Дисертації з теми "Prédictions des complications du diabète"
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Toofanee, Mohammud Shaad Ally. "An innovative ecosystem based on deep learning : Contributions for the prevention and prediction of diabetes complications." Electronic Thesis or Diss., Limoges, 2023. https://aurore.unilim.fr/theses/nxfile/default/656b0a1f-2ff2-49c5-bb3e-f34704d6f6b0/blobholder:0/2023LIMO0107.pdf.
In the year 2021, estimations indicated that approximately 537 million individuals were affected by diabetes, a number anticipated to escalate to 643 million by the year 2030 and further to 783 million by 2045. Diabetes, characterized as a persistent metabolic ailment, necessitates unceasing daily care and management. In the context of Mauritius, as per the most recent report by the International Diabetes Federation, the prevalence of diabetes, specifically Type 2 Diabetes (T2D), stood at 22.6% of the population in 2021, with projections indicating a surge to 26.6% by the year 2045. Amidst this alarming trend, a concurrent advancement has been observed in the realm of technology, with artificial intelligence techniques showcasing promising capabilities in the spheres of medicine and healthcare. This doctoral dissertation embarks on the exploration of the intersection between artificial intelligence and diabetes education, prevention, and management.We initially focused on exploring the potential of artificial intelligence (AI), more specifically, deep learning, to address a critical complication linked to diabetes – Diabetic Foot Ulcer (DFU). The emergence of DFU poses the grave risk of lower limb amputations, consequently leading to severe socio-economic repercussions. In response, we put forth an innovative solution named DFU-HELPER. This tool serves as a preliminary measure for validating the treatment protocols administered by healthcare professionals to individual patients afflicted by DFU. The initial assessment of the proposed tool has exhibited promising performance characteristics, although further refinement and rigorous testing are imperative. Collaborative efforts with public health experts will be pivotal in evaluating the practical efficacy of the tool in real-world scenarios. This approach seeks to bridge the gap between AI technologies and clinical interventions, with the ultimate goal of improving the management of patients with DFU.Our research also addressed the critical aspects of privacy and confidentiality inherent in handling health-related data. Acknowledging the extreme importance of safeguarding sensitive information, we delved into the realm of Peer-to-Peer Federated Learning. This investigation specifically found application in our proposal for the DFU-Helper tool discussed earlier. By exploring this advanced approach, we aimed to ensure that the implementation of our technology aligns with privacy standards, thereby fostering a trustworthy and secure environment for healthcare data management.Finally, our research extended to the development of an intelligent conversational agent designed to offer round-the-clock support for individuals seeking information about diabetes. In pursuit of this goal, the creation of an appropriate dataset was paramount. In this context, we leveraged Natural Language Processing techniques to curate data from online media sources focusing on diabetes-related content
Garnier, Laurent. "Etude du bénéfice à court et moyen terme d'une mise en normoglycémie stricte chez 72 patients diabétiques non insulino-dépendants : recherche de facteurs prédictifs." Bordeaux 2, 1995. http://www.theses.fr/1995BOR2M103.
Potier, Louis. "Rôle du système kallicréine-kinines dans le diabète et ses complications." Phd thesis, Université Pierre et Marie Curie - Paris VI, 2014. http://tel.archives-ouvertes.fr/tel-00990006.
Desposito, Dorinne. "Rôle du système kallicréine-kinine(s) dans les complications du diabète." Thesis, Paris 6, 2015. http://www.theses.fr/2015PA066258/document.
The kallikrein-kinin(s) system (KKS) is a peptide system with various pathophysiological effects. Kinins exert their actions through activation of two different receptor subtypes: B1 receptor (B1R) and B2 receptor (B2R). The aim of my thesis was to study the role of this system in diabetic complications in mice. We used pharmacological approaches using new specific agonists of B1R or B2R, or a specific antagonist of B2R. In the first part, we showed that selective pharmacological activation of B1R or B2R overcomes the effect of diabetes on post-ischemic neovascularization and restores tissue perfusion through inflammation. In a second model, we showed that B2R agonist impairs wound repair in mice, inducing skin disorganization and epidermis thickening. Interestingly, B2R blockade improves skin wound healing in two mouse models of diabetes. In a last part, we showed that B2R activation increases mortality after transient cerebral ischemia. In diabetic mice, B1R activation has neuroprotective effects. Indeed, B1R agonist treatment decreases infarct size and improves neurological deficit at day 2 after transient cerebral ischemia. To conclude, KKS activation has contradictory effects depending on the organs studied. The study of new B1 or B2 kinin receptor agonists opens new therapeutic options in diabetic complications
Pascual, Luc. "Aspects épidémiologiques des complications du diabète dans une population de diabétiques camerounais." Bordeaux 2, 1996. http://www.theses.fr/1996BOR2M137.
Liuu, Evelyne. "Cancer, diabète et complications vasculaires : approche épidémiologique de cohortes oncogériatrique et diabétique." Thesis, Poitiers, 2020. http://www.theses.fr/2020POIT1408.
