OPADIA Study: Is a Patient Questionnaire Useful for Enhancing Physician-Patient Shared Decision Making on Physical Activity Micro-objectives in Diabetes?

Introduction: Regular physical activity (PA) is recommended by all type 2 diabetes mellitus (T2DM) management guidelines. The OPADIA study aimed to determine whether using a specific patient questionnaire (Optima-PA©) could help T2DM patients increase their PA by leading to better physician-patient communication and improved levels of shared decision making concerning Specific, Measurable, Acceptable, Realistic, Timely (SMART)-PA micro-objectives.

Methods: Physicians participating in this multicentre, prospective, randomised, real-life study were allocated to a standard group (T2DM patients managed according to usual clinical practice, n = 24) or the OPTIMA-PA group (additional use of the questionnaire, n = 30).

[An example of clinical controversy related to evidence-based medecine].

An example of clinical controversy related to EBM. The DCCT study for type 1 diabetes (1993) and UKPDS for type 2 (1998) had demonstrated the benefit of the hypoglycemic treatment with, for 1 point of HbA1c less, 30% less microangiopathy events. The cardiovascular benefit was less obvious, as these studies were performed in patients with primary prevention.

Breaking Barriers to Effective Type 2 Diabetes Management: Findings from the use of the OPTIMA© Questionnaire in Clinical Practice.

Background: The OPTIMA© (MSD, Courbevoie, France) questionnaire was developed to promote shared decisions and the set-up of specific micro-objectives in clinical practice by optimizing communication between type 2 diabetes (T2DM) patients and their physicians. The present study aimed to assess OPTIMA in clinical practice.

Methods: A cross-sectional multicenter observational study was conducted in France from 2012 to 2014.

[Hyperglycemia and cardiovascular risk: lessons from randomized trials].

Diabetes is a major cardiovascular risk factor However, hyperglycemia is much more closely associated with microangiopathy than with macrovascular complications. Epidemiologic studies have shown a 15% increase of myocardial infarction for 1% increase in HbA1c level. It is accepted but not absolutely demonstrated, that reduction of HbA1c results in an equal reduction of cardiovascular events.

[Thoughts about patient education: the experience of diabetes].

Patient education is not simply information or teaching or coaching. It is learning that is both practical and specialized, intended to help patients acquire therapeutic skills and to support them in changing their self-care practices to attain personalized objectives. It is therapeutic.

Effects of bed-time insulin versus pioglitazone on abdominal fat accumulation, inflammation and gene expression in adipose tissue in patients with type 2 diabetes.

Aims/hypothesis: Intra-abdominal fat (IAF) and inflammatory markers are correlated with cardio-vascular risk. We compared the impact of bed-time insulin versus pioglitazone treatment on these parameters in type 2 diabetic (T2D) patients.

Methods: Twenty-eight T2D patients poorly controlled with metformin and sulfonylurea were randomized to receive add-on therapy with pioglitazone or bed-time NPH insulin.

Intensive cardiovascular risk factors therapy and prevalence of silent myocardial ischaemia in patients with type 2 diabetes.

Background: Screening for silent myocardial ischaemia (SMI) is a controversial strategy undergoing intensive risk factor therapy.

Aims: To assess the prevalence of SMI and coronary artery disease (CAD) in asymptomatic type 2 diabetic patients at high cardiovascular risk (two additional risk factors or more) and undergoing long-term intensive risk factor therapy and tight glycaemic control.

Methods: SMI screening, using isotopic or echographic stress tests, was carried out in 122 asymptomatic type 2 diabetic patients at high cardiovascular risk and undergoing long-term intensive risk factor therapy.

Lowering of brachial pulse pressure in 9379 hypertensives with type 2 diabetes and reduction of cardiovascular events.

Objectives: Pulse pressure (PP) is a major risk factor for cardiovascular (CV) events, mainly in diabetic hypertensives. The objectives of the study were to determine which clinical characteristics could predict the fall in PP and the reduction of CV events under treatment. Design and methods.

Screening for liver fibrosis by using a noninvasive biomarker in patients with diabetes.

Background & Aims: Patients with diabetes are at risk for nonalcoholic fatty liver disease leading to advanced fibrosis, cirrhosis, and liver cancer. We examined the efficacy of a screening strategy with a noninvasive fibrosis biomarker (FibroTest) in patients with diabetes.

Methods: We prospectively studied 1131 consecutive patients without a history of liver disease seen for diabetes.

Rosiglitazone for nonalcoholic steatohepatitis: one-year results of the randomized placebo-controlled Fatty Liver Improvement with Rosiglitazone Therapy (FLIRT) Trial.

Background & Aims: Nonalcoholic steatohepatitis (NASH) is a liver disease that complicates insulin-resistant states. This trial tested the efficacy and safety of rosiglitazone, an insulin-sensitizing agent, in patients with NASH.

Methods: Sixty-three patients with histologically proven NASH were randomly assigned to receive rosiglitazone (4 mg/day for the first month and 8 mg/day thereafter; n = 32) or placebo (n = 31) for 1 year.

[Insulin in the treatment of ischemic stroke].

Hyperglycemia is correlated with poor prognosis in ischemic strokes and also increases the risk of hemorrhagic transformation after thrombolysis. The toxicity of hyperglycemia, already well established in animals, is beginning to be clear for humans. On the other hand, the beneficial effect of insulin remains controversial in animals and has never been demonstrated in humans.

Sampling variability of liver biopsy in nonalcoholic fatty liver disease.

Background & Aims: In nonalcoholic fatty liver disease (NAFLD), the distinction between steatosis and steatohepatitis (NASH) and the assessment of the severity of the disease rely on liver histology alone. The aim of this study was to assess the sampling error of liver biopsy and its impact on the diagnosis and staging of NASH.

Methods: Fifty-one patients with NAFLD underwent percutaneous liver biopsy with 2 samples collected.