Prof. Anne Vambergue

Prof. Anne Vambergue

Department of Endocrinology Diabetology, Nutrition Metabolisms of the University Hospital of Lille.

Today, Professor Anne Vambergue tells us about her projects within PreciDIAB and concrete progress for diabetic patients.

Can you explain to us what led you to specialize in diabetes and the interest for you in combining care and research?

I very quickly oriented myself during my intern course towards diabetology even if I acquired training as an endocrinologist. The particularity of diabetology is to be a specialty at the crossroads of many other specialties and allows comprehensive management of the patient in multi-disciplinarity. Even if I invested myself largely in the theme “diabetes and pregnancy” in collaboration with the obstetrical team whose structure is a reference in France, I kept an important activity of general diabetology (diabetes type 1, diabetes type 2 . …).

Diabetology is a specialty allowing translational research with the aim of setting up research protocols on the rational basis of experimental results which can thus be confirmed in humans. It allows the development of relevant experimental research to explore medical issues. Indeed, translational research makes it possible to carry out so-called “patient-to-patient” research, but involving fundamental and/or experimental studies.

Can you tell us about your projects within the PreciDIAB National Center? How will these allow advances in research and the care of diabetic patients?

Some projects currently implemented within the framework of PreciDIAB gravitate directly around the diabetic patient. Indeed, the success of these projects depends first of all on the recruitment of patients in order to encourage them to participate in these prospective cohorts*.

A good example is “PreciDIAB Heart and Brain” whose objective is to predict cardiac dysfunction and the onset of cognitive disorders in type 2 diabetes. This cohort will study the mechanisms involved in cardiac immunomodulation, myocardial mechanics and cognition.

In addition, we participate directly in the reflection of projects that are centered on the institution such as the development of strategies for the prevention of iatrogenia* using computerized decision support systems, in particular with the team of Prof. Jean-Baptiste Beuscart. The development of this project will make it possible to better detect and correct situations at iatrogenic risk and/or requiring therapeutic optimization in hospitalized patients in connection with the outpatient department* and the patient.

Other projects are being prepared, such as the genotyping of patients with gestational diabetes in order to identify those most at risk of becoming diabetic and requiring special follow-up. All of these projects will allow a better understanding of the mechanisms involved in diabetes and will be very useful in the context of medical care, but also for the training of all the actors who gravitate around the patient.

What are the latest big concrete advances for diabetes patients and do you see any future prospects that offer new hope?

The contribution of new technologies is a real revolution in the management of type 1 diabetic patients (insulin pump, continuous glucose measurement, telemedicine, etc.). The current major advance is the possibility of having insulin therapy optimized by “hybrid or closed loop” (insulin pump, glucose sensor and insulin adjustment algorithm). This technology is already applicable to type 1 diabetics, whether children, adolescents or adults, with excellent results in terms of glycemic control, reduction in the number of hypoglycemias and improved quality of life. The use of these technologies is only possible thanks to the therapeutic education that is part of diabetes care.

With regard to type 2 diabetes, the arrival of new drug classes with cardio-renal protection is also a major advance which will make it possible to delay and reduce mortality linked to diabetes complications.
These prospects require continuing to set up clinical or experimental research projects, whether in the context of type 1 or type 2 diabetes.

The National PreciDIAB Center is an excellent opportunity for clinicians to answer the many unresolved questions, thanks in particular to the study of genetic variants. The objective is to promote the development of genuine precision medicine in order to adapt the treatment of people carrying certain so-called “actionable” genes, in order to avoid heavy, restrictive, ineffective and costly treatments for them. company. Nevertheless, the success of these projects will only be possible at the cost of setting up a team of clinicians with a defined profile making the link between the fundamental teams and the clinical teams, clinical research assistants and paramedics.

We have therefore set up a monthly meeting to present “atypical diabetes” case files. These meetings bring together experts from different disciplines with the aim of deploying, within a defined framework, the real and concrete application of precision diabetes medicine for the benefit of patients who do not respond to the usual treatments. I invite you to read “La Une” of this newsletter to find out more.

Finally, one of our objectives is also to attract young clinicians to research in diabetes thanks to the various research teams on the site and to train diabetes of excellence.

Cohorts: Cohorts studies consist of following a group of people who share common characteristics over time, in order to identify the occurrence of a health event of interest (disease or dysfunction of the body).

Iatrogenicityadverse effects caused by taking one or more drugs.

Ambulatory: :(or city care) is care carried out in city surgeries, dispensaries, care centers, during outpatient consultations in public or private hospitals, in spa treatments and laboratory analysis acts. They are dispensed by doctors, dentists and medical auxiliaries (nurses, physiotherapists, speech therapists, orthoptists) as part of their self-employed activity

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