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Les hypoglycémies et leurs conséquences dans l’essai DCCT

Abstract : With an increasing incidence, type 1 diabetes is a major health problem. Glycemic control is the necessary measure for the prevention of chronic complications of type 1 diabetes. However, this control is associated with side effects such as hypoglycemia and weight gain, so with significant negative impacts on health and the quality of life of patients. Based on data from DCCT (Diabetes Control Complications Trial), the United States-Canada trials from 1983 to 1993, which included 1441 patients with type 1 diabetes, we examined the determinants and the impact of hypoglycemia (severe or not), in patients with type 1 diabetes. First, we studied the variation of glycated hemoglobin (HbA1c) after an episode of severe hypoglycaemia (SH). We showed that the occurrence of SH was followed by a modest but significant increase in HbA1c 3 months later in all participants. This result suggests that severe hypoglycaemia may be a major barrier to achieving optimal glycemic control in patients with T1D, and should be considered in educational and therapeutic programs for these patients. Second, we studied the association between the frequency of non-severe hypoglycemia detected by self-monitoring of blood glucose (SMBG) and the incidence of severe hypoglycaemia. Non-severe hypoglycaemia has been shown to be a major predictor of episodes of severe hypoglycaemia in patients with T1D. Data on glycemic self-monitoring of DCCT is very similar to current routine care practices and our results reinforce current preventive strategies for severe hypoglycemia in T1D patients. Third, we investigated the association between non-severe hypoglycemia and weight gain in type 1 diabetes. Higher rate of non-severe hypoglycemia, based on self-monitoring of blood glucose, was significantly associated with greater weight gain. This association was independent of factors such as sex, age, duration of diabetes, change in HbA1c and type of treatment. This negative consequence requires the implementation of a hypoglycemic management strategy and specific educational programs aimed at reducing weight gain in type 1 diabetes.
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Abdul Kayoum Moutairou. Les hypoglycémies et leurs conséquences dans l’essai DCCT. Médecine humaine et pathologie. Sorbonne Université, 2019. Français. ⟨NNT : 2019SORUS251⟩. ⟨tel-02969189⟩

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