Increases of cancer incidence and mortality are a major public health issue, accentuated by population aging. Among the age-related comorbidities, we wanted to specify the burden of diabetes, in particular type 2 (T2D) due to, like cancer, its high prevalence in older population and its multi-system consequences. This work explores the relationship between diabetes, its vascular complications (VC) and cancer, with a particular interest in the geriatric setting. This thesis is based on several finalized and ongoing publications:Article 1: Comprehensive geriatric assessment in older patients with cancer: an external validation of the multidimensional prognostic index in a French prospective cohort study. BMC Geriatr. 2020; 20: 295. doi: 10.1186 / s12877-020-01692-8Heterogeneity of health status in older age claims for the identification of frailty factors influencing life expectancy during oncological diagnosis and follow-up. The geriatric oncology assessment identifies frailty of older patient with cancer. We evaluated the impact of co-morbidities on life expectancy. This geriatric oncology study involved 433 patients included for two years (42% women; mean age 83 ± 5 years). It highlighted a significant association between comorbidities score (assessed by the Cumulative Illness Rating Scale for Geriatrics as part of the MPI Multidimensional Prognostic Index) and 12-month mortality. Compared to group 1, MPI groups 2 and 3 individuals have a higher risk of death (adjusted HR 1.56 [95% CI 1.70–2.09] and 1.72 [1.33–2.22], respectively).Article 2: Frailty and diabetes status in older patients with cancer: impact on mortality in the ANCRAGE cohort. Aging Clin Exp Res. 2020. doi: 10.1007 / s40520-019-01362-9.What is the relationship between diabetes, geriatric oncology frailty and mortality in older cancer patients? In the single-center ANCRAGE cohort, we analyzed the prognostic factors in 1092 elderly subjects with cancer (47% women, mean age 82 ± 5 years), with 20% of diabetic. Frailty prevalence was high in this cohort (84%). During follow-up (median: 15 months [6-29], death in 60%), risk of mortality was higher in patients with diabetes vascular complications (aHR 1.75 [1.15-2.66]), compared to non-diabetic counterparts and whose with diabetes but no VC.Article 3: Diabetes phenotypic characteristics and incident cancer: A cohort approach in French patients with type 2 diabetes - The SURDIAGENE study (manuscript in preparation)Vascular complications increase the progression of cancer and mortality. Yet the relationship between death and diabetes VC has never been explored before in an oncological setting. We focused on the relationship between diabetes VC and cancer: incidence, progression, death. This study in the local SURDIAGENE cohort included 1468 diabetes patients (42% women, mean age 65 ± 11 years, 8% prevalent cancer, 14% incident cancer during the mean follow-up of 7 ± 4 years). Our results confirmed the increased risk of overall mortality in diabetes patients with a past or current history of cancer (n = 313), which was all the more marked in presence of VC (HR 1.73 [1.25-2.38]). Our analyses did not reveal any association between diabetes VC and cancer (prevalent and incident), lymph node and / or metastatic progression, and cancer-related death. There was no relationship between cancer and several plasma biomarkers of metabolic pathways involved in the development of CV: oxidative stress and systemic inflammation.Our results pave the way for improving cancer care in older people with diabetes
David, Hélène. "Le diabète rénal et les glycosuries chez l'adulte jeune." Bordeaux 2, 1990. http://www.theses.fr/1990BOR25203.
Sangla, Nicole. "Diabète gestationnel : revue de la littérature et étude clinique." Bordeaux 2, 1989. http://www.theses.fr/1989BOR25220.
Saulnier, Pierre-Jean. "Étude des déterminants génétiques et environnementaux des complications du diabète de type 2." Thesis, Poitiers, 2012. http://www.theses.fr/2012POIT1403/document.
Type 2 diabetes (T2D) is a public health issue because of vascular and renal complications, which are complex diseases with interaction between genetic and environmental determinants.The objective of this work was to study these determinants in three independent populations of T2D patients by coupling cross-sectional (DIAB2NEPHROGENE) and longitudinal studies (SURDIAGENE and DIABHYCAR). Through a candidate-gene approach, we first focused on the natriuretic peptides system, NPR3 gene and sodium intake and then on the metabolic pathway of sex hormones, CYP19A1 gene (coding for aromatase) and sex steroid levels.Our first results showed that NPR3 rs2270915 G Allele was associated with high blood pressure (BP) and a reduced salt-sensitivity of BP. However, this SNP was not associated with any significant risk of cardio-vascular events (CVE) or death, at variance with rs6889608. Ultimately, CVE-free survival was impacted by salt intake with a reduced risk of morbi-mortality in those patients having the greatest intake, though a higher BP.In our second study, we confirmed that male gender was a risk factor for diabetic nephropathy (DN), but also for the occurrence of CVE. In men, we showed higher levels of estradiol (E2) associated with a higher prevalence of ND but without any significant increase in renal or CVE during follow-up. CYP19A1 variants were not associated with either E2 levels or the prevalence of ND. However, 2 SNPs tested, were significantly associated with the occurrence of end stage renal failure. Altogether, we have identified 2 different metabolic ways contributing to the genetic determinants of complications associated with T2D including a gene-environment interaction
Lacquemant, Corinne. "Étude génétique de l'insulino-résistance, du diabète et de leurs complications cardio-vasculaires." Lille 1, 2000. https://pepite-depot.univ-lille.fr/LIBRE/Th_Num/2000/50376-2000-322-323.pdf.
Par contre, l'incidence des maladies athérosclereuses prématurées a considérablement augmenté ces dernières années a l'île Maurice. Les facteurs de risque généralement associés à cette pathologie sont les anomalies du métabolisme du glucose, des lipides et des facteurs de la coagulation, l'hyperinsulinisme, l'obésité centrale et l'hypertension artérielle. Ce syndrome d'insulinorésistance à une forte composante héréditaire en raison de l'existence d'une forte prévalence de diabète et de maladie coronarienne. L'analyse familiale de liaison dans la population mauricienne nous a permis de détecter des régions liées aux différents facteurs de l'insulinorésistance. D'autres étapes seront nécessaires pour identifier et valider les gènes de prédisposition au développement de ces différentes pathologies
Poussin, Agathe. "Hypercortisolisme infra-clinique dans le diabète de type 2." Bordeaux 2, 2001. http://www.theses.fr/2001BOR23003.
Prevost, Gaëtan. "L'implication du Récepteur des Produits Avancés de Glycation (RAGE) dans les complications du diabète : approches génétique et pharmacologique." Lille 2, 2006. http://www.theses.fr/2006LIL2S040.
