Papers by Jean-françois Yale
Diabetic Medicine, Nov 1, 1999
Summary Aims New approaches to continuing medical education will facilitate the implementation of... more Summary Aims New approaches to continuing medical education will facilitate the implementation of clinical practice guidelines. This study assessed the short and long‐term impact of a 7‐h, small group workshop on family physicians’ attitude, knowledge and self‐reported practice patterns regarding diabetes mellitus. Methods One hundred and seventy‐seven of 1807 family physicians who participated in this nationwide workshop, and 113 non‐participant controls completed two validated questionnaires. Participants completed one questionnaire before the workshop and a second equivalent questionnaire 1 month later. Non‐participant controls also completed the two questionnaires 1 month apart. Between 8 and 24 months later, these individuals were mailed the same questionnaire they completed on the first occasion; 143 participants and 50 controls returned this third questionnaire. Results Participants were more likely to be female (P = 0.03), not certified in family practice (P = 0.02), in a smaller centre (P = 0.0005), recent medical graduates (P = 0.001) and seeing fewer patients per month (P = 0.01) than controls. Compared to controls, participants had improved their attitude (P < 0.0001), knowledge (P = 0.04) and self‐reported practice patterns (P < 0.002) regarding diabetes after 1 month but not after 1 year. Conclusions An interactive, small group, diabetes continuing education programme effectively disseminates practice guidelines to family physicians. The impact of such a programme declines after 1 year.Keywords clinical practice guidelines, continuing medical education, diabetes mellitus, primary care
Diabetes Care, Feb 1, 2001
Canadian Journal of Diabetes, Apr 1, 2013
If glycemic targets are not achieved within 2 to 3 months of lifestyle management, antihyperglyce... more If glycemic targets are not achieved within 2 to 3 months of lifestyle management, antihyperglycemic pharmacotherapy should be initiated. Timely adjustments to, and/or additions of, antihyperglycemic agents should be made to attain target glycated hemoglobin (A1C) within 3 to 6 months. In patients with marked hyperglycemia (A1C 8.5%), antihyperglycemic agents should be initiated concomitantly with lifestyle management, and consideration should be given to initiating combination therapy with 2 agents, 1 of which may be insulin. Unless contraindicated, metformin should be the initial agent of choice, with additional antihyperglycemic agents selected on the basis of clinically relevant issues, such as contraindication to drug, glucose lowering effectiveness, risk of hypoglycemia and effect on body weight.
Diabetes & Metabolism, Mar 1, 2013
récepteur insulinique IRS-1. La leucine, en activant cette boucle de rétrocontrôle, inactive les ... more récepteur insulinique IRS-1. La leucine, en activant cette boucle de rétrocontrôle, inactive les voies de signalisation insulinique ; ce qui, selon l'hypothèse, participerait à l'inhibition des effets métaboliques de l'insuline. Puisque l'insulino-résistance cardiaque participe à l'apparition de cardiomyopathies diabétiques, nous avons voulu vérifier cette hypothèse dans un modèle cellulaire cardiaque. Matériels et méthodes : Des cardiomyocytes de rat en culture primaire ont été stimulés par l'insuline (3x10-9 M, 30 minutes) après avoir été incubés (durant des périodes de 1 à 20 heures) en présence ou non de différentes concentrations (de 1 à 10 mM) en leucine. Résultats : L'insuline stimule 6 fois le transport de glucose cardiaque (0,31+/-0,04 vs. 0,05+/-0,01 μmoles/mg. h, p = 0,05). Cette stimulation corrèle avec la phosphorylation de deux protéines impliquées dans ce phénomène, Akt et AS160. Une préincubation d'une heure avec la leucine induit la phosphorylation de la voie mTOR/p70S6K corrélant avec la phosphorylation inhibitrice d'IRS-1. Cela s'accompagne d'une insulino-résistance caractérisée par une diminution significative de la phosphorylation d'Akt et d'AS160. Cependant, la stimulation insulino-dépendante du transport de glucose n'est pas affectée par cette pré-incubation (0,31+/-0,05 μmoles/mg. h). Par contre, des incubations plus longues avec la leucine induisent une diminution drastique du transport insulino-dépendant du glucose (0,056+/-0,01 μmoles/mg. h) indépendamment des voies de signalisations insuliniques. Les mécanismes moléculaires expliquant cette inhibition sont en cours d'investigation. Conclusion : La leucine bloque le transport de glucose cardiaque indépendamment de son effet sur les voies de signalisation insulinique. P1079 Poids, stéatose hépatique, syndrome métabolique et risque de diabète : impact sur le risque d'albuminurie et d'altération de la fonction rénale au sein de la population générale
