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Summary: Background & aims: Non-alcoholic fatty liver disease (NAFLD) is commonly associated with obesity, metabolic syndrome and type 2 diabetes. Although dietary fat contributes substantially to the accumulation of liver fat, the role of individual fatty acids in this accumulation is unclear. Objective: In this study, we set out to determine whether liver fat content (LFC), was associated with red blood cell fatty acid (RBC-FA) composition in people with type 2 diabetes. Design, settings, and participants: One hundred and sixty-two type 2 diabetic patients were included in this study. LFC was measured using 1H-MR Spectroscopy. RBC-FA composition was measured by gas chromatography. Results: One hundred and nine (67.2%) patients had steatosis. Patients with steatosis had a higher BMI (p =0.0005), and higher plasma triglyceride levels (p =0.009) than did patients without steatosis. We report a significant association between palmitic acid (16:0), palmitoleic acid (16:1n-7) concentrations and ratio of monounsaturated to saturated fatty acid (palmitoleic acid to palmitic acid) and higher liver fat content. Total polyunsaturated fatty acid (PUFA), homo-gamma-linolenic acid (20:3n-6), docosahexaenoic acid (22:6n-3), and arachidonic acid (20:4 n-6) were associated with lower LFC. Conclusions: Our data showed that an increased erythrocytes long-chain n-3 and n-6 fatty acids was associated with a lower prevalence of steatosis in patients with type 2 diabetes. These results suggest that n-3 and n-6 fatty acids supplementation could be a promising treatment for NAFLD in patients with type 2 diabetes. [Copyright &y& Elsevier]

Introduction In nondiabetic patients with acute myocardial infarction (AMI), acute hyperglycemia is associated with high-risk of cardiovascular (CV) mortality but the prognostic value of glycosylated haemoglobin (HbA 1c) remains uncertain. Objective In a large observational study, we aimed to identify the prognostic values of admission HbA1c and plasma glucose for acute MI in non-diabetic patients regarding in-hospital and one-year CV mortality. Methods From the RICO survey database all the consecutive non-diabetic patients with AMI (N = 6884) from January 2001 to June 2016 were included. Cut off levels (high/low) were determined by ROC curve analysis for the prediction of CV one-year death (HbA 1c : 5.9% and glucose: 156 mg/dL) to set up 4 groups: low HbA 1c /low glucose (N = 3849), low HbA 1c /high glucose (N = 734), high HbA 1c /low glucose (N = 1802) and high HbA 1c /high glucose (N = 499). Results Elevation of glucose or HbA1c was associated with elevated rate of hospital mortality, when compared to all other groups (Fig. 1). By multivariate logistic regression analysis, only high glucose remains a prognostic factor of hospital death (OR(95%CI): 1.59 (1.16–2.17)). In survivors at discharge, group with elevated levels of both plasma glucose and HbA 1c had a higher rate of one-year CV mortality compared to all other groups (P < 0.001). High HbA 1c was an independent predictive factor of one-year CV mortality, beyond high glucose (OR(95%CI): 1.75(1.35–2.27) and 1.98(1.49–2.61), respectively) and covariates (Fig. 1). Conclusions In our large population-based study in nondiabetic patients with AMI, high levels of admission HbA 1c and/or plasma glucose give different prognostic information and were associated with increased risk of mortality at short or long-term. Early mortality risk was mainly driven by acute hyperglycemia and one-year mortality by HbA 1c , independently of plasma glucose. Our findings may help identifying high-risk patients to target for aggressive secondary prevention after AMI. [ABSTRACT FROM AUTHOR]

