus., Methods: From a sample of 200 cases of schizophrenic patients hospitalized at the Sidi Chami psychiatric hospital of Oran in Algeria, we carried out a descriptive transversal and analytical study during the period of one year., Results: Our results are consistent with those of the different studies carried out in neighboring countries. Among the risk factors recorded in our study, we mention the age of 40 and over, divorce, dyslipidemia, high blood pressure, overweight and severe and moderate obesity, the age of schizophrenia of 30 to 40 years, the first-generation neuroleptic treatment and family history related to diabetes. While the male sex, celibacy and second-generation neuroleptics were found in the study as protective factors against the onset of diabetes mellitus in schizophrenic patients., Conclusion: The factors associated with comorbidity schizophrenia and type 2 diabetes are manifold. These factors must be taken into account when introducing preventive behaviors that must be multidisciplinary in order to ensure better patient care., (Copyright © 2019 Elsevier Masson SAS. All rights reserved.)

Introduction: This study aims to determine the clinical and evolutionary profile of skin and soft tissue lesions in diabetics followed up at the dressing room., Methods: We conducted an observational descriptive and analytical study in the dressing room of the Marc Sankalé Diabetes Center, Dakar from 1 January to 31 December 2017. Our study focused on diabetics who were examined in the dressing room., Results: A total of 37.173 procedures were recorded at the Marc Sankalé Diabetes Center; 16.418 patients were treated in the dressing room, representing a prevalence of 14.16%. The average age of patients was 56,6 ±12 years, the sex ratio (M/F) was 0,88. Type 2 diabetes predominated (78,97%) and the average disease duration was 8.06 ± 7.9 years. The mean capillary blood glucose concentration was 2.4±1 g/l. Diabetic neuropathy was found in 72.33% of patients. Limb lesions were found in 93,98% of patients(1185 cases). The most common lesions included: ulcer (46,76%), abscess (13.46%), phlegmon (13.20%), gangrene (8.41%), erysipelas (3.78%), perforating ulcer (3.53%), intertrigo (3.95%). The lesions were be divided into infectious lesions (61,41), non-infectious lesions(33,50%), pure vascular lesions (1.57%) and mixed lesions (3.70%). Out of 1189 patients 7.57% had had osteitis. The germs found were Gram-positive bacteria (12.70%), Gram-negative bacteria (23.80%). Amputation was performed according to the topographical features of the lesion (p=0.00), the type of lesion (p=0.000), the seniority of diabetes (p=0.02), the type of diabetes (p=0.008), the presence of osteitis (p=0.006). Minor amputation was performed in 43,33% of cases, major amputation in 37.43% of cases; 70 deaths were recorded (5.89%)., Conclusion: Skin and soft tissue lesions were dominated by diabetic foot. Mortality is not negligible and the risk of amputation was statistically related to the topographical features of the lesion, the type of lesion, the seniority and the type of diabetes and the presence of osteitis., Competing Interests: Les auteurs ne déclarent aucun conflit d'intérêts.

Introduction: Diabetic retinopathy (DR) is a leading cause of blindness worldwide. Non-mydriatic fundus photography (NMFP) has been adopted as a screening tool for this disease. We aim to determine the prevalence of DR through this method in Lebanese diabetic patients and to evaluate the impact of such screening in this population., Materials and Methods: This study explores data from an awareness and screening campaign conducted in Lebanon. Diabetic patients from multiple regions were referred by their endocrinologists to undergo NMFP using the Optomed SmartScope ® handheld fundus camera. Photographs were interpreted by a remote observer, and recommendations were given accordingly. The prevalence of DR was calculated, and statistical analyses were performed on the clinical characteristics, fundus findings and number of referrals to ophthalmologists., Results: The campaign lasted 11 months, during which 2205 patients were examined in 37 screening locations. Out of the 97.41% of patients with type 2 diabetes mellitus, 12.56% had signs of DR, with no significant difference between the regions. 6.28% of the photos were uninterpretable. Positive results were associated with a longer duration of diabetes (P<0.01), treatment with insulin (P<0.01), as well as the presence and chronicity of systemic hypertension (P=0.01). 25% of patients with positive testing were retrospectively asked about their follow-up; only one third had an ophthalmologic examination as per the recommendation, among whom 68.18% underwent treatment for proliferative DR and/or diabetic macular edema., Conclusion: Tele-ophthalmology is useful in mass screening for DR. The importance of dilated fundus examinations still needs to be highlighted for diabetic patients, and better collaboration between endocrinologists and ophthalmologists is required to improve screening outcomes., (Copyright © 2019 Elsevier Masson SAS. All rights reserved.)

Despite numerous health challenges, African healthcare systems are faced with limited financial and human resources. In this context, the epidemiological transition witnessing an explosion in the prevalence of non-communicable diseases, particularly diabetes, there are tremendous challenges to be met. Given the lack of human resources in these health systems, therapeutic education relies on networks of trained peer educator patients who also provide significant psychosocial support., (Copyright © 2018 Elsevier Masson SAS. All rights reserved.)

