
Paul ValensiAssistance Publique – Hôpitaux de Paris | AP-HP · endocrinology diabetology nutrition. Jean Verdier hospital. Bondy
Paul Valensi
Professor of Nutrition
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Publications (817)
The association between type 2 diabetes mellitus (T2DM) and heart failure (HF) has been firmly established; however, the entity of diabetic myocardial disorder (previously called diabetic cardiomyopathy) remains a matter of debate. Diabetic myocardial disorder was originally described as the occurrence of myocardial structural/functional abnormalit...
In the primary care setting providers have more tools available than ever before to impact positively obesity, diabetes, and their complications, such as renal and cardiac diseases. It is important to recognise what is available for treatment taking into account diabetes heterogeneity. For those who develop type 2 diabetes (T2DM), effective treatme...
Background:
Fast acting insulin analogues are known to improve arterial stiffness. The combination of metformin with insulin represents a widely used therapeutic strategy in diabetes. We hypothesized that insulin treatment in patients with type 2 diabetes (T2D) with long-acting, fast-acting or basal bolus insulin as an add-on to metformin would pr...
Aims:
We used N-terminal pro-B-type natriuretic peptide (NT-proBNP) point-of-care testing (POCT) for heart failure risk stratification of individuals with type 2 diabetes for >10 years and hypertension.
Methods:
Overall 259 participants aged 50 years or older with type 2 diabetes (duration of >10 years), hypertension, and no overt cardiovascular...
Background
The 2019 guidelines for cardiovascular risk stratification by the European Society of Cardiology and European Association for the Study of Diabetes (ESC-EASD) suggested screening for silent coronary disease in very high risk patients with severe target organ damage (TOD) (i.e. peripheral occlusive arterial disease or severe nephropathy)...
Background
Endothelium function is often impaired in patients with type 2 diabetes. We hypothesized that by improving endothelial function using diastole-synchronized compressions/decompressions (DSCD) to the lower body may improve the metabolic profile. The objective of this research was to evaluate the effects of single and multiple DSCD sessions...
Aims
To explore (i) in what proportion and direction coronary artery calcium (CAC) score reclassifies coronary risk in asymptomatic diabetic patients at high a priori coronary risk, and (ii) whether screening for asymptomatic myocardial ischemia / coronary stenosis only in patients at very high coronary risk - whether a priori or combined with thos...
Abstract Background The relationships between glucose abnormalities, insulin resistance (IR) and heart failure (HF) are unclear, especially regarding to the HF type, i.e., HF with reduced (HFrEF) or preserved (HFpEF) ejection fraction. Overweight, diabetes and hypertension are potential contributors to IR in persons with HF. This study aimed to eva...
Aim. Recent studies have shown that women with hyperglycaemia in pregnancy and insulin resistance have a greater risk of adverse pregnancy outcomes than women with normoglycaemic pregnancies. This study aimed to determine adverse pregnancy outcomes of women with hyperglycaemia in pregnancy only as a function of insulin resistance.
Methods. From a p...
The Special Issue, “Chronic Diabetic Complications: Current Challenges and Opportunities”, is rich in scientific content, covering a wide field of diabetic complications via both original studies and reviews [...]
Background
The benefit of the coronary artery calcium score (CACS) measured by cardiac CT is well documented in asymptomatic patients at intermediate risk, however is not known in symptomatic patients. The coronary CT angiography (CCTA) allows an anatomical evaluation of the coronary arteries.
Purpose
The objective was to determine, in symptomatic...
Abstract Background Epicardial adipose tissue (EAT) is considered a novel diagnostic marker for cardiometabolic disease. This study aimed to evaluate whether EAT volume was associated with stress-induced myocardial ischemia in asymptomatic people living with diabetes—independently of confounding factors—and whether it could predict this condition....
Background:
The purpose of this document is to provide clinicians with guidance, using expert consensus, to help summarize evidence and offer practical recommendations.
Methods:
Expert Consensus Documents are intended to provide guidance for clinicians in areas in which there are no clinical practice guidelines, especially for new and evolving t...
Type 2 diabetes is one of the most relevant risk factors for heart failure, the prevalence of which is increasing worldwide. The aim of the review is to highlight the current perspectives of the pathophysiology of heart failure as it pertains to type 2 diabetes. This review summarizes the proposed mechanistic bases, explaining the myocardial damage...
