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Le diabète de type 1 (DT1) commence par deux stades précliniques bien caractérisés : stade 1, avec une auto-immunité sans retentissement sur l’insulinosécrétion (code diagnostique ICD-10 : E10.A1) ; et stade 2, avec une auto-immunité et des altérations débutantes de l’insulinosécrétion (code diagnostique ICD-10 : E10.A2). Ce continuum se poursuit par un stade 3 clinique, correspondant à la prise en charge actuelle. La possibilité de dépister le DT1 aux stades précliniques par un dosage des auto-anticorps permet désormais une prise en charge anticipée, notamment chez les apparentés des personnes vivant avec un DT1 (PaDT1) qui présentent un risque génétique supérieur à celui de la population générale. Dépister permet d’ores et déjà de prévenir l’acidocétose inaugurale, les hospitalisations prolongées, la dégradation rapide de l’insulinosécrétion résiduelle responsable d’instabilité glycémique et d’un risque supérieur de complications à long terme. De plus, une prise en charge précoce peut permettre d’anticiper les difficultés d’adaptation à la maladie et de corriger les facteurs de risque modifiables (obésité, sédentarité). De nouveaux traitements en cours d’essai ou de déploiement clinique offrent également la possibilité de retarder la progression vers le stade 3 clinique. L’ensemble de ces arguments plaide pour proposer dès à présent un parcours de dépistage et prise en charge au niveau national pour les apparentés de PaDT1. Ce parcours représente pour les professionnels de santé en charge des PaDT1 un nouveau champ de compétences à acquérir. En adaptant les recommandations internationales aux spécificités françaises, cette prise de position a pour objectif de décrire les étapes du parcours de dépistage et de prise en charge dans le cadre des soins courants.

Nous avons évalué à l’aide d’un auto-questionnaire le ressenti des hypoglycémies chez des personnes avec un diabète de type 1 venant en consultation au cours du premier semestre 2022. Une proportion importante (21,6 %) avait une perception altérée des hypoglycémies et ne prenait pas les mesures correctives appropriées avec, comme facteur de risque l’âge, mais sans relation avec les modalités de l’insulinothérapie. Les hypoglycémies étaient associées avec les inquiétudes rapportées et les stratégies d’évitement. Ce travail nous incite à systématiser l’évaluation du ressenti des hypoglycémies en consultation afin d’alerter les sujets à risque.

La télésurveillance est une modalité de la télémédecine dont l'intérêt principal est de compléter les soins courants afin de renforcer les interactions entre les personnes avec un diabète et l'équipe de soins afin d'améliorer la prise en charge, de renforcer l'autonomie à travers des approches personnalisées. Après les 4 ans de l'expérimentation ÉTAPES, la télésurveillance est inscrite dans les soins courants. Plusieurs défis et quelques interrogations persistent. Tout d'abord une véritable interopérabilité des dispositifs disponibles donnant un accès facile aux données glucose et insuline. Une réelle prise en compte de la complexité, du temps nécessaire et des enjeux des situations cliniques concernées est indispensable à travers des forfaits adaptés.

Adults with type 1 diabetes who are treated with multiple daily injections of insulin plus intermittently scanned continuous glucose monitoring (isCGM) can have suboptimal glucose control. We aimed to assess the efficacy of an advanced hybrid closed loop (AHCL) system compared with such therapy in this population.

OBJECTIVE--Specific autoantibodies characterize type 1 diabetes in childhood but are also found in adult-onset diabetes, even when initially non-insulin requiring, e.g., with latent autoimmune diabetes (LADA). We aimed to characterize [...]

OBJECTIVE--The benefits of real-time continuous glucose monitoring (CGM) have been demonstrated in patients with type 1 diabetes. Our aim was to compare the effect of two modes of use of [...]

OBJECTIVE--The purpose of this study was to estimate whether prevalence of metabolic syndrome in adult European diabetic patients is associated with type of diabetes. RESEARCH DESIGN AND METHODS--A consecutive series [...]

OBJECTIVE--To evaluate the cost of islet transplantation in type 1 diabetic patients with a functional renal graft in a multicenter network. RESEARCH DESIGN AND METHODS--The study involved nine diabetic patients [...]