Background: Patterns of hyperglycaemic emergencies (HE) include diabetic ketoacidosis, (DKA), hyperglycaemic hypero-smolar state, (HHS), normo-osmolar non-ketotic hyper-glycaemic state, (NONKHS), or the mixed/indeterminate form. Certain factors are predictive of adverse HE outcome. There is a paucity of literature on the patterns and poor prognostic factors of HE in the South East (SE) region of Nigeria, hence, the need for this study., Materials and Methods: This was a prospective observa-tional study done to assess the pattern of prognostic factors for HE managed at the Federal Medical Centre, (FMC), Umuahia, South East, Nigeria. Consecutively recruited adult patients managed for HE at FMC, Umuahia between July 2015 and March 2016 were studied. Patterns of HE were determined via biochemical tests while prognostic factors were determined from biodata, precipitating illnesses, clinical presentations and other comorbid illnesses. Analysis of data was done using SPSS 20.0 and the level of statistical significance was set at p < 0.05., Results: A total of 110 subjects were recruited, made up of 46 (42%) males and 64 (58%) females. Death from HE occurred in 10% of the subjects with case fatality rates of 3.6%, 2.7%, and 0.9% for the mixed type, DKA/NONKHS and HHS respectively. Mixed/indeterminate form was the commonest pattern followed by DKA and then NONKHS. The correlates of HE death included stroke, diastolic hypotension and presence of complication(s) attributable to HE but the independent risk factors for death from HE were diastolic hypotension and stroke Cerebrovascular Accident (CVA) only., Conclusion: Mixed form of HE and DKA were the most common presentations of HE in this facility and the independent risk factors for death from HE were diastolic hypotension and stroke (CVA).

Objective: To describe the etiologies, clinical presentation and therapeutic management of neovascular glaucoma (NVG) in Senegalese patients., Patients and Methods: We retrospectively studied the records of patients followed for NVG between 1993 and 2016. We included eyes with Iridis rubeosis with or without ocular hypertension. We recorded age, sex, medical and ophthalmologic history, results of the eye examination, treatment modalities broken up into hospitalisation, procedural interventions and number of antiglaucoma medications prescribed. The data analysis was performed by epi-info 7., Results: Forty-eight eyes of 44 patients were included. The mean age was 59.7 years and sex ratio 2.1. Etiologies were type 2 diabetes in 31.8 % cases and central retinal vein occlusion in 16.6 % cases. All eyes were blind. Eye pain was present in 75 % of eyes, a limbal flush in 29.1 % of eyes and mydriasis in 31.25 % of eyes. Mean intraocular pressure was 49.7mmHg. Corneal edema occured in 54.1 % of eyes. Fundus examination showed proliferative retinopathy in 14.5 %. Treatment required hospitalisation for 43.75 % of patients. Therapeutic procedures were cyclocryoapplication for 31.25 % of eyes, retrobulbar xylo-alcohol injection for 14.5 % of eyes and panretinal laser photocoagulation (PRP) for 12.5 % eyes. Antiglaucoma preparations were used in dual therapy for 29 % of eyes, in triple therapy and quadruple therapy for 25 % of eyes each., Discussion: The etiologies are comparable to those described in the literature. The diagnosis was late and treatment limited by adverse economic conditions., Conclusion: NVG in Senegalese patients is an affection of men in their sixties. It is responsible for irreversible painful blindness for which treatment is difficult - thus the interest in prevention by strict monitoring and prompt treatment of any retinal ischemia., (Copyright © 2018 Elsevier Masson SAS. All rights reserved.)

Recent studies conducted in patients with Addison's disease (AD) highlighted that this disease, even after treatment, is a significant cause of morbi-mortality. This study aims to determine the cardiovascular and metabolic deleterious impact of long-course glucocorticoid substitution therapy. We conducted a retrospective study of 28 patients with treated Addison's disease evolving for more than 15 years. The average age of patients was 58, 53 years, with a female predominance (65%). The average follow-up period was 17, 87 years. Initial dose of hydrocortisone was 32, 5 mg/day (20.52 mg/m 2 ) and 27, 9 mg/day (16,41mg/m 2 ) at the time of the study. The prevalence of the metabolic syndrome (MS) in patients with AM was 35.71% after a period of treatment longer than 15 years. At the end of the follow-up period, 28.57% of patients were obese; 25% of patients had developed AH (arterial hypertension) and type 2 diabetes. The prevalence of dyslipidemia went from 3.57% to 42.85%. Only one patient had myocardial infarction at 25-year follow-up. Factors favoring the onset of MS in our study were history of disease and weight loss at the moment of diagnosis. Adjustment of substitution therapy is a challenge in patients with Addison's disease due to morbi-mortality associated with overdose. A regular follow-up and a personalized therapeutic approach are necessary to improve patients' prognosis.