Objectif
Évaluer l’association entre les paramètres métaboliques et la TSH (norme : 0,27–4,2 mU/l) dans une cohorte de femmes présentant un diabète gestationnel (DG).
Matériaux et méthodes
Nous avons inclus 754 femmes, sans antécédent de dysthyroïdie ni de diabète, ayant eu un dosage de TSH et anticorps anti-TPO (aTPO) lors de leur prise en charge...
Objectif
Le tissu adipeux épicardique (TAE), dont le volume est augmenté en cas de diabète et chez les hommes, joue un rôle dans l’athérosclérose. Nous avons fait l’hypothèse que son volume était plus élevé en cas d’ischémie myocardique silencieuse (IMS).
Patients/méthodes
Nous avons sélectionné 274 patients (121 femmes) diabétiques depuis 16 ± 9...
Introduction
Une femme de 48 ans s’est présentée pour hypothyroïdie chronique profonde (TSH > 100 mUI/L et hormones thyroïdiennes indétectables), malgré la majoration progressive des doses de lévothyroxine qu’elle affirmait prendre régulièrement tous les matins, à jeun. Nous avons exclu une maldigestion/malabsorption de la lévothyroxine et tenté pl...
The SPARTE study (Strategy for Preventing cardiovascular and renal events based on ARTErial stiffness; URL: https://www.clinicaltrials.gov ; Unique identifier: NCT02617238) is a multicenter open-label randomized controlled trial with blinded end point evaluation, undertaken at 25 French research centers in university hospitals. Patients with primar...
The incidence and prevalence of hypertension is increasing worldwide, with approximately 1.13 billion of people currently affected by the disease, often in association with other diseases such as diabetes mellitus, chronic kidney disease, dyslipidemia/hypercholesterolemia, and obesity. The autonomic nervous system has been implicated in the pathoph...
Background and aims
Studies of dipeptidyl peptidase inhibitors (DPP4is) report heterogeneous effects on cardiovascular targets in type 2 diabetes. This study aimed to investigate, in patients with impaired glucose tolerance (IGT), whether saxagliptin, a DPP4i, had beneficial cardiovascular effects at fasting and during the post-prandial state.
Met...
Recent studies have shown that pregnancies complicated by hyperglycemia in pregnancy (HIP) and insulin resistance had the highest risk of poor outcomes as compared to normoglycemic pregnancies. This study aimed to determine, only among women with HIP, the characteristics and pregnancy outcomes by increasing insulin resistance. We included from a pr...
Funding Acknowledgements
Type of funding sources: None.
Introduction : Some studies suggest a high rate of unknown glycemic abnormalities in coronary patients. The aim of the study was to determine the prevalence of dysglycemia detected by oral glucose load (OGL) in patients ongoing Cardiac Rehab , and to analyse chronotropic response to exercise b...
Heart failure (HF) and chronic kidney disease (CKD) are often associated in type 2 diabetes (T2D), aggravate each other and exert synergistic effects to increase the risk of cardiac and renal events. The risks of renal worsening in HF patients and HF in CKD patients need to be evaluated to tailor preventive therapy. The recent CV and renal trials e...
The puzzle of the multifaceted actions of sodium–glucose cotransporter type-2 inhibitors (SGLT2is) is still incomplete. For diabetologists (who are accustomed to dealing with the burden of cardiovascular autonomic neuropathy), the relationship between SGLT2is and the autonomic nervous system (ANS) represents one of the most intriguing aspects of th...
Background and aims
Dipeptidyl-peptidase inhibitors might be useful in type 2 diabetes prevention. ACCES (ACute and Chronic Effects of Saxagliptin) was a randomized, placebo-controlled, double-blind, controlled phase 2, pilot study aiming to examine in obese patients with impaired glucose tolerance (IGT) the acute effects and the effects after 12 w...
Background
Medico-economic data of patients suffering from chronic nausea and vomiting are lacking. In these patients, gastric electrical stimulation (GES) is an effective, but costly treatment.
Aim
The aim of this study was to assess the efficacy, safety and medico-economic impact of Enterra™ therapy in patients with chronic medically refractory...
Aim
To evaluate whether the initial care of women with fasting plasma glucose (FPG) levels at 5.1–6.9 mmol/L before 22 weeks of gestation (WG), termed ‘early fasting hyperglycaemia’, is associated with fewer adverse outcomes than no initial care.
Methods
A total of 523 women with early fasting hyperglycaemia were retrospectively selected in our de...