Diabetes, Jun 20, 2023
Real-world (RW) drug safety studies complement safety information from randomized clinical trials... more Real-world (RW) drug safety studies complement safety information from randomized clinical trials. This post hoc analysis of pooled data from nine global non-interventional studies (SURE program: 10 countries, ~30 weeks duration) investigated the safety and prescription patterns of once-weekly (OW) semaglutide in 3,505 adults with T2D in routine practice, overall and by patient subgroup and medical specialty stratification. All safety data reported by site physicians were collected and presented using descriptive statistics. Results: Tables 1 and 2. A two-fold increase in level-2 hypoglycemia was associated with insulin use and microvasculopathy. No new safety concerns were observed with OW semaglutide in this large, diverse, RW population with T2D; the safety profile was in line with that of phase 3 trials of semaglutide. Disclosure J.Yale: Advisory Panel; Sanofi, Novo Nordisk Canada Inc., Eli Lilly and Company, Bayer Inc., Boehringer Ingelheim (Canada) Ltd., Abbott, Mylan, Research Support; Sanofi, Novo Nordisk Canada Inc., Bayer Inc., Speaker's Bureau; Sanofi, Novo Nordisk Canada Inc., Eli Lilly and Company, Bayer Inc., AstraZeneca, Merck & Co., Inc., Boehringer Ingelheim (Canada) Ltd., Janssen Pharmaceuticals, Inc., Abbott, Dexcom, Inc. A.Major-pedersen: Employee; Novo Nordisk A/S. A.Catarig: Employee; Novo Nordisk, Stock/Shareholder; Novo Nordisk. R.Jain: Employee; Novo Nordisk Global Business Services, Stock/Shareholder; Novo Nordisk Global Business Services. M.Menzen: Advisory Panel; Boehringer Ingelheim Pharma GmbH&Co.KG, Novo Nordisk A/S, Ascensia Diabetes Care, Eli Lilly and Company, Novartis, Speaker's Bureau; Abbott Diabetes, AstraZeneca, Santis, Boehringer Ingelheim Pharma GmbH&Co.KG, Novo Nordisk A/S, Bayer Inc., Eli Lilly and Company, Novartis. P.Holmes: Advisory Panel; Boehringer-Ingelheim, Sanofi, Research Support; Novo Nordisk, Roche Diagnostics, Speaker's Bureau; Novo Nordisk, AstraZeneca, Eli Lilly and Company, Bayer Inc. Funding Novo Nordisk A/S
Canadian Journal of Diabetes, Apr 1, 2018
The experience of living with diabetes is often associated with concerns specific to the illness ... more The experience of living with diabetes is often associated with concerns specific to the illness and can cause conditions, such as diabetes distress, psychological insulin resistance and the persistent fear of hypoglycemic episodes. • A wide range of psychiatric disorders, including major depressive disorder, bipolar and related disorders, schizophrenia spectrum and other psychotic disorders, anxiety disorders, sleep disorders, eating disorders and stress-related disorders are more prevalent in people with diabetes compared to the general population. • People living with diabetes and depressive disorders are at increased risk for earlier all-cause mortality compared to people living with diabetes without a history of depression. • All individuals with diabetes should be regularly screened for the presence of diabetes distress, as well as symptoms of common psychiatric disorders. • Compared to those with diabetes only, individuals with diabetes and mental health concerns have decreased participation in diabetes self-care, a decreased quality of life, increased functional impairment, increased risk of complications associated with diabetes, and increased health-care costs. • Cognitive behaviour therapy, patient-centred approaches (e.g. motivational interviewing), stress management, coping skills training, family therapy and collaborative case management should be incorporated into primary care. Self-management skills, educational interventions that facilitate adaptation to diabetes, addressing co-occurring mental health issues, reducing diabetes-related distress, fear of hypoglycemia, and psychological insulin resistance are all helpful. • Individuals taking psychiatric medications, particularly (but not limited to) atypical antipsychotics, benefit from regular screening of metabolic parameters to identify glucose dysregulation, dyslipidemia and weight gain throughout the course of the illness so that appropriate interventions can be instituted. KEY MESSAGES FOR PEOPLE WITH DIABETES • Living with diabetes can be burdensome and anxiety provoking, with the constant demands taking a psychological toll. As a result, many people experience distress, decreased mood and disabling levels of anxiety. Diabetes is often associated with a significant