In a population study conducted from 1985 to 1989 in Belgium, the authors investigated whether exposure to cadmium is associated with blood pressure elevation and with an increased prevalence of cardiovascular diseases. The participants, aged 20-88 years, constituted a random sample of the households living in two low exposure areas (n = 803) and two high exposure areas (n = 1,283). For each exposure level, a rural and an urban district were selected. The cadmium levels in blood (8.5 vs. 11.0 nmol/liter) and urine (7.2 vs. 8.7 nmol/24 hours) were significantly (p less than 0.001) raised in the two high exposure areas compared with the two low exposure areas (p less than 0.001). Systolic pressure was similar in both rural areas, but in the urban area with high exposure systolic pressure was 5 mmHg (p less than 0.001) higher than in the control town. Diastolic pressure was similar in the four districts and the same was true for the prevalence of hypertension and of other cardiovascular diseases. Adjustment of systolic pressure for blood and urinary cadmium did not remove the difference in systolic pressure between both urban areas, suggesting that it was not related to the cadmium burden on the environment. Further analyses in individual subjects showed that neither blood pressure nor the presence of cardiovascular diseases were significantly and positively correlated with blood and urinary cadmium. Thus, the present population study did not confirm the hypothesis that increased exposure of the population to cadmium is associated with blood pressure elevation and with a higher prevalence of cardiovascular diseases.

Aim. -This study aimed to assess the effectiveness of continuous glucose monitoring (CGM) for glucose control in type 1 diabetic patients treated by continuous subcutaneous insulin infusion (CSII) and presenting with frequent hypoglycaemic episodes.Methods. -Thirteen patients with type 1 diabetes (diabetes duration: 25 ± 15 years; CSII duration: 5.5 ± 7.0 years), with more than six recorded capillary blood glucose (CBG) values < 60 mg/dL, according to their metres for the past 14 days, were offered the permanent use of a CGM device (Guardian RT ® , Medtronic) plus ongoing self-monitoring of blood glucose (SMBG) for 12 weeks, followed by a 12-week crossover period of SMBG only, or vice versa. Glucose control, determined by recorded 14-day CBG values < 60 mg/dL and HbA 1c levels, and quality of life according to the Diabetes Quality of Life (DQOL) questionnaire, were assessed at baseline, and after 12-and 24-week follow-ups.Results. -Four patients withdrew from the study during the first period (of whom three were using CGM). In the nine study completers, the number of low CBG values decreased significantly from 13.9 ± 9.2 to 7.6 ± 6.8 (P = 0.011) when patients used CGM, in either the initial or final trial period, while a decrease in HbAi c from 8.3 ± 0.7 to 7.7 ± 0.6% (P = 0.049) was also observed, in contrast to the absence of any significant differences during the SMBG-only period. DQOL scores were also essentially unaffected.Conclusion. -This pilot observational study supports the hypothesis that CGM use can significantly improve overall glucose control while reducing hypoglycaemic episodes in hypoglycaemia-prone type 1 diabetic patients treated by CSII. Objectif. -Étudier l'efficacité d'un système de mesure continue du glucose sur le contrôle glycémique de patients diabétiques de type 1 traités par pompe portable à insuline et présentant des hypoglycémies fréquentes.Méthodes. -Treize patients diabétiques de type 1 (durée du diabète : 25 ± 15 années ; durée du traitement par pompe : 5,5 ± 7,0 années), présentant plus de six glycémies capillaires inférieures à 60 mg/dl enregistrées dans leur lecteur à mémoire durant les 14 derniers jours, ont participé à une étude observationnelle. Cette dernière comprenait deux périodes de 12 semaines en ordre croisé, avec soit le recours complémentaire à un système de monitoring du glucose (Guardian RT ® , Medtronic), soit seulement lapoursuite de l'autosurveillance glycémique habituelle. Le contrôle glycémique, évalué sur la base du nombre de glycémies capillaires inférieures à 60 mg/dl au cours des 14 derniers jours et du taux d'HbA 1c , et la qualité de vie ont été analysés à l'inclusion, après 12 semaines et après 24 semaines.Résultats. -Quatre patients se sont retirés de l'essai durant la première période (dont trois alors qu'ils étaient sous Guardian RT ® ). Chez les neuf patients ayant achevé l'étude, le nombre de valeurs glycémiques basses a diminué de 13,9 ± 9,2 à 7,6 ± 6,8 (p = 0,011) lorsque les patients utilisaient le Guardian RT ® , que ce soit en périod...

Aim To explore the occurrence and the distribution of glucose excursions > 7.8 mmol/l by continuous glucose monitoring (CGM) in non-diabetic patients admitted with acute coronary syndrome (ACS).Methods Twenty-one non-diabetic patients without baseline hyperglycaemia admitted for ACS wore a continuous glucose monitoring system (CGMS) for a median period of 45.6 h. Occurrence and 24-h distribution of time spent with blood glucose > 7.8 mmol/l (TS > 7.8) were retrospectively investigated.Results CGMS data disclosed time spent > 7.8 in 17 patients, whereas only seven of them showed at least one capillary blood glucose test value above the threshold for the same time period. Glucose excursions were detectable earlier from CGMS data. Hyperglycaemia was detected most frequently in the morning, more than 2 h after breakfast.Conclusions CGM discloses early and frequent hyperglycaemia in non-diabetic patients with ACS. Intensive glucose monitoring during the morning time period is the most efficient in screening for hyperglycaemia and could be a valuable guide to initiating insulin therapy and to further investigate outcomes in ACS.

No abstract