Innovative care for diabetic patients

SUMMARY - Innovative care for diabetic patients

Person in charge : Prof. David Montaigne

Cardiovascular complications

Type 2 diabetes is a risk factor for heart failure. Heart failure is a progressive disease characterized by the passage of the patient to a stage of ‘risk of heart failure’ (stage A), asymptomatic structural heart disease or preclinical cardiomyopathy (stage B), clinical manifestations of heart failure ( stage C) and finally terminal or refractory heart failure (stage D).

In type 2 diabetic patients, there is currently no primary prevention, cardiovascular follow-up and monitoring strategy focused on cardiac function that will reduce the incidence of heart failure (stage C).

In this study, we therefore wish to show that the appearance of heart failure (≥stage B) in type 2 diabetic patients without a history of cardiovascular disease (stage A) can be anticipated using biological biomarkers and / or imaging and thus allow the implementation of precision, individualized medicine.

Person in charge : Prof. Charlotte Cordonnier

Neurovascular complications

Type 2 diabetes has emerged in recent years as a major player in vascular and metabolic risk factors for cognitive disorders. People with type 2 diabetes develop progressive cognitive impairment early on, which can lead to dementia.

The definitions which are commonly used in the literature for the diagnosis of dementia in diabetic subjects are the same as for non-diabetic subjects. However, we know that the rate of progression of dementia in people with diabetes may be up to 50% faster than that of cognitive decline related only to age.

Despite multiple risk factors that may explain this finding, each taken separately seems to have only a minor effect that cannot explain the deficits observed in diabetic patients. Our work aims to define preclinical markers of neurovascular complications and cognitive decline in people with type 2 diabetes in order to be able to offer them earlier and personalized care according to the risk factors present.

Person in charge : Prof. Dominique Eladari

Kidney complications

The metabolic diseases diabetes and / or obesity have become the leading cause of end-stage chronic renal failure worldwide and as such represent a public health problem. However, not all patients with diabetes or obesity develop chronic kidney disease, and not all patients showing signs of kidney disease progress to end-stage kidney disease.

Despite considerable research efforts a number of important questions remain unanswered:

  • Who are the patients who will progress to chronic kidney disease?
  • What are the mechanisms responsible for this pejorative development?
  • What are the possible links between chronic kidney disease in diabetic or obese patients and other serious complications of these two diseases (cardiac, neurological, ophthalmological, etc.)?

Recently, new scientific techniques making it possible to analyze in an individual all the genes of the organism and their products (messenger RNA and proteins), or all the circulating metabolites, or the state of the immune system have been developed. . These techniques provide a great deal of information on the body’s systems (cell function, signals allowing different cells to communicate, immune system and inflammation, etc.) explaining the consequences of a disease. These techniques called “multi-omics” are already used in current medical practice in serious diseases such as cancer and allow:

  • To classify patients according to the anomalies responsible for their disease
  • To predict the evolution or the response to the treatment of each patient
  • To develop drugs specifically targeting the main mechanism responsible for the disease involved for a given individual.

These approaches therefore make it possible to develop a personalized approach to the care of each individual, also called precision medicine. With the help of the phenomena center of the University Hospital of Amiens specializing in kidney problems, our goal is to implement this strategy (eg: NGS sequencing of kidney disease genes, metabolome analysis) to screen for patients with high-grade diabetes. risk of developing kidney complications and implementing a preventive approach to these complications.