emotional burden, distress over the self-care regimen and stress in relationships (with family and friends, as well as health-care providers). • It is important to recognize your emotions and talk to your friends, family and members of your diabetes health-care team about how you are feeling. Your team can help you to learn effective coping skills and direct you to support services that can make a difference for you. • Mood and anxiety disorders are particularly common in people with diabetes. Eating, sleeping and stress-related disorders are also common. Speak to your health-care providers about any concerns you have if you think you may be developing any of these problems. • Mental health disorders can affect your ability to cope with and care for your diabetes. In view of this, it is just as important to look after your mental health as it is your physical health. • People diagnosed with serious mental illnesses, such as major depressive disorder, bipolar disorder and schizophrenia, have a higher risk of developing diabetes than the general population. Psychological Effects of Diabetes in Adults Diabetes is a demanding chronic disease for both individuals and their families (5). It is associated with a number of challenges, including adjusting to a new diagnosis, diabetes distress impairing selfmanagement, psychological insulin resistance, and fear of hypoglycemia. In addition, a range of psychiatric disorders can arise that contributes to greater complexity in both assessment and treatment. For instance, distinguishing between diabetes distress, major depressive disorder (MDD) and the presence of depressive symptoms Conflict of interest statements can be found on page S137. Can J Diabetes 42 (2018) S130-S141 Contents lists available at ScienceDirect Canadian Journal of Diabetes j o u r n a l h o m e p a g e : w w w. c a n a d i a n j o u r n a l o f d i a b e t e s. c o m
Diabetes, Jun 1, 2022
Background: Real-time continuous glucose monitors (rtCGM) are associated with improved type 1 dia... more Background: Real-time continuous glucose monitors (rtCGM) are associated with improved type 1 diabetes (T1D) management and quality of life but little is known on their impact on fear of hypoglycemia (FOH) . This review and meta-analysis assessed the impact of rtCGM on FOH in T1D. Methods: Studies assessing FOH in non-pregnant adults with T1D using rtCGM compared to capillary blood glucose (CBG) or intermittently scanned CGM (isCGM) were included. Results from RCTs were pooled using a random-effects model to calculate the standardized mean difference (SMD) with 95% CI. Results: We identified 14 original studies, with 2590 participants and lasting 8 to 26 weeks for RCTs and 16 to 52 weeks for observational studies. Ten RCTs were included in the meta-analysis. A clear trend was observed that rtCGM was associated with lower FOH (mean difference (MD) = -3.44, 95%CI [-4.02, -2.85]) with the effect size showing a significant moderate association between rtCGM and FOH reduction compared to controls (SMD= -0.52, 95%CI [-1.02, -0.02], I2= 92%) (Figure) . Observational studies (n= 4) showed a significant association between rtCGM use and lower FOH (MD = -4.10, 95%CI [-4.84, -3.36]) . Conclusions: Compared to both isCGM and CBG; rtCGM use shows a moderate trend for lower FOH in medium-term RCTs, which was further supported by results from longer observational studies. Disclosure M.K.Talbo: None. A.Katz: None. T.Peters: None. J.Yale: Advisory Panel; Bayer AG, Boehringer Ingelheim International GmbH, Eli Lilly and Company, Novo Nordisk Canada Inc., Sanofi, Research Support; Bayer AG, Speaker's Bureau; Abbott Diabetes, AstraZeneca, Bayer AG, Dexcom, Inc., Eli Lilly and Company, Janssen Pharmaceuticals, Inc., Merck & Co., Inc., Novo Nordisk Canada Inc., Sanofi. Z.Wu: Other Relationship; Eli Lilly and Company. A.Brazeau: Research Support; Eli Lilly and Company, Novo Nordisk, Sanofi.
Canadian Journal of Diabetes, Oct 1, 2012
Polskie Archiwum Medycyny Wewnetrznej-polish Archives of Internal Medicine, Feb 28, 2022
ing on a review on the topic of diabetes technologies use and impact on fear of hypoglycemia in t... more ing on a review on the topic of diabetes technologies use and impact on fear of hypoglycemia in type 1 diabetes, registered as PROSPERO 2021 CRD42021253618. OpEn AccEss This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial-¬ShareAlike 4.0 International License (CC BY-NC-SA 4.0), allowing third parties to copy and redistribute the material in any medium or format and to remix, transform, and build upon the material, provided the original work is properly cited, distributed under the same license, and used for noncommercial purposes only.
