Browsing by Author "Dardari, D"
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- ItemReal-life application and validation of flexible intensive insulin-therapy algorithms in type 1 diabetes patients.(2009-12-16) Franc, S; Dardari, D; Boucherie, B; Riveline, J-P; Biedzinski, M; Petit, C; Requeda, E; Leurent, P; Varroud-Vial, M; Hochberg, G; Charpentier, GAIMS Flexible intensive insulin therapy FIT has become the reference standard in type 1 diabetes Besides carbohydrate counting CHO it requires the use of algorithms to adjust prandial insulin doses to the number of CHO portions As recourse to standard algorithms is usual when initiating FIT the use of personalized algorithms would also allow more precise adjustments to be made The aim of the present study was to validate personalized prandial algorithms for FIT as proposed by Howorka et al in 1990 METHODS We conducted a 4 month observational study of 35 patients with type 1 diabetes treated with FIT for at least 6 months who were already using Howorka s prandial algorithms meal related and correctional insulin doses for blood glucose increases induced by CHO These patients were asked to use a personal digital assistant PDA phone with an electronic diary instead of a paper one to take advantage of the computerized data collection system to assess the quality of postprandial metabolic control RESULTS Whatever the number of CHO portions mean postprandial blood glucose values remained close to the target of 7 8mmol L and the compensatory algorithm allowed precise correction of preprandial hyperglycaemia In fact the algorithms for meal related and correctional insulin doses at the end of the study did not differ significantly from those initially calculated but they generally differed from one patient to another CONCLUSION In type 1 diabetic patients treated with FIT the use of individualized parameters permits fast and accurate adjustment of mealtime insulin doses leading to good control of the postprandial state
- ItemTelemedicine and diabetes: achievements and prospects.(2011-12-13) Franc, S; Daoudi, A; Mounier, S; Boucherie, B; Dardari, D; Laroye, H; Neraud, B; Requeda, E; Canipel, L; Charpentier, GHealth authorities currently have high expectations for telemedicine TM as it addresses several major challenges to improve access to healthcare especially for patients in underserved or remote areas to overcome the scarcity of specialists faced with epidemic disease and to reduce the costs of healthcare while improving quality The aims of TM in the field of diabetes differ according to the type of diabetes In type 1 diabetes T1DM associated with complex insulin regimens the goal of TM is to help patients achieve better control of their blood glucose levels through accurate adjustment of insulin doses In type 2 diabetes T2DM while therapeutic adjustments may be necessary improvement in blood glucose control is based primarily on behavioural changes reduced calorie and carbohydrate intakes increased physical activity Many TM studies focusing on management of blood glucose levels have been published but most failed to demonstrate any superiority of TM vs traditional care While previously published meta analyses have shown a slight advantage at best for TM these meta analyses included a mix of studies of varying durations and different populations both T1DM and T2DM patients adults and children and tested systems of inconsistent quality Studies published to date on TM suggest two currently promising approaches First handheld communicating devices such as smartphones loaded with software to apply physicians prescriptions have been shown to improve glycaemic control These systems provide immediate assistance to the patient such as insulin dose calculation and food choice optimization at meals and all data stored in the smartphone can be transmitted to authorized caregivers enabling remote monitoring and even teleconsultation These systems initially developed for T1DM appear to offer many possibilities for T2DM too Second systems combining an interactive Internet system or a mobile phone coupled to a remote server with a system of communication between the healthcare provider and the patient by e mail texting or phone calls have also shown certain benefits for glycaemic control These systems primarily aimed at T2DM patients generally provide motivational support as well Although the individual benefits of these systems for glycaemic control are fewer than with smartphones their widespread use should be of particular value for overcoming the relative shortage of doctors and reducing the health costs associated with a disease of such epidemic proportions
- ItemTelemedicine and type 1 diabetes: is technology per se sufficient to improve glycaemic control?(2014-02-10) Franc, S; Borot, S; Ronsin, O; Quesada, J-L; Dardari, D; Fagour, C; Renard, E; Leguerrier, A-M; Vigeral, C; Moreau, F; Winiszewski, P; Vambergue, A; Mosnier-Pudar, H; Kessler, L; Reffet, S; Guerci, B; Millot, L; Halimi, S; Thivolet, C; Benhamou, P-Y; Penfornis, A; Charpentier, G; Hanaire, HIn the TELEDIAB 1 study the Diabeo system a smartphone coupled to a website improved HbA1c by 0 9 vs controls in patients with chronic poorly controlled type 1 diabetes The system provided two main functions automated advice on the insulin doses required and remote monitoring by teleconsultation The question is how much did each function contribute to the improvement in HbA1c