Advanced glycation endproducts (AGE) are implicated in diabetic micro- but also macrovascular complications of diabetes mellitus. AGE toxicity is partially mediated via receptor dependant pathway especially via the RAGE (Receptor for Advanced Glycation Endproducts). The RAGE implication in the genetic of diabetic nephropathy and in the endothelial dysfunction has been investigated. First, the polymorphisms of exon 3 has been analysed by Denaturant Gradient Gel Electrophoresis. Although no association of this RAGE gene polymorphisms with type 1 diabetes susceptibility was found, we reported a strong linkage disequilibrium between the variant carrying the serine amino acid at position 82 and HLA class II genes. Finally, in a case control study, we reported an association between the 82 serine variant and advanced nephropathy in type I diabetic patients. This suggests that some RAGE gene polymorphisms may be associated with progression to diabetic advanced nephropathy in Caucasian type 1 diabetic patients. Thus, AGE have been implicated in diabetic endothelial dysfunction as vascular hyperpermeability and procoagulant and inflammatory states. However, the link between AGE and the endothelium dependent vasorelaxation impairment is still controversial. Vascular relaxation response to acetylcholine was tested in isolated segments of phenylephrine precontracted mice aorta at several stages of streptozotocin-induced diabetes. Blood levels of AGE (ELISA) and aortic tissue RAGE expression (Western Blot) were simultaneously quantified. Compared to control mice, significant impairment of endothelium dependant relaxation occurred four weeks after diabetes induction (-24% vs control, P<0,01) and was more severe eight weeks later. Simultaneously, blood AGE concentrations and RAGE aortic expression were significantly increased. Moreover, vasorelaxation impairment was associated with induced diabetic structural changes in the wall of aorta : intima-media thickening, disorganization of elastin lamina and actin network, increased amount and disorganization of the type III collagen. Four weeks after diabetes induction, aminoguanidine, AGE inhibitor, completely prevented the diabetes-induced decrease of relaxation to acetylcholine by decreasing AGE blood levels and RAGE expression. Moreover, aminoguanidine treatment significantly improves the induced diabetic structural changes. In conclusion, our work is in favour of a strong implication of the AGE pathway both in diabetic complications as nephropathy and vasorelaxation impairment. The use of anti AGE or AGE-RAGE inhibitors could be attractive therapeutics
Reynier, Frédéric. "Génomique du diabète de type 1 : contributions à l'étude de l'étiopathogénie et des complications." Lyon 1, 2007. http://www.theses.fr/2007LYO10074.
Sanchez, Manuel. "Oxydation de l’ADN, longueur des télomères, et complications vasculaires du diabète de type 1." Thesis, Sorbonne université, 2019. http://www.theses.fr/2019SORUS368.
Introduction: The purpose of this study is to assess the association between (i) 8-hydroxy-2'-deoxyguanosine (8-OHdG), a marker of DNA oxidation; (ii) leukocyte telomere length (LTL); and (iii) allelic variations of genes involved in DNA oxidation and LTL; with the occurrence of renal and vascular complications in people with type 1 diabetes. Participants and Methods: The GENEDIAB and GENESIS cohorts included 494 and 662 participants with an average follow-up of 9.3 and 6.3 years, respectively. Plasma concentrations of 8-OHdG were measured at baseline and 27 SNPs were genotyped in both cohorts. LTL was measured by Q-PCR at baseline in the GENEDIAB cohort. Results: Higher concentrations of 8-OHdG were associated with lower GFR, higher albuminuria at baseline, and a higher risk of end-stage renal disease (ESRD) during follow-up. Minor alleles A of rs7675998 (NAF1), rs2125173 and rs10506083 (BICD1) were associated with a high risk of ESRD during follow-up. LTL was not associated with the risk of ESRD. In contrast, participants with the shortest telomeres and the highest concentrations of 8-OHdG had a higher risk of lower limb amputation. Conclusion: High concentrations of 8-OHdG and NAF1 and BICD1 polymorphisms are associated with the severity of diabetic nephropathy in 2 cohorts of type 1 diabetic patients. LTL appears to be an independent marker of amputation risk, as well as 8-OHdG
Rajaobelina, Kalina. "Autofluorescence cutanée des produits de glycation avancée (AGE), mémoire métabolique et complications du diabète." Thesis, Bordeaux, 2016. http://www.theses.fr/2016BORD0256/document.
In the context of the ageing of the population and the increase of age related diseases such as diabetes, new biomarquers of the long-term health status should be considered. Advanced glycation end products (AGE) are molecules indicators of the metabolic burden over time, called “metabolic memory”. AGE play an important role in long term diabetes injuries and in the global decline of the metabolism related to ageing. Skin accumulation of AGE can be measured by autofluorescence instantly and non-invasivly with a tool called AGE-READER. The objectives of my dissertation were to evaluate the value of the skin autofluorescence (sAF) of AGE as marker of metabolic memory in elderly people from the 3-City cohort and in parallel, in patients with type 1 diabetes, evaluate the prognostic value of sAF for diabetes complications. In the elderly population, we showed that sAF reflected glycemic and renal status of 10 years before. In patients with type 1 diabetes, sAF was associated to the presence of neuropathy 4 years later. Moreover, in this same population, we described the evolution of sAF in 4 years of follow-up and we showed that the principal determinants of the evolution of sAF were kidney function and insulin pump therapy. Finally, we also found that increase of sAF in 4 years was associated with the occurrence of kidney disease. This work rises new research opportunities about the interest of sAF at differents key ages as biomarker of pathologies which evolve in several decades
Sabalette, Sophie. "Le gliclazide et ses atouts dans le traitement du diabète de type II : rappel sur le diabète de type II et ses complications." Paris 5, 1992. http://www.theses.fr/1992PA05P096.
Joannes, Marie-Odile. "Recherche de polymorphysmes génétiques associés à des complications majeures de pathologies prédominantes en Martinique et en Guadeloupe : la drépanocytose et le diabète." Antilles-Guyane, 2009. http://www.theses.fr/2009AGUY0269.
SICKLE CELL DISEASE (SCD) AND DIABETES MELLlTUS ARE LEADING CAUSES OF MORBIDITY IN MARTINIQUE AND GUADElOUPE. BECAUSE OF THE ASSOCIATION OF SOME GENETIC POLYMORPHISMS AND PATHOlOGIES, WE WONDERED IF SOME GENETIC POLYMORPHISMS COULD PREDICT COMPLICATIONS IN SICKLE CELL PATIENTS AND TYPE 2 DIABETIC WE INVESTIGATED POLYMORPHISM OF GENES INVOLVED IN THE IMMUNE SYSTEM (MYELOPEROXYDASE, HLA, TNF ALPHA, IFN GAMMA, IL6 AND IL10) AS MODULATORS OF INFECTIOUS COMPLICATIONS IN SCD. WE ALSO TRIED TO FIND AN ASSOCIATION BETWEEN FABP2 POLYMORPHISM, METABOLIC SYNDROME AND CARDIOVASCULAR COMPLICATIONS IN T2D SUBJECTS. OUR RESULTS REVEALED AN ASSOCIATION BETWEEN MYELOPEROXIDASE POLYMORPHISM AND INFECTIOUS COMPLICATIONS IN SICKLE CELL PATIENTS JUST AS IFNr POLYMORPHISM. ON THE OTHER HAND, HLA-DRB1*11 COULD HAVE A PROTECTIVE EFFECT AGAINST INFECTIONS. MOREOVER, OUR RESULTS HIGHLIGHTED A PREDOMINANT COMBINATION OF DYSLlPIDEMIA AND OBESITY IN T2D PATIENTS CARRYING THE THREONINE VARIANT OF FABP2
Joubert, Michaël. "Diabète et remodelage cardiaque : approches physiopathologiques et mécanistiques." Caen, 2016. http://www.theses.fr/2016CAEN3164.