Background:
Triglyceride Glucose (TyG) index has been associated with an increased risk in cardiovascular events. Silent coronary disease is common in patients with type 2 diabetes. In Vietnam, a low-middle income country, the burden of cardiovascular disease is growing simultaneously with the epidemiologic transition. Our aim was to assess the pr...
Nous rapportons le cas d’une patiente de 30 ans en échec d’une sleeve gastrectomie réalisée en 2014 au poids de 120 kg (taille 173 cm). Son obésité, dans un contexte d’obésité familiale, remonte à l’enfance, associée à une croissance staturale à +2DS et à une aménorrhée primaire rapportée à une atrophie ovarienne. Elle a perdu 58 kg après l’interve...
Background: Studies of dipeptidyl peptidase inhibitors (DPP4is) report heterogeneous effects on cardiovascular targets in type 2 diabetes. Little is known about the cardiovascular effects of DPP4is in patients with impaired glucose tolerance (IGT) in particular during the post-prandial state.
Methods: In this randomized, placebo-controlled, double-...
In the pandemic "Corona Virus Disease 2019" (COVID-19) people with diabetes have a high risk to require ICU admission. The management of diabetes in Intensive Care Unit is always challenging, however, when diabetes is present in COVID-19 the situation seems even more complicated. An optimal glycemic control, avoiding acute hyperglycemia, hypoglycem...
Résumé
L’European Society of Cardiology (ESC), en collaboration avec l’European Association for the Study of Diabetes (EASD), a publié en 2019 ses dernières recommandations sur « Diabète, prédiabète et maladie cardiovasculaire ». L’American Diabetes Association (ADA) et l’EASD, un peu pressées par ces recommandations, ont aussitôt actualisé leur po...
Some guidelines recommend immediate care for women with fasting plasma glucose level (FPG) ≥5.1 mmol/L in early pregnancy (early-diagnosed gestational diabetes mellitus: eGDM). As diagnosis and care of hyperglycaemia can be delayed later in pregnancy, we assessed whether immediate vs. no immediate care for eGDM is associated with pregnancy outcomes...
The aim of the study was to test various criteria to select asymptomatic patients with diabetes to be screened for silent myocardial ischemia (SMI). This screening might improve cardiovascular prognosis through identification of coronary stenoses (CS) suitable for revascularization. Clinical/biological/imaging criteria including coronary artery cal...
People with diabetes compared with people without exhibit worse prognosis if affected by coronavirus disease 2019 (COVID-19) induced by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), particularly when compromising metabolic control and concomitant cardiovascular disorders are present. This Perspective seeks to explore newly occur...
The Task Force for diabetes, pre-diabetes, and cardiovascular diseases of the European Society of Cardiology (ESC) and the European Association for the Study of Diabetes (EASD)
Diabetes mellitus (DM) is a major chronic disease with ever‐increasing prevalence and a variety of serious complications for persons with DM, such as cardiovascular and/or renal complications. New glucose‐lowering therapies like DPP‐4 inhibitors, GLP‐1 receptor agonists, and SGLT‐2 inhibitors have undergone cardiovascular outcome trials (CVOTs) for...
Background Triglyceride Glucose index (TyG) was associated with an increased risk of cardiovascular events. Silent coronary disease is common in patients with type 2 diabetes. In Vietnam, a low-middle income country, the burden of cardiovascular disease is growing in parallel to the epidemiologic transition. The aim was in patients with type 2 diab...
Background: Triglyceride Glucose (TyG) index has been associated with an increased risk in cardiovascular events. Silent coronary disease is common in patients with type 2 diabetes. In Vietnam, a low-middle income country, the burden of cardiovascular disease is growing simultaneously with the epidemiologic transition. Our aim was to assess the pre...
Abstract The 4th Cardiovascular Outcome Trial (CVOT) Summit of the Diabetes & Cardiovascular Disease (D&CVD) EASD Study Group was held in Munich on 25–26 October 2018. As in previous years, this summit served as a reference meeting for in-depth discussions on the topic of recently completed and presented CVOTs. This year, focus was placed on the CV...
In the era of precision medicine, treatments that target specific modifiable characteristics of high-risk patients have the potential to lower further the residual risk of atherosclerotic cardiovascular events. Correction of atherogenic dyslipidemia, however, remains a major unmet clinical need. Elevated plasma triglycerides, with or without low le...