Introduction In diabetic patients with acute myocardial infarction (MI), prognostic value of glycosylated hemoglobin (HbA 1c) remains debated. Objective In a large observational study, we aimed to identify the prognostic value of HbA 1c measured on admission for acute MI in diabetic patients regarding one-year major adverse cardiovascular events (MACE). Methods From the RICO survey database, all consecutive patients with or without known diabetes with acute MI (N = 3005) from January 2001 to June 2016 were included. We divided our population into 4 quartiles: HbA 1c ≤ 6.5% (N = 807), 6.5–7% (N = 722), 7.2–8.1% (N = 748), ≥ 8.2% (N = 728) for the analysis. Results On admission, median age was 73 years old, median HbA 1c and glucose were 7.0% and 9.6 mmol/L. Compared to HbA 1c ≤ 6.5% group, HbA 1c ≥ 8.2% group was made up of younger persons (74 vs. 70 years old, P < 0.001), had most important body mass index > 30 kg/m2 (221 (28%) vs. 241 (33%), P = 0.041), had less important high blood pressure rate (610 (76%) vs. 508 (70%), P = 0.016) and had a stronger anti-diabetic treatment (insulin plus oral anti-diabetic medication: 44 (6%) vs. 176 (24%), P < 0.001). Regarding the clinical data, HbA 1c ≥ 8.2% group had more STEMI (372 (46%) vs. 395 (54%), P = 0.002), more multi-vessel disease (446 (60%) vs. 455 (67%), P = 0.007) but lower GRACE score (156 vs. 150, P = 0.020) than HbA 1c ≤ 6.5% group. We did not observed any difference concerning one year MACE between the 4 groups (HbA 1c ≤ 6.5%: 243 (30.1%); 6.6–7.0%: 227 (31.4%); 7.1–8.1%: 246 (32.9%); ≥ 8.2%: 239 (32.8%), P = 0.6). Conclusions Even in case of extreme glycometabolic chronic derangement, our results showed that the initial HbA1c has no one-year prognostic significance value after acute MI in our large diabetic population. However, these patients remain in a high-risk cardiovascular population and need close multidisciplinary follow-up. The chronical hyperglycemia prognostic value should be studied over a much longer period. [ABSTRACT FROM AUTHOR]

Background In acute myocardial infarction (AMI), high blood glucose at admission is associated with mortality, but randomized trials using intravenous insulin infusions (IVII) have presented conflicting results. In diabetic patients with CAD, glucose variability (GV) is a prognostic factor through progression of non-culprit lesions, coronary plaque vulnerability, and left ventricular remodeling. We aim to identify factors associated with high GV among diabetic patients admitted for AMI and treated with IVII. Methods All consecutive diabetic patients admitted to our University Hospital for AMI between January 2014 and March 2016 and who received IVII were included. Mean amplitude of glycemic excursions (MAGE) was calculated within 2 days after admission, as an index of GV. Results Among the 1305 AMI admitted, 196 patients were included. Mean age was 71.3 ± 12.1 years, 31% were women, with MAGE at 0.72 ± 0.41. When compared with lower MAGE tertiles, patients from the last tertile were more often women, chronically treated with insulin, with history of renal failure, higher glycemia at admission, HbA 1c levels, SYNTAX and GRACE scores, and lower systolic (SBP) and diastolic (DBP) blood pressures. After multivariate analysis, female (OR (95% CI): 5.67 (2.29–14.02)), HbA 1c (OR (95% CI): 1.77 (1.33–2.34)), SBP (OR (95% CI): 0.99 (0.97–1),) and SYNTAX score (OR (95% CI): 1.05 (1.01–1.08)) were associated with the highest tertile. Moreover, age (OR (95% CI): 1.05 (1.02–1.09)), history of stroke (OR (95% CI): 6.25 (1.65–23.5)) and the highest tertile of MAGE (OR (95% CI): 2.60 (1.24–5.41)) were associated with the highest tertile of SYNTAX score, whereas HbA 1c was not. Conclusion GV was mainly associated with diabetes-related factors, and was independently associated with a high SYNTAX score. Our findings suggest that assessment of blood GV could contribute to the identification of high-risk diabetics and become a therapeutic target in primary and secondary prevention. [ABSTRACT FROM AUTHOR]

Aim of the study. – To determine if thyroi¨d surgery increase or not the eye symptoms in patients with Graves'ophtalmopathy.Material and method. – This retrospective study included between 1981 and 2001 two groups of patients: – group 1 : 24 patients who underwent thyroid surgery, – group 2 : 13 patients who were treated only by antithyroid drugs. Eye signs were evaluated according to the “NOSPECS” classification. The effect of the thyroid surgery and the medical treatment were evaluated with the NOSPECS classification modified by Orgiazzi in order to allow quantitative comparative data. The reasons why the patients were refered to surgery were:– the important size of the goitre (n = 10), – a recurrent hyperthyroidy despite an appropriated medical treatment (n = 10), – a pregnancy desire (n = 2), – a worsening of the eye signs (n = 2). Eighteen subtotal thyroidectomies and 6 total thyroidectomies were performed.Results. – after thyroid surgery, ophtalmic status was noted to improve in 18 patients, to remain inchanged in 1 patient and to deteriorate in 5 patients. In the non-operated group, the results were quite similar, but the mean goitre size was statistically lower and the ophtalmic lesions were statistically appearing later, these two parameters traducting a less serious disease in this group.Conclusions. – this study suggests that thyroidectomy doesn't worsen the eye symptoms in patients with Graves'ophtalmopathy. [Copyright &y& Elsevier]