Type 2 diabetes is growing epidemic worldwide and this metabolic disease is associated with increased cardiovascular morbidity and mortality. Long term hyperglycemia is involved in the development of atherosclerosis, especially in coronary arteries, but diabetes also causes direct myocardial abnormalities (diabetic cardiomyopathy). The mechanisms involved in the deleterious effects of diabetes on the heart are not yet fully explained. Using a rodent models with streptozotocin-induced diabetes, we explored the impact of diabetes, especially glycemic variability, on ischemia-reperfusion injury and the early impact of diabetes on the occurrence of diabetic cardiomyopathy. In addition, using a mouse model of lipo-atrophic diabetes, we also studied the mechanisms involved in diabetic cardiomyopathy and in particular the consequences of glucotoxicity. Parallel to this work, a methodological study evaluated the reproducibility of cardiac MRI in rodents, the main exploration tool for our work
Auberval, Nathalie. "Prévention du stress oxydant dans le diabète et ses complications par des antioxydants d’origine naturelle." Strasbourg, 2010. https://publication-theses.unistra.fr/public/theses_doctorat/2010/AUBERVAL_Nathalie_2010.pdf.
Oxidative stress, common point between endogenous antioxidative defences (enzymes, vitamins. . . ) and free radicals especially reactive oxygen species (ROS) in favour of these. Diabetic patients present a lack in antioxidative capacity. Pancreatic β-cells are very susceptible to oxidative stress but they can be protected by exogenous antioxidative molecules from diet. These antioxidants improve glycaemia and a moderate consumption of red wine, which contains antioxidative polyphenols, is associated to a reduction of mortality due to cardiovascular diseases. Oxidative stress and diabetes are strongly involved and the aim of my thesis was to develop some screening and analysing tools for natural antioxidative molecules and to test selected molecules on rat model of glucose intolerance. Thanks to these tools, two antioxidants with protective effect against oxidative stress on β-cells line (RINm5F) were selected: red wine polyphenols from Corbières (PP) and EGCG ( EpiGalloCatechin Gallate) from green tea. On rats become diabetic by high fat diet and presenting an oxidative stress, both antioxidants and exercise show benefic effects: EGCG reduces oxidative stress markers while exercise and PP decrease steatosis. All treatment seems to decrease hyperinsulinism while only EGCG improve glycemia. Combination of three treatments could improve more important different studied parameters. Thus, some dietary and lifestyle modifications associated to oxidative supply could be an effective prophylactic means to fight against oxidative stress in type 2 diabetes
Caillier, Bertrand. "Effets modulateurs du diabète, de l'obésité et de la génétique sur l'électrophysiologie des médicaments prolongeant l'intervalle QT." Thesis, Université Laval, 2012. http://www.theses.ulaval.ca/2012/28614/28614.pdf.
Vigneault, Jessica. "Étude des altérations métaboliques associées au diabète de type 2 selon le statut pondéral après une grossesse compliquée par un diabète gestationnel." Master's thesis, Université Laval, 2014. http://hdl.handle.net/20.500.11794/25796.
Women with prior gestational diabetes present higher risk to develop adverse metabolic complications such as type 2 diabetes in the years following delivery. In recent years, the prevalence of gestational diabetes has increased and proportionally reflects the increase in the rates of type 2 diabetes and obesity. Findings from the present study suggest that a genetic score is associated with both gestational diabetes and progression to prediabetes and type 2 diabetes in women with prior gestational diabetes. Secondly, metabolic deteriorations associated with gestational diabetes were investigated on glucose and insulin homeostasis according to weight status after delivery. Even with a normal weight, women with previous gestational diabetes present higher risk to develop type 2 diabetes and present same clinical risk factors compared to overweight and obese women. A further increase in postpartum weight favours the apparition of metabolic deteriorations in women with gestational diabetes.
Dedieu, Michel. "Dépistage du diabète gestationnel : intérêt de l'association de la glycémie à jeun et des facteurs de risque." Montpellier 1, 1996. http://www.theses.fr/1996MON11098.
Nel, Isabelle. "Les cellules MAIT dans le diabète de type 1 chez l'homme." Electronic Thesis or Diss., Université Paris Cité, 2019. http://www.theses.fr/2019UNIP5156.
T1D is an autoimmune disease that involved both innate and adaptative immune system and in which intestinal homeostasis is altered. MAIT cells are innate-like T lymphocytes that recognize MR1-presenting ligands from bacterial origin, strongly interacting with gut microbiota. T1D is one of the most common chronic disease of the childhood, however T1D concerns both adults and children. To determine MAIT cells involvement in T1D physiopathology, circulating MAIT cell frequency, phenotype and function were analyzed by flow cytometry separately in children and in adult T1D. Frequency of MAIT cells from children at the onset of T1D is decreased and might reflect their migration from blood to inflamed tissues or their sustained activation leading to cell exhaustion. Interestingly, in adult T1D MAIT cell alterations are more pronounced in adults with established T1D as in adults at the onset of the disease. These data are in agreement with the emerging idea of disease heterogenity between T1D patients according to their age, probably involving different physiopathological mechanisms. Altogether, these data in humans support a potential involvment of MAIT cells in T1D physiopathology as already shown in NOD mice. Moreover, MAIT cell alterations have been detected in patients before the onset of T1D indicating MAIT cells might represent a new biomarker for the development of T1D. Finally, we hypothesize MAIT cells could also be involved in the insidious steps leading to develoment of diabetes complications, since MAIT cell alterations are more pronounced in adults as in children with established T1D. Further studies are needed however it clearly appears MAIT cells could become a new therapeutic way in next decades
Bihan, Hélène. "Précarité et impact sur les comportements de santé : consommation de fruits et légumes, et prise en charge du diabète." Phd thesis, Conservatoire national des arts et metiers - CNAM, 2011. http://tel.archives-ouvertes.fr/tel-00631236.