Canadian Journal of Diabetes, Oct 1, 2012
1,546 diabetic patients who started, 84.9% of nondiabetic versus 79.5% of diabetics completed CR ... more 1,546 diabetic patients who started, 84.9% of nondiabetic versus 79.5% of diabetics completed CR (p<0.0001); stratified by sex, the difference between diabetics and non-diabetics was greater in women (81.7 vs 72.1%, p <0.0001) than men (85.5 vs 82.5%, p¼0.004). Diabetics were less likely to return for 1-year assessment than non-diabetics (52.7 vs 61.9%, p<0.0001). Men were more likely to attend follow-up than women (63.3 vs 51.8%, p<0.0001); difference between diabetics and non-was similar in women and men. Change in CRF from baseline to 12-weeks was +1.0 METs in non-diabetic men, +0.8 METS in diabetic men, +0.9 METs in non-diabetic women and +0.7 METs in diabetic women (p¼0.0009). Changes in CRF at 1-year were +0.9, +0.6, +0.9, and +0.5 METS, respectively (p¼0.0001). Conclusions: Patients with diabetes, in particular females, were less likely to complete CR and attend follow up assessment. For subjects who attended follow-up, changes in CRF were similar across sex, however diabetics were less likely to maintain improvements. Identifying barriers and targeting CR adherence interventions to diabetic subjects may help improve outcomes.
Diabetes, Obesity and Metabolism, Aug 14, 2023
Canadian Journal of Diabetes, Oct 1, 2016
Diabetes, Obesity and Metabolism, Jun 29, 2022
Diabetes, Oct 1, 1985
The spontaneously diabetic BB rat syndrome is associated with a marked lymphopenia, which affects... more The spontaneously diabetic BB rat syndrome is associated with a marked lymphopenia, which affects all members of litters of diabetes-prone rats, and may be a necessary condition for the development of the disease. We assessed peripheral blood lymphocyte counts and subsets from birth to 66 days of age with a view to assessing the early time course. At birth, total numbers were decreased, as were total T-cells (monoclonal antibody W3/13 + , with an even greater deficit in 0X19 + cells), the helper/inducer subset (W3/25 +), and the suppressor/cytotoxic subset (0X8+), but la+ (B, 0X6 +) cells were not reduced. There was a less-thannormal rise in these values with time, and a similar pattern was observed at 66 days. Rats followed thereafter to onset of diabetes showed no differences at 66 days that were predictive of subsequent diabetes development. Another set of rats studied at the same age and again at onset of diabetes showed no changes concurrent with diabetes onset. The data are consistent with a genetically determined defect in lymphocyte numbers that leads to a subnormal rise in circulating cells later in life, and may predispose to another unidentified factor responsible for precipitation of the beta cell cytotoxicity. DIABETES 1985; 34:955-59.
Diabetes
We conducted a non-inferiority randomized crossover trial to alleviate carbohydrate counting (CC)... more We conducted a non-inferiority randomized crossover trial to alleviate carbohydrate counting (CC) in people with diabetes using automated dual-pump delivery of faster aspart (Fiasp) and pramlintide. Adults (N=15, 9 F, 39 ± 14 years, A1c 7.2 ± 0.9%) and adolescents (N=15, 8 F, 16 ± 1 years, A1c 8.4 ± 0.9%) used (i) Fiasp and placebo with CC, (ii) Fiasp and pramlintide with meal announcement (MA) , and (iii) Fiasp and placebo with MA for 2 weeks. Fiasp and pramlintide were delivered at a fixed 1 U:µg ratio to mimic a co-formulation. MA arms delivered fixed, user-specific priming meal boluses, independent of carbohydrate content. Prior to the first arm, participants had a 1-week run-in with automated Fiasp (single pump) delivery and CC, with mean time in range (70-180 mg/dL) of 71% in adults and 64% in adolescents. In adults, mean time in range was 65% on Fiasp and placebo with CC, 71% on Fiasp and pramlintide with MA, and 64% on Fiasp and placebo with MA; non-inferiority with a pre-de...
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Papers by Jean-françois Yale