To describe the 10‐year outcomes of islet transplantation within the Swiss‐French GRAGIL Network, in patients with type 1 diabetes experiencing high glucose variability associated with severe hypoglycemia and/or with functional kidney graft. We conducted a retrospective analysis of all subjects transplanted in the GRAGIL‐1c and GARGIL‐2 islet transplantation trials and analyzed components of metabolic control, graft function and safety outcomes over the 10‐year period of follow‐up. Forty‐four patients were included between September 2003 and April 2010. Thirty‐one patients completed a 10‐year follow‐up. Ten years after islet transplantation, median HbA1c was 7.2% (6.2–8.0) (55 mmol/mol [44–64]) versus 8.0% (7.1–9.1) (64 mmol/mol [54–76]) before transplantation (p < .001). Seventeen of 23 (73.9%) recipients were free of severe hypoglycemia, 1/21 patients (4.8%) was insulin‐independent and median C‐peptide was 0.6 ng/ml (0.2–1.2). Insulin requirements (UI/kg/day) were 0.3 (0.1–0.5) versus 0.5 (0.4–0.6) before transplantation (p < .001). Median (IQR) β‐score was 1 (0–4) (p < .05 when comparing with pre‐transplantation values) and 51.9% recipients had a functional islet graft at 10 years. With a 10‐year follow‐up in a multicentric network, islet transplantation provided sustained improvement of glycemic control and was efficient to prevent severe hypoglycemia in almost 75% of the recipients. Despite a low rate of insulin independence, islet transplantation in patients with type 1 diabetes continues to yield benefit 10 years after transplantation, providing 50% of recipients with good metabolic control and nearly 75% with freedom from severe hypoglycemia episodes.

Oral administration of antigens has been proposed in the prevention and treatment of autoimmune diseases. We reported that oral administration of 0.8 mg of recombinant human insulin to 6-week-old NOD [...]

The involvement of adhesion molecule in the process of T-cell homing to the pancreas was investigated in the model of the T-cell transfer of type I diabetes in NOD mice. [...]

Le diabète de type 1 (DT1) se définit par la nécessité de suppléer à la carence de production d’insuline par le pancréas. De nombreux éléments expérimentaux et cliniques ont permis de corréler cette situation clinique qui se manifeste, souvent brutalement, à une destruction sélective des cellules ß des îlots de Langerhans par un mécanisme auto-immun. Récemment, les études histologiques des pancréas de diabétiques et l’amélioration des techniques de mesure du peptide C ont nuancé cette affirmation avec, chez certains sujets, la persistance en nombre limité de cellules ß fonctionnelles. Cette découverte surprenante, chez ces sujets micro-sécréteurs, remet en cause les dogmes sur la physiopathologie du DT1 et ouvre des perspectives thérapeutiques.

Successful diabetes management is associated with an effective partnership between People with Diabetes (PwD) and healthcare professionals. Though possible to measure using Patient-Reported Experience Measures (PREMs), none are specific to Type 1 or Type 2 Diabetes (T1D/T2D) and validated in French. Thus, we developed and validated the DREMS (Diabetes Reported Experience MeasureS) e-questionnaire.

Malgré l’amélioration et l’intensification des traitements, la gestion des repas reste un élément capital au cours de la prise en charge des personnes atteintes d’un diabète de type 1. Nous avons voulu évaluer par une enquête anonyme les pratiques de 301 personnes concernées par cette pathologie chronique, en tenant compte de l’impact respectif d’une formation au comptage des glucides et des différentes modalités d'insulinothérapie. Dans cette enquête, 2/3 des patients effectuaient leurs insulines prandiales avant les repas, mais seule une minorité se servait d’un calcul de glucides. Cette étude met en évidence l’écart entre les aspects théoriques des programmes éducatifs et la réalité des pratiques, y compris pour les sujets en boucle fermée hybride.

In this article, we report the identification of a new autoantigen in type 1 diabetes originating from the exocrine pancreas. This antigen is a pancreatic enzyme termed bile salt-dependent lipase [...]

Restoration of peripheral tolerance to target autoantigens during autoimmune diseases has met with several limitations because of the limited efficacy of this approach in an already immune host. To optimize [...]

Islet transplantation is indicated for patients with type 1 diabetes with severe hypoglycaemia or after kidney transplantation. We did a randomised trial to assess the efficacy and safety of islet transplantation compared with insulin therapy in these patients.

Routine screening of carotid atherosclerosis lesions is frequently suggested for people with type 2 diabetes, the presence of a carotid lesion being associated with a significant increase risk for vascular events. However, the impact of this strategy on medical management is not validated. We herein question the usefulness of such screening.