Goueslard, Karine. "Intérêt des bases de données médico-administratives dans l'évaluation du dépistage, de la surveillance et des complications du diabète." Thesis, Bourgogne Franche-Comté, 2017. http://www.theses.fr/2017UBFCI022.
Diabetes is a priority health target worldwide. Access to conclusive data is equally a priority in order to establish clear objectives and to implement coordinated action. Medico-administrative databases are being used more and more frequently for this purpose. We set out to illustrate and assess the interest of using a French healthcare consumption database to evaluate screening, surveillance and the risk of acute or chronic complications of diabetes in certain at-risk populations. We concluded that early screening for type-2 diabetes in women with a history of gestational diabetes was inadequate. Although a slight improvement occurred following the recommendations published in 2010, one woman in two has no screening test in the first year following the pregnancy.Recommended screening for type-2 diabetes following myocardial infarction in the general population is seriously insufficient. At the time of cardiac rehabilitation, 97% of patients were screening for type-2 diabetes screening and 40% of these are diagnosed with diabetes or prediabetes. After stroke, surveillance of diabetes remains poor. In the least severe cases of stroke, it seems that the control of risk factors for recurrence is an integral part of the management of the cerebrovascular disease. We showed that women with gestational diabetes have a risk of early cardiovascular complications and that young persons with type-1 diabetes and schizophrenia have a risk of rehospitalisation for acute complications. Prevention policies for diabetes could be improved if they were based on opportunities to create strong partnerships involving actors from different sectors. The use of medico-administrative databases and observational studies has extended our knowledge of diabetes. However, before being used, data quality and the pertinence of selection algorithms must be evaluated, and it must be shown that the methods used for the statistical analysis are appropriate
Levac, Xavier. "Influence du diabète de type II et de l'obésité à risque sur la biotransformation des médicaments." Thesis, Université Laval, 2010. http://www.theses.ulaval.ca/2010/27599/27599.pdf.
Bodin-Rollin, Sophie. "Rôle de l'enzyme de conversion et du système kallicréine-kinines dans le diabète et ses complications rénales." Paris 6, 2008. http://www.theses.fr/2008PA066282.
Ray, Valérie. "Le Scléroedème de Buschke : étude descriptive de 49 cas en Martinique." Montpellier 1, 1999. http://www.theses.fr/1999MON11115.
Mohsen, Mroueh Fatima. "Diabète et cancer colorectal : épidémiologie et physiopathologie." Thesis, Strasbourg, 2017. http://www.theses.fr/2017STRAJ117.
Diabetes is a chronic systemic malfunction characterized by persistent metabolic disturbances that culminate in a high rate of complications to which cancer was recently annexed. In fact, diabetes inflates colorectal cancer (CRC) risk by 1.2-1.5 folds. However, the cellular and molecular pathways involved are not well understood. Our results show that AMPK/mTORC1 pathway is deregulated in both diabetes and CRC. This was paralleled by an elevation in the expression of the NADPH oxidase Nox4 leading to an increase in ROS production. Furthermore, our results show that oxidative stress, secondary to alteration in the level and activity of Nox4 is augmented in diabetes and contributes to the progression of CRC. The resulting oxidative stress further led to an alteration in the signaling of the AMPK/mTORC1 pathways culminating in an exacerbated aggressiveness in cancer cell behavior and colon polyp formation. Our project allows the identification of novel molecular mechanisms involved in diabetes-induced CRC progression and development of effective therapeutic strategies to reverse the progression of CRC in diabetic patients
Clotteau, Marie-Claire. "Réactivité vasculaire sur le rein isolé perfusé de rat : effet du diabète." Paris 5, 1994. http://www.theses.fr/1994PA05P191.
Fagot-Campagna, Anne. "Anomalies lipidiques : rôles sur l'incidence du diabète de type 2 et de ses complications micro et macro vasculaires." Paris 11, 1998. http://www.theses.fr/1998PA11T034.
Lipid abnormalities (decreased HDL and HDL2 cholesterol, increased VLDL triglycerides and small and dense LDL, glycation, oxidation) are an important component of the insulin-resistance syndrome that precedes type 2 diabetes. Free fatty acids play an aggravating and potentially initiator role in the development of type 2 diabetes. HDL cholesterol may have a protective effect in women only, which may imply a role of sexual hormones. Lipids have a potential effect on the development of micro-vascular complications. Their role on retinopathy has not been well studied. LDL cholesterol and especially its qualitative modifications may have deleterious effects on nephropathy, whereas HDL cholesterol may be protective in women only. Lipids play a major role in the development of macro-vascular complications. LDL and HDL cholesterol and their qualitative modifications are recognized risk factors. Triglycerides may also be an independent risk factor for cardiovascular diseases in type 2 diabetes, and free fatty acids may have deleterious effects on cardiac function and blood pressure. In conclusion, the lipid abnormalities associated with type 2 diabetes bring a fatal combination. As compared with glucose control, lipid abnormalities lead a minor but potential role in the development of micro-vascular complications, but a major role in the development of macro-vascular complications, which correspond to the first cause of mortality. Hypolipidemic treatment, together with other preventive measures of cardiovascular diseases, should probably be ranked first, and may be before diabetes control, during type 2 diabetes care
Nicolas, Anthony. "Polymorphismes du gène de la t-cadhérine (CDH13), récepteur de l'adiponectine, dans les diabètes et leurs complications." Thesis, Paris 6, 2016. http://www.theses.fr/2016PA066232/document.