Hepatocellular carcinoma is the third most frequent cause of cancer death worldwide, particularly in Asia and Africa. Most cases complicate an underlying liver cirrhosis due to hepatitis B or C chronic virus infection or alcoholic abuse. But, following the current epidemics of obesity and type 2 diabetes, it appears that these diseases, associated in metabolic syndrome, are responsible for non alcoholic fatty liver disease at risk of HCC frequently before the stage of cirrhosis. Recent hypotheses consider that in the near future, cancer deaths due to HCC will overpass in USA those due to breast or colorectal cancers. Governments should develop policies to prevent obesity, type 2 diabetes and the metabolic syndrome as well as fight against alcoholism and hepatitis B and C virus infections., (Copyright © 2018 Société Française du Cancer. Published by Elsevier Masson SAS. All rights reserved.)

Introduction: First Nations/Métis populations develop diabetes earlier and at higher rates than other Canadians. The Canadian diabetes risk questionnaire (CANRISK) was developed as a diabetes screening tool for Canadians aged 40 years or over. The primary aim of this paper is to assess the effectiveness of the existing CANRISK tool and risk scores in detecting dysglycemia in First Nations/Métis participants, including among those under the age of 40. A secondary aim was to determine whether alternative waist circumference (WC) and body mass index (BMI) cut-off points improved the predictive ability of logistic regression models using CANRISK variables to predict dysglycemia., Methods: Information from a self-administered CANRISK questionnaire, anthropometric measurements, and results of a standard oral glucose tolerance test (OGTT) were collected from First Nations and Métis participants (n = 1479). Sensitivity and specificity of CANRISK scores using published risk score cut-off points were calculated. Logistic regression was conducted with alternative ethnicity-specific BMI and WC cut-off points to predict dysglycemia using CANRISK variables., Results: Compared with OGTT results, using a CANRISK score cut-off point of 33, the sensitivity and specificity of CANRISK was 68% and 63% among individuals aged 40 or over; it was 27% and 87%, respectively among those under 40. Using a lower cut-off point of 21, the sensitivity for individuals under 40 improved to 77% with a specificity of 44%. Though specificity at this threshold was low, the higher level of sensitivity reflects the importance of the identification of high risk individuals in this population. Despite altered cut-off points of BMI and WC, logistic regression models demonstrated similar predictive ability., Conclusion: CANRISK functioned well as a preliminary step for diabetes screening in a broad age range of First Nations and Métis in Canada, with an adjusted CANRISK cutoff point for individuals under 40, and with no incremental improvement from using alternative BMI/WC cut-off points., Competing Interests: Dr. Gina Agarwal was contracted to lead this project by the Science Integration Division of the Public Health Agency of Canada. Research ethics board approval was obtained from each of the regions in which data were collected and from the Health Canada/Public Health Agency of Canada Research Ethics Board. The authors declare no conflict of interest.

Introduction: Diabetes is a disorder of assimilation, use and storage of sugars provided in the diet. Its management is based on follow-up of overweight and obese patients and on regular glycemic control. This study aimed to analyze overweight, obesity and glycemic control in 2227 patients with different types of diabetes (type 1, 2 and gestational) presenting to the Provincial referral center of diabetes (RCD) in Kenitra, Morocco., Methods: We conducted a study over the period January-December 2015. Overweight and obesity assessment was performed using Body Mass Index calculator (BMI = weight/height 2 (kg/m 2 ). Overweight and obesity were defined by BMI > 25 kg/m 2 and BMI > 30 kg/m 2 respectively; the weight and the height were measured according to World Health Organization's recommendations. Glycemic control was based on glycated hemoglobin levels and fasting blood glucose test. Current guidelines recommend a glycosylated hemoglobin level of 7% and a fasting blood glucose of 0.70g/l - 1.10g/L., Results: The age of patients ranged from 8 months to 80 years, with a prevalence of diabetic patients from the urban environment (74%) compared to those from the rural areas (26%). The entire study population was overweight. The average BMI of women showed a trend toward obesity (BMI≈30): (29.21 kg/m 2 ± 3,1) in patients with gestational diabetes and (29.15 kg/m 2 ± 3.2) in patients with type 2 diabetes. Blood sugar levels were above the standards: 8.5% ± 2.6 > 7% for glycosylated hemoglobin and 1.5 g/L ± 1.3>1.10g/L for fasting blood glucose. The difference between glycosylated hemoglobin levels between men (8.57% ± 2.6) and women (8.1% ± 2.3) were not significant (p > 0.05), it was the same with fasting blood glucose: men (1.44 g/L ± 1,1) and women (1.43 g/L ± 1.2). Pearson's correlation coefficients were highly significant (p<0.005); on the one hand between BMI and fasting blood glucose(r = 0.5) and on the other hand between BMI and glycosylated hemoglobin levels (r = 0.4)., Conclusion: The entire study population had BMI and glycaemic control levels above the standards. More research is needed on diabetic patients in order to develop a remediation plan.