The challenges of diabetes treatment are to prevent or delay microangiopathic complications and macrovascular disease. Early, effective and sustained glycaemic control is advocated by all diabetes guidelines to mitigate the risks of prolonged hyperglycaemia. The post-hoc analyses of the large randomised glucose intervention trials and the long-term...
Type 2 diabetes mellitus is a major risk factor for developing cardiovascular disease, and many patients with diabetes have prevalent cardiovascular complications. Recent cardiovascular outcome clinical trials suggest that certain new glucose-lowering drugs are accompanied by additional cardioprotective properties. Indeed, selected glucagon-like pe...
The recent CVOTs which tested the new glucose-lowering drugs (GLD) show that in patients with type 2 diabetes mellitus (T2DM) it is now possible to reduce cardiovascular complications including ischemic events and hospitalization for heart failure, and mortality, and, to some extent, microvascular complications of diabetes, in particular renal outc...
Background
To investigate whether chronic adherence to the French Nutrition and Health Program (PNNS) guidelines was associated with better cardiovascular health.
Methods
A study nested within the SU.VI.MAX2 cohort was conducted on participants without cardiovascular risk factors. Long-term adherence to the PNNS guidelines was estimated using vali...
Aim:
Our study evaluated the performance of a selective screening strategy for hyperglycaemia in pregnancy (HIP) based on the presence of risk factors (RFs; body mass index ≥ 25 kg/m², age ≥ 35 years, family history of diabetes, personal history of HIP or macrosomia) to diagnose HIP and to predict HIP-related events.
Methods:
Women with no known...
Background & aims:
There have been conflicting results from trials of gastric electrical stimulation (GES) for treatment of refractory vomiting, associated or not with gastroparesis. We performed a large, multicenter, randomized, double-blind trial with cross-over to study the efficacy of GES in patients with refractory vomiting, with or without g...
Aims:
To evaluate the percentage of women with untreated fasting hyperglycaemia in early pregnancy who develop gestational diabetes mellitus after 22 weeks' gestation, the determinants of gestational diabetes development in such women and the prognosis of early fasting hyperglycaemia according to whether the women go on to develop gestational diab...
Background:
Metabolic surgery is now considered as a therapeutic option in type 2 diabetes (T2D). However, few data are available regarding perioperative management of T2D.
Objectives:
To assess current practice among bariatric teams regarding perioperative management of T2D in order to propose guidelines.
Methods:
A two-round Delphi method us...
Résumé
Introduction
La chirurgie métabolique est maintenant considérée comme une option thérapeutique dans le diabète de type 2 (DT2). Cependant, peu de données sont disponibles concernant la gestion périopératoire du DT2.
Objectifs
Évaluer les pratiques actuelles au sein des équipes bariatriques en matière de gestion périopératoire du DT2 afin d...
Objective: In diabetic patients, autonomic alterations are associated with hypertension. In healthy individuals, FFAs were shown to enhance sympathetic activity. We aimed to examine the influence of autonomic function alterations and FFA on hypertension and artery stiffness (pulse wave velocity, PWV) in overweight patients with normal or impaired g...
Some guidelines, as the French one, recommend to screen early in pregnancy for hyperglycaemia first-diagnosed during pregnancy and to immediately care for high-risk women with a fasting plasma glucose level (FPG) higher than 92 mg/dL before 22 weeks of gestation (WG) (eFHG: early fasting hyperglycaemia). To date, no randomized study has shown any b...
The aim of the study was to evaluate the prevalence of hyperglycemia first diagnosed during pregnancy (Hgly), including gestational diabetes mellitus appearing early (eGDM) or after 22 weeks of gestation (GDM) or diabetes in pregnancy (DIP) and their prognosis whether women had risk factors (RFs) for Hgly or not. We included the women without known...
Introduction: Standardized meals have been suggested as a potential tool to diagnose glycemic disorders. In obese patients with different glycemic status (normal glucose tolerance (NGT) or intermediate hyperglycemia (IH: IFG and/or IGT), or type 2 diabetes (T2D), we aimed to examine the relationship between the glucose response to 75g OGTT and a “F...
In asymptomatic patients with type 2 diabetes (T2D), the prevalence of silent myocardial infarction on routine electrocardiograms is about 4% while for silent myocardial ischemia it is 20–30%. Some studies showed that silent myocardial infarction is associated with an increased risk of incident heart failure (HF), whereas no prospective study has e...