Context:Recurrent somatic mutations in KCNJ5, CACNA1D, ATP1A1, and ATP2B3have been identified in aldosterone-producing adenomas (APAs). The question as to whether they are responsible for both nodulation and aldosterone production is not solved.Case Description:We describe the case of a young patient who was diagnosed with severe arterial hypertension due to primary aldosteronism at age 26 years, followed by hemorrhagic stroke 4 years later. Abdominal computed tomography showed bilateral macronodular adrenal hyperplasia. Identification of lateralized aldosterone secretion led to right adrenalectomy, followed by normalization of biochemical and hormonal parameters and amelioration of blood pressure. The resected adrenal showed three nodules, one of them expressing aldosterone synthase and harboring a somatic KNCJ5mutation. A Weiss revisited index of 3 of the APA prompted us to perform a second 18F-2-fluoro-2-deoxy-D-glucose-positron emission tomography after surgery, which revealed abnormal rectal activity despite the absence of clinical symptoms. Gastrointestinal exploration showed multiple polyps with severe dysplasia, and the diagnosis of familial adenomatous polyposis was established in the presence of a germline heterozygous APCgene mutation. Sequencing of somatic DNA from the APA and a second adrenal nodule revealed biallelic APCinactivation due to loss of heterozygosity in both nodules.Conclusions:This case report underlines the need for establishing the frequency of germline APCvariants in patients with primary aldosteronism and bilateral macronodular adrenal hyperplasia because their presence may predispose to APA development and severe hypertension well before the first familial adenomatous polyposis symptoms appear. From a mechanistic point of view, it supports a two-hit model for APA development, whereby the first hit drives increased cell proliferation whereas the second hit specifies the pattern of hormonal secretion.

Discriminating Cushing disease (CD) from pseudo-Cushing syndrome (PCS) is a challenging task that may be overcome with the 4-mg intravenous (IV) dexamethasone suppression test (DST).

Continuous ambulatory peritoneal dialysis is used in about one-third of the diabetic population as an alternative to hemodialysis for end-stage renal disease (ESRD). Several case reports and articles (1-3) have [...]

In patients with type 1 diabetes, insulin antibodies (IA), altering the pharmacokinetics of circulating insulin, might be associated with high glucose concentration, prolonged hypoglycemia, and higher insulin requirement. The impact of IA on islet transplantation has never been explored. Our aim was to evaluate islet transplantation results at 1 year according to the presence of IA.

If pancreas transplantation is a validated alternative for type 1 diabetic patients with end-stage renal disease, the management of patients who have lost their primary graft is poorly defined. This study aims at evaluating pancreas retransplantation outcome.

Insulin independence after islet transplantation is generally achieved after multiple infusions. However, single infusion would increase the number of recipients. Our aim was to evaluate the results of islet-after-kidney transplantation according to the number of infusions.

Whether islet transplantation should be aimed at restoring insulin independence or providing adequate metabolic control is still debated. The GRAGIL2 trial was designed as a phase 1–2 study where primary outcome was the rate of insulin independence, and secondary outcome was the success rate defined by a composite score based upon basal C-peptide, HbA1c, hypoglycemic events, and exogenous insulin needs.

Since the Edmonton trial in 2000, increasing numbers of transplant centers have been implementing islet transplantation programs. Some institutions have elected to associate in multicenter networks, such as the Swiss-French GRAGIL (Groupe Rhin-Rhône-Alpes-Genève pour la Transplantation d’Îlots de Langerhans) consortium.

The influence of islet transportation on pancreatic islet allotransplantation in type 1 diabetic patients was evaluated within the GRAGIL network.

OBJECTIVE: To study the existence of autoimmunity against the cerebellum in patients with sporadic cortical cerebellar atrophy. DESIGN: The presence of autoantibodies against the cerebellum in the serum and cerebrospinal fluid samples that were obtained from patients with sporadic cortical cerebellar atrophy and control patients was investigated by using immunohistochemical techniques. SETTING: University hospital and research laboratory in Lyons, France. PATIENTS: Eight patients with cortical cerebellar atrophy that was associated with or without other neurological symptoms; 350 patients with various neurological diseases; and 33 normal, healthy subjects. OUTCOME MEASURES: Serum and cerebrospinal fluid anti—cerebellar autoantibodies were investigated by using indirect immunofluorescence techniques in rat cerebellum. To characterize antigen labeled by patient's serum, we used an immunotrapping enzyme activity assay of glutamate decarboxylase. RESULTS: Serum and cerebrospinal fluid samples that were taken from one patient with sporadic cortical cerebellar atrophy associated with peripheral neuropathy and slow eye movements contained anti—glutamate decarboxylase autoantibodies. CONCLUSIONS: These results suggest a participation of autoimmunity in the pathogenesis of some cases of sporadic cerebellar cortical atrophy and the involvement of the cerebellar γ-aminobutyric acid—ergic system in the pathogenesis of this disease.