T-cadherin is a receptor of adiponectin, a protein involved in the pathophysiology of diabetes. In genome-wide association studies, T-cadherin gene (CDH13) polymorphisms are associated with adiponectin concentrations. The aim of our study was to deepen the relationship between polymorphisms of CDH13, plasma adiponectin, and the risk of diabetes and its complications. We selected two polymorphisms in CDH13. Genotyping was performed in D.E.S.I.R., cohort drawn from the French general population, DIABHYCAR (subjects with type 2 diabetes) and three cohorts of patients with type 1 diabetes, GENESIS, GENEDIAB and SURGENE. In the general population, CDH13 polymorphisms were associated with body mass index, HbA1c, Fatty Liver Index, an index of hepatic steatosis, and plasma adiponectin. In a case-control study between D.E.S.I.R. and DIABHYCAR, polymorphisms were associated with the risk of type 2 diabetes. These associations with clinical phenotypes could be due to the beneficial effects of adiponectin. In subjects with type 1 diabetes from GENESIS and GENEDIAB, we observed associations between polymorphisms of CDH13 and the prevalence and the incidence of kidney disease. The analysis in the SURGENE prospective study confirmed these associations. The direction of the relationships observed in this study is in favor of a deleterious role of adiponectin in diabetic nephropathy. In conclusion, these associations may be explained by variations in adiponectin and suggest a causal relationship
Richardot, Jean-Jacques. "Le diabète sucré en milieu hospitalier : aspects épidémiologiques sur 379 dossiers colligés en 2 ans dans un service de médecine interne." Bordeaux 2, 1989. http://www.theses.fr/1989BOR25205.
Ariche, Valérie. "Le suivi du diabète : méthodes de dosage des hémoglobines glyquées, avantages et inconvénients de la méthode par H.P.L.C." Paris 5, 1993. http://www.theses.fr/1993PA05P237.
Al-Salameh, Abdallah. "Influence du genre sur la prise en charge des patients diabétiques âgés en soins primaires Gender-RelatedDifferencesintheControlofCardiovascularRisk FactorsinPrimaryCareforElderlyPatientsWithType2Diabetes: A CohortStudy Al-Salameh Abdallah et al. Sex Differences in the … Exp Clin Endocrinol Diabetes 2018; 00: 00–00 Sex Differences in the Occurrence of Major Clinical Events in Elderly People with Type 2 Diabetes Mellitus Followed up in the General Practice." Thesis, Université Paris-Saclay (ComUE), 2018. http://www.theses.fr/2018SACLS446.
The prevalence of type 2 diabetes mellitus (T2DM) is increasing worldwide and this trend is projected to persist because of the demographic shift and the obesity pandemic. The elderly represent more than half of subjects with T2DM and this proportion is expected to increase in the future. Cardiovascular disease is the main cause of morbidity and mortality in elderly subjects with T2DM. Moreover, although non-diabetic women have lower risk of developing cardiovascular diseases compared to non-diabetic men of the same age, this “female advantage” seems to diminish or disappear in the setting of T2DM. Indeed, compiled data suggest that type 2 diabetes affects the risk of cardiovascular disease differentially according to gender. To the best of our knowledge, there is no French study that had looked at this issue. The majority of international studies have not focused on the elderly group but on the whole diabetic population and many of them are conducted before the introduction of evidence-based cardiovascular treatments.The aim of the present work was to assess gender-related differences in the management of elderly patients with T2DM followed-up in the primary care. Specifically, we compared the control of T2DM and other cardiovascular risk factors between women and men, the occurrence of major clinical events (all-cause mortality and major vascular events as well as all-cause hospitalization) between women and men, and the influence of physician gender on the quality of care in subjects with T2DM.The S.AGES T2DM cohort is a prospective observational study whose objective was to describe the real-life medical management of subjects aged 65 years or more with T2DM. 983 non institutionalized subjects were included by 213 general practitioners from April 2009 through June 2011 and followed-up for 3 years. For data obtained during the follow-up period, multilevel mixed-effect regression models were used to account for repeated measurements (for each subject) and clustering (A cluster is a group of subjects followed-up by the same GP).Over the follow-up period, T2DM and blood pressure control were not different between the genders but LDL cholesterol was better controlled in men than in women. The odds ratio for women being associated with uncontrolled LDL cholesterol (>1 g/l) was 2.51 (95% CI 1.79–3.53, p<0.001). This gender-related difference in LDL cholesterol levels was independent of statin therapy.Concerning major clinical events, women were at lower risk than men to develop the composite endpoint (all-cause mortality and major vascular events) with a relative risk of 0.60 (95% CI 0.40-0.91, p=0.016) and the hospitalization endpoint (OR 0.71, 95% CI 0.52-0.96, p=0.029). Coexisting diseases were responsible to the majority of hospitalizations especially in men who were more likely to be admitted to a university hospital when compared to female counterparts. The risk of developing microvascular complications and hypoglycemia were not different between men and women.Finally, we didn’t find any significant difference between male and female physicians in terms of quality of care in subjects with T2DM (control of T2DM and other cardiovascular risk factors, tests to screen for diabetes complications, or the prescription of anti-diabetic and cardiovascular treatments).Our results show that gender differences in this population of elderly diabetics are restricted to higher LDL cholesterol in women than in men but this does not seem to increase the risk of major clinical events (which are higher in male subjects). However, these results should be interpreted with cautious because of selection biases at the physician and patient level as well as under-representation of female physicians
Crouigneau, Roxane. "Nouvelles microcapsules fonctionnalisées et standardisées : Application à la thérapie cellulaire du diabète de type 1." Thesis, Université Grenoble Alpes (ComUE), 2019. http://www.theses.fr/2019GREAS033.
Cell therapy with allogenic pancreatic islets is a treatment used for type 1 diabetic patients for whom the usual insulin treatments does not work anymore. However, this therapy requires administration of an immunosuppressive treatment, that leads to many side effects and complications. The implantation of microencapsulated islets that become stealth to the host’s immune system consists in an alternative to immunosuppressive treatments. This technique presents very promising results in several clinical trials, but there are still many challenges that need to be tackled, to increase the durability of a functional graft. The FUTURCAPS project, in which this PhD is integrated, focused on improving two currently limiting points : the properties of the polymers used for the encapsulation, by using chemically modified alginates, that increase the mechanical stability of the capsules ; and the control in size and shape of the capsules, that enables to have an optimal diffusion barrier, by using a microfluidics flow focusing (MFFD) droplet generation system, developed at the CEA (Grenoble). To do this, the physicochemical properties of the different alginates were first characterized, and theoretical rheological models that define their behaviour were determined. Then, the parameters involved in the formation and gelation of the droplets were studied (viscosity, surface tension, contact angle, shear rate while forming the droplets, and gelation rate). Following these studies, monodisperse capsules (variation coefficients under 5 %) were obtained in microfluidics with the different alginates (that have very diverse properties), and these latter were characterized in terms of size, shape and permeability. Eventually, neo-natal pig, and human pancreatic islets were encapsulated in the alginates studied. The encapsulated islets viability was measured in vitro, and they have also been implanted in mice, in order to check for biotolerability and viability in vivo after 15 days
Poggi-Travert, Florence. "Contribution de l'hyperglycémie au risque cardiovasculaire des diabétiques de type 2." Paris 6, 2008. http://www.theses.fr/2008PA066497.