Background:
We aimed to evaluate whether pre and perinatal education of pregnant women would reduce childhood overweight.
Methods:
Four French centers included women at ≤21 gestational weeks (GWs) with body mass index (BMI) >25 kg/m2 before pregnancy. Patients were randomized to a control group (routine care including at least one dietary visit)...
The 3rd Cardiovascular Outcome Trial Summit of the Diabetes & Cardiovascular Disease EASD Study Group was held on the 26–27 October 2017 in Munich. As in 2015 and 2016, this summit was organised in light of recently completed and published CVOTs on diabetes, aiming to serve as a reference meeting for in-depth discussions on the topic. Amongst other...
Aims:
In addition to screening for hyperglycaemia during pregnancy after 24 weeks of gestation (WG), the current guidelines also suggest screening in early pregnancy and referring women with early gestational diabetes mellitus (eGDM) or overt diabetes (OD) for immediate care. Our aim was to evaluate this strategy.
Methods:
This study evaluated,...
Rationnel
Outre la recherche de diabète gestationnel (DG) après 24 SA, le dépistage précoce recommandé depuis 2010 pourrait améliorer le pronostic des grossesses.
Patientes and méthodes
Nous avons comparé chez les femmes ayant accouché (2012–2016) la survenue d’un critère composite (prééclampsie ou enfant de poids élevé pour l’âge gestationnel ou...
Aim:
Because type 2 diabetes (T2D) is related to obesity, it is often associated with obstructive sleep apnoea syndrome (OSAS), although OSAS is also frequently diagnosed in patients with type 1 diabetes (T1D) and may promote gestational diabetes. Thus, this systematic review of the scientific evidence aimed to evaluate the epidemiological associa...
Le cadre juridique des pratiques en santé va être adapté aux progrès de la science et de la technologie avec notamment l’encadrement des tests génétiques, des diagnostics préconceptionnels, la maîtrise de l’impact de la révolution numérique, la traçabilité des données collectées en masse, la redéfinition du consentement éclairé du patient face à de...
Rationale: CACS can improve the cardio-vascular risk (CVR) estimate and select the patients eligible for further cardio-vascular investigations. We aimed to examine the relationship between a CACS ≥100 Agatston units (AU) and integrators of CVR in the diabetic population.
Patients and Methods: CACS was measured in type 2 diabetic patients without s...
Rationale: Depressed cardiac vagal activity and elevated sympathetic activity have been reported in prediabetic obese patients. In healthy individuals, insulin was shown to acutely induce such changes, and free fatty acids (FFA) to enhance sympathetic activity. This study aimed to examine the relations between glycemia, insulinemia and plasma FFA w...
In addition to screening for gestational diabetes mellitus (GDM) after 24 gestational weeks (GW), the IADPSG proposed to screen in early pregnancy and to refer women with early GDM (eGDM) for immediate care. The usefulness of this strategy is still unknown. We included women with a singleton pregnancy, without personal history of diabetes or bariat...
Purpose of review:
The aim of this review is to describe in diabetic patients the determinants underlying atherogenic dyslipidemia, a complex dyslipidemia defined as the coexistence of fasting hypertriglyceridemia and low high-density lipoprotein cholesterol level. Atherogenic dyslipidemia is often comorbid with hyperglycemia in patients with the...
OBJECTIVE: To determine the prevalence of overweight and obesity in Algerian adolescents and investigate the associated cardiometabolic complications. METHODS: The study was conducted in the city of Constantine (Algeria). The population included 1100 schooled adolescent, aged 12-18 years, randomly selected. All had anthropometric measurements, and...
Follow on from continuous intravenous administration of insulin with an electronic syringe (IVES) is an important element in the postoperative management of a diabetic patient. The basal-bolus scheme is the most suitable taking into account the nutritional supply and variable needs for insulin, reproducing the physiology of a normal pancreas: (i) s...
Ambulatory surgery can be carried out in diabetic patients. By using a strict organisational and technical approach, the risk of glycaemic imbalance is minimised, allowing the patients to return to their previous way of life more quickly. Taking into account the context of ambulatory surgery, with a same day discharge, the aims are to minimise the...
In diabetic patients undergoing surgery, we recommend assessing glycaemic control preoperatively by assessing glycated haemoglobin (HbA1c) levels and recent capillary blood sugar (glucose) levels, and to adjust any treatments accordingly before surgery, paying particular attention to specific complications of diabetes. Gastroparesis creates a risk...