S. Borot

Accuracy of a new patch pump based on a microelectromechanical system (MEMS) compared to other commercially available insulin pumps: results of the first in vitro and in vivo studies.

Background: The JewelPUMP™ (JP) is a new patch pump based on a microelectromechanical system that operates without any plunger. The study aimed to evaluate the infusion accuracy of the JP in vitro and in vivo. Methods: For the in vitro studies, commercially available pumps meeting the ISO standard were compared to the JP: the MiniMed® Paradigm® 712 (MP), Accu-Chek® Combo (AC), OmniPod® (OP), Animas® Vibe™ (AN). Pump accuracy was measured over 24 hours using a continuous microweighing method, at 0.1 and 1 IU/h basal rates. The occlusion alarm threshold was measured after a catheter occlusion. The JP, filled with physiological serum, was then tested in 13 patients with type 1 diabetes simultaneously with their own pump for 2 days. The weight difference was used to calculate the infused insulin volume. Results: The JP showed reduced absolute median error rate in vitro over a 15-minute observation window compared to other pumps (1 IU/h): ±1.02% (JP) vs ±1.60% (AN), ±1.66% (AC), ±2.22% (MP), and ±4.63% (OP), P < .0001. But there was no difference over 24 hours. At 0.5 IU/h, the JP was able to detect an occlusion earlier than other pumps: 21 (19; 25) minutes vs 90 (85; 95), 58 (42; 74), and 143 (132; 218) minutes (AN, AC, MP), P < .05 vs AN and MP. In patients, the 24-hour flow error was not significantly different between the JP and usual pumps (–2.2 ± 5.6% vs –0.37 ± 4.0%, P = .25). The JP was found to be easier to wear than conventional pumps. Conclusions: The JP is more precise over a short time period, more sensitive to catheter occlusion, well accepted by patients, and consequently, of potential interest for a closed-loop insulin delivery system.

Practical implementation, education and interpretation guidelines for continuous glucose monitoring: A French position statement

The use by diabetes patients of real-time continuous interstitial glucose monitoring (CGM) or the FreeStyle Libre® (FSL) flash glucose monitoring (FGM) system is becoming widespread and has changed diabetic practice. The working group bringing together a number of French experts has proposed the present practical consensus. Training of professionals and patient education are crucial for the success of CGM. Also, institutional recommendations must pay particular attention to the indications for and reimbursement of CGM devices in populations at risk of hypoglycaemia. The rules of good practice for CGM are the precursors of those that need to be enacted, given the oncoming emergence of artificial pancreas devices. It is necessary to have software combining user-friendliness, multiplatform usage and average glucose profile (AGP) presentation, while integrating glucose and insulin data as well as events. Expression of CGM data must strive for standardization that facilitates patient phenotyping and their follow-up, while integrating indicators of variability. The introduction of CGM involves a transformation of treatment support, rendering it longer and more complex as it also includes specific educational and technical dimensions. This complexity must be taken into account in discussions of organization of diabetes care.

Pituitary function and glucose tolerance in a family with a PAX6 mutation

BACKGROUND PAX6 is a transcription factor involved in the regulation of eye and islet cell development in humans and has also been shown to be an early marker of the pituitary gland in mice. While some subjects with PAX6 mutations were found to have impaired glucose tolerance or diabetes in two previous studies, there has been no report of systematic pituitary function assessment in these patients. AIM The objective of this report was to assess pituitary function and glucose tolerance in five related patients with a heterozygous PAX6 mutation and an unusual ocular and neurological phenotype. SUBJECTS AND METHODS Pituitary function (static and dynamic exploration of the five ante-pituitary axes) and glucose tolerance (oral glucose tolerance test) were explored in all patients. RESULTS Glucose tolerance was normal in all patients. We found no obvious pituitary deficiency in four of the five patients. However, borderline cortisol levels were observed in three out of these patients, with subnormal values, at baseline and/or after stimulation test. Basal and stimulated cortisol levels were both more clearly diminished in one subject. CONCLUSIONS We report here the first complete pituitary function assessment, together with glucose tolerance evaluations, in five related patients with a PAX6 mutation. We cannot rule out subtle corticotrope deficiency induced by PAX6 mutation. The conflicting results with the literature about glucose tolerance could be explained by genotype/phenotype correlations.

Admissions aux urgences pour hypoglycémie ou décompensation hyperglycémique chez les patients diabétiques : un passage obligé ?

Resume Les consultations dans les services d’accueil d’urgence (SAU) pour hypoglycemie ou hyperglycemie chez les patients diabetiques, sont frequentes. Le temps d’attente est parfois long, et les patients sont souvent hospitalises dans des services non specialises pour la prise en charge de leur diabete. Le but de notre travail etait d’analyser, sur une annee, les venues aux urgences pour desequilibre du diabete, afin de voir s’il etait possible d’envisager une prise en charge alternative, en ambulatoire, ou en hospitalisation differee dans un service de diabetologie.

CA-095: Admission aux urgences pour hypoglycémie ou décompensation hyperglycémique chez les patients diabétiques : un passage obligé ?

Resume Les consultations dans les services d’accueil d’urgence (SAU) pour hypoglycemie ou hyperglycemie chez les patients diabetiques, sont frequentes. Le temps d’attente est parfois long, et les patients sont souvent hospitalises dans des services non specialises pour la prise en charge de leur diabete. Le but de notre travail etait d’analyser, sur une annee, les venues aux urgences pour desequilibre du diabete, afin de voir s’il etait possible d’envisager une prise en charge alternative, en ambulatoire, ou en hospitalisation differee dans un service de diabetologie.

Évaluation du fonctionnement hypophysaire et de la tolérance au glucose chez cinq membres d’une famille atteints d’une mutation du gène PAX6

P054 « Silencieux mais pas invisibles ». Intérêt des séquences T2 pour le dépistage des adénomes corticotropes silencieux L. Cazabat a,∗, M. Dupuy b, A. Boulin c, M. Bernier d, B. Baussart b, L. Foubert b, A. Kouadri b, M.-L. Raffin-Sanson a, P. Caron e, J. Bertherat f, S. Gaillard b a Service d’endocrinologie, CHU d’Ambroise-Paré, 92100 Boulogne, France b Service de neurochirurgie, CMC Foch, Suresnes, France c Service de radiologie, CMC Foch, Suresnes, France d Service d’anatomopathologie, CMC Foch, Suresnes, France e Service d’endocrinologie, Toulouse, France f Service d’endocrinologie, CHU Cochin, Paris, France ∗Auteur correspondant.