Beauchène, Dominique. "Diabète sucré et dyslipidémie à propos d'une étude portant sur 256 familles de diabétiques non insulino-dépendants." Paris 5, 1994. http://www.theses.fr/1994PA05P166.
Skinner, Sarah. "Mécanismes et conséquences des altérations de la fonction vasculaire dans le diabète de type 2 associé au trait drépanocytaire." Thesis, Lyon, 2018. http://www.theses.fr/2018LYSE1270/document.
Rates of type 2 diabetes (T2D) are rapidly increasing worldwide, including in regions, and among populations, of the globe where sickle cell trait (SCT) is prevalent. SCT, the heterozygote form of sickle cell disease, is generally considered a benign condition. However, evidence shows that vascular function is more severely impaired in people with combined T2D and SCT (T2D-SCT) than in those with T2D only. Furthermore, evidence suggests that SCT could complicate screening for T2D, thereby increasing the risk of delayed diagnosis of T2D. In light of this information, the main objectives of this thesis were to study the challenges related to diagnosing and monitoring T2D in individuals with SCT, and to evaluate the mechanisms and consequences of the amplified vascular dysfunction observed in T2D-SCT. Study 1 compared the agreement between two standard measures of glycemia, HbA1c and fasting glucose, and one alternative measure of glycemia, fructosamine, in Senegalese adults with and without SCT. The findings revealed substantial disparities between the markers of glycemia, and these differences were exaggerated in individuals with SCT. Study 2 illustrated that SCT could potentially augment the risk of developing retinopathy, nephropathy, and hypertension in T2D, and demonstrated that AGEs are likely implicated in the vascular dysfunction observed in T2D-SCT. Studies 3 and 4 studied microvascular function in a mouse model of T2D-SCT. Study 3 showed that T2D-SCT mice had significantly impaired endothelium-dependent vasodilation in-vivo. Study 4 revealed that ACH-mediated vasodilation in-vivo was significantly elevated in the microvasculature of mice with combined T2D and SCT due to cyclooxygenase-2 dependent mechanisms. Overall these findings deepen our understanding about the complexities related to diagnosing and managing T2D in individuals with SCT
Petit, Michaël. "Le rôle du diabète de type II sur la biotransformation des médicaments par la sous-famille CYP3A." Thesis, Université Laval, 2011. http://www.theses.ulaval.ca/2011/28493/28493.pdf.
Lasalle, Manuel. "TGR5, cible thérapeutique pour le traitement du diabète de type 2 et ses complications métaboliques : de la chimie aux effets biologiques." Thesis, Lille 2, 2015. http://www.theses.fr/2015LIL2S023/document.
Bile acids have long been known as lipid solubilizing agents, enabling efficient absorption of nutrients and vitamins during digestion. Since 2000, several teams have demonstrated the signaling properties of these molecules, especially through the activation of two receptors : the nuclear receptor FXR and the membrane receptor TGR5.The TGR5 receptor is expressed in various tissues, such as smooth and skeletal muscles, brown adipose tissue, gallbladder, but also on some immune or intestinal cell lines such as the enteroendocrine L cells. Depending on the studied tissue, TGR5 activation can trigger various biological effects. In the intestine, its activation can stimulate the secretion of an incretin hormone, the GLP-1.Incretin hormones play a role in glycaemia regulation, especially during the postprandial phase during which they potentiate the action of the insulin, the main hypoglycemic hormone. Diabetes mellitus correspond to a decreased response of the organism to insulin signaling. This leads to a default in the glycaemia handling that can lead to serious complications, such as amputation, blindness, or cardiovascular problems. Prevalence and incidence of this disease have lead the WHO to define diabetes as the first non-infectious epidemic, illustrating its impact on public health and the constant need for new therapeutic opportunities.In this context, TGR5 appears as an appealing potential therapeutic target, especially because of the GLP-1 secretagogue effect triggered by its activation. Indeed, among the antidiabetic therapeutic options, two classes of drugs work by increasing the incretin signaling: the incretinopotentiators (inhibitors of the DPP4, which is the enzyme responsible for the very short half-life of GLP-1), and the incretinomimetics (synthetic agonists of the GLP-1 receptor). Recently, this last class has also been approved to treat obesity. This demonstrates the interest of this signaling pathway in the treatment of metabolic disorders. Hence, GLP-1 secretagogue compounds may prove to be an interesting approach, and could complement the two other classes.The aim of this work was then to obtain potent, selective and original agonists of the TGR5 receptor. In order to decrease the risk of on-target and off-target effects, we decided to take advantage of the intestinal localization of our target by designing compounds that would only expose the gastro-intestinal tract, by limiting their absorption. Thus, we wanted to obtain non systemic GLP-1 secretagogue compounds.Our strategy was to develop chimeric compounds consisting of a pharmacophore part, which would be a potent and selective agonist of TGR5, linked to a kinetophore part, which would decrease membrane permeability. After having optimized the pharmacophore part and having identified a position where we could link various kinetophore moieties with only weak impact on the activity, we obtained several potent TGR5 agonists with very low membrane permeability. In vivo evaluations of these compounds have validated both their GLP-1 secretagogue activity and their low systemic exposure. In the end, evaluation of our lead compound on mouse model of diabetes was recently started
Deloumeaux-Tyndal, Jacqueline. "Aspects épidémiologiques des anomalies du métabolisme glucidique et du diabète de type 2 en Guadeloupe." Bordeaux 2, 2006. http://www.theses.fr/2006BOR21376.
Type 2 diabetes is now qualified as a worldwide epidemic by the World Health Organization (WHO). The links of type 2 diabetes with co morbidities such as hypertension and dyslipidemia, focuse on the need of primary health care in the next decades. Guadeloupe is a French Carobbean archipelago with more than 422 000 inhabitants including people of Indian and African descents and Caucasians. Prevalence of type 2 diabetes reaches 6,6 % in general population compared to 22,5 % in subjects of Indian descents which are respectively 2 and 7 fold higher than in mainland France. Diabetic subjects represent about 30 % of patients on hemodialysis with a mortality rate 3 fold higher than non diabetic subjects. Our works are presented in four studies preceded by a review of the literature. The association between anthropometric parameters (WHO criteria) and type 2 diabetes was studied for potential use in clinical practice in a population with a mean age over 50 years old. The distribution of metabolic syndrome, involved in type 2 diabetes and cardiovascular complications, was studied by comparing subjects of Indian descents with subjects of the general population. We report in a third study, the association of arterial pulse pressure, a non-traditional risk factor, with cardiovascular complications in type 2 diabetic patients undergoing haemodialysis. We finally study, glucose metabolism abnormalities, dyslipidemia and proinflammatory cytokines (adiponectin and leptin), as risk factors for insulin resistance in an HIV infected cohort of patients
Demiot, Claire. "Étude de la vasodilatation cutanée induite par la pression au cours d'un diabète expérimental avec ou sans neuropathie." Angers, 2005. http://www.theses.fr/2005ANGE0510.
Pressure-induced vasodilation (PIV) is a mechanism whereby skin blood flow increases in response to progressive locally applied pressure. PIV decreases early in diabetic patients as a result of vascular and/or neural impairment. This work was designed to determine the effect of vascular changes and neurovascular changes on PIV in streptozotocin-induced diabetic mice. We determined whether the diabetes-induced PIV alteration could be prevented or restored by pharmacological agents in these different terms of diabetes. Alpha-lipoïc acid treatment was able to preserve PIV response in diabetic mice in short-term diabetes without neuropathy. Sorbinil treatment restored PIV response in a long-term diabetes with severe neuropathy. Alpha-lipoic acid and sorbinil treatments by preserving and by restoring the cutaneous PIV response respectively should preserve the normal reaction to pressure strain, which might limit the risk of pressure-induced ulcer in diabetic patients
Achon, Valérie. "La grossesse de la diabétique : accouchement ou césarienne ?" Bordeaux 2, 1990. http://www.theses.fr/1990BOR25193.
Taverna, Mariano Javier. "Rétinopathie diabétique humaine : aspects génétiques et physiopathologiques." Paris 6, 2005. http://www.theses.fr/2005PA066113.
Nehiri, Touria. "Etude des conséquences à long terme de l'exposition in utero à un diabète maternel sur la fonction rénale et la pression artérielle chez le rat : implication du rein et du système vasculaire." Paris 7, 2007. http://www.theses.fr/2007PA077023.
Many experimental and epidemiological studies show that an alteration of the fetal development induced by various factors of its environment leads to the programmation of adult diseases, such as kidney and cardiovascular diseases. Previous studies of our laboratory have clearly demonstrated a nephron deficit in rats exposed in utero to maternal diabetes (diabetes induced by streptozotocin injection to pregnant rats). In the first part of this work we study the long term consequences of alterations in kidney development induced by in utero exposure to maternal diabetes on blood pressure control, and on renal function. Our results show that in utero exposure to maternal diabetes, which induces nephron deficit, leads to an alteration of the renal function and to the development of a volodependant hypertension. These results point to a renal origin of the observed pathological consequences. In the second part of this work we study in rats issued from diabetic mothers the potential involvement of vascular system, which could be added to the renal origin of the programmation of their hypertension observed. First results of this current study show structural and genique vascular modifications in these rats. In conclusion, in utero exposure to maternal diabetes influences the progression of chronical kidney diseases and the development of volodependant hypertension in adulthood
Chaudet, Barbara. "Les cellules endothéliales circulantes (CECs) : évaluation de la souffrance endothéliale et application clinique au cours du diabète." Bordeaux 2, 1999. http://www.theses.fr/1999BOR2P082.
Brulport, Valérie. "Dépistage systèmatique de l'ischémie myocardique silencieuse chez le diabètique asymptomatique par la scintigraphie myocardique." Saint-Etienne, 1994. http://www.theses.fr/1994STET6418.
Ruf, Jean-Claude. "Influence du régime et des antioxydants (vitamine E, D myo-inositol 1,2,6-triphosphate) sur les altérations lipidiques et la fonction plaquettaire chez le rat diabétique de type I." Lyon 1, 1991. http://www.theses.fr/1991LYO1T181.
Guérin-Dubourg, Alexis. "Étude des modifications structurales et fonctionnelles de l'albumine dans le diabète de type 2 : identification de biomarqueurs de glycoxydation et de facteurs de risque de complications vasculaires." Thesis, La Réunion, 2014. http://www.theses.fr/2014LARE0017/document.
Type 2 diabetes is dramatically associated with an enhanced cardiovascular complication risk. The identification of novel biomarkers associated with endothelial dysfunction remains highly warranted to improve diabetes screening and prevention. Oxidative stress and protein modifications are frequently observed in numerous disease states. Albumin, the major circulating protein in blood, can undergo increased glycoxidation in diabetes. Objectives of my thesis were to clarify the impact of glycoxidative modification of albumin on its structure and its functions and to determine whether such impairments may be encountered in albumin purified from diabetics. The occurrence of oxidative modifications was found to be enhanced in in vitro glycoxidized HAS and albumin purified from diabetics, after determination of their free thiol group content, relative electrophoretic migration, carbonyl content, and antioxidant activities. In addition, glycoxidized albumin exhibited impaired pharmaceutic molecule binding capacities. Cells treated with glycoxidized albumin exhibited a proinflammatory state attested by an overgeneration of intracellular reactive oxygen species, enhancements in RAGE expression, and an accumulation of carbonylated proteins.Methods to detect IMA (ischemia modified albumin) were developed and applied to diabetics patients. Relationships have been established between specific pathological parameters (cardiovascular disorders, hyperglycemia…) with an enhanced glycoxidative modification of albumin in diabetics. We thus propose that impaired albumin structure and function in relation in the enhanced oxidant stress observed in diabetics might be involved in the increased mortality risk of these patients