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1.  Use of Vildagliptin in Management of Type 2 Diabetes: Effectiveness, Treatment Persistence and Safety from the 2-Year Real-Life VILDA Study 
Diabetes Therapy  2014;5(1):207-224.
There is an increasing interest for real-life data on drug use in many countries. Reimbursement authorities more and more request observational studies to assess the conditions of use of the products but also to improve knowledge about efficacy and safety in the real world and on a longer term than in clinical trials.
To evaluate the effectiveness, treatment persistence and tolerability of vildagliptin in clinical practice.
This observational, 2-year prospective cohort study was conducted in France on request of the Health Authorities [Haute Autorite de Sante (HAS)]. Type 2 diabetic mellitus (T2DM) patients initiating vildagliptin (including the fixed combination vildagliptin-metformin) or treated for <6 months were recruited through a national representative sample of general practitioners (GPs) (n = 482) and diabetologists (n = 84) between March 2010 and December 2011. At inclusion and each follow-up visit at ~ 6, 12, 18 and 24 months, a questionnaire was completed by the physician collecting information on socio-demographic, clinical and biological data, treatments and adverse events.
1,700 patients were included: 60% were males, aged 63 ± 11 years, with diabetes duration 7 ± 6 years and body mass index (BMI) 30 ± 6 kg/m2. 45% were obese, 70% treated for hypertension and 66% for dyslipidemia. 64% of the patients received vildagliptin in dual therapy with metformin. 82% of patients completed the 2-year follow-up. Glycosylated hemoglobin (HbA1c) decreased from a mean baseline of 7.8 ± 1.2% when vildagliptin was started, to 7.0 ± 1.1% at 6 months and remained stable thereafter over 2 years. Mean weight, glomerular filtration rate, liver enzymes, and lipid parameters were unchanged over the study period. Eight patients (0.5%), all concomitantly treated with insulin and/or sulphonylureas, reported one severe hypoglycemia and 47 (2.9%) patients reported 64 non-severe symptomatic hypoglycemia (59% occurred when patients were treated with insulin and/or sulphonylureas). At 6 months, 44.9% of vildagliptin-treated patients reached an HbA1c <7% without hypoglycemia and no weight gain, and this percentage increased to 49.7% at 24 months. Vildagliptin treatment maintenance at 2 years was 88.8% [95% CI (87.2%; 90.4%)], with 4% of patients discontinuing for adverse events.
In everyday conditions of care, vildagliptin efficacy was in line with existing data from randomized clinical trials, sustained over 2 years, with low discontinuation rate and low hypoglycemia risk.
Electronic supplementary material
The online version of this article (doi:10.1007/s13300-014-0064-0) contains supplementary material, which is available to authorized users.
PMCID: PMC4065290  PMID: 24729158
Diabetes; Effectiveness; Endocrinology; HAS-requested study; Hypoglycemia; Observational; Type 2 diabetes mellitus; Vildagliptin
2.  Characteristics of Suicide Attempts in Anorexia and Bulimia Nervosa: A Case–Control Study 
PLoS ONE  2011;6(8):e23578.
Compared to other eating disorders, anorexia nervosa (AN) has the highest rates of completed suicide whereas suicide attempt rates are similar or lower than in bulimia nervosa (BN). Attempted suicide is a key predictor of suicide, thus this mismatch is intriguing. We sought to explore whether the clinical characteristics of suicidal acts differ between suicide attempters with AN, BN or without an eating disorders (ED).
Case-control study in a cohort of suicide attempters (n = 1563). Forty-four patients with AN and 71 with BN were compared with 235 non-ED attempters matched for sex, age and education, using interview measures of suicidal intent and severity.
AN patients were more likely to have made a serious attempt (OR = 3.4, 95% CI 1.4–7.9), with a higher expectation of dying (OR = 3.7,95% CI 1.1–13.5), and an increased risk of severity (OR = 3.4,95% CI 1.2–9.6). BN patients did not differ from the control group. Clinical markers of the severity of ED were associated with the seriousness of the attempt.
There are distinct features of suicide attempts in AN. This may explain the higher suicide rates in AN. Higher completed suicide rates in AN may be partially explained by AN patients' higher desire to die and their more severe and lethal attempts.
PMCID: PMC3155572  PMID: 21858173
3.  Systems medicine and integrated care to combat chronic noncommunicable diseases 
Genome Medicine  2011;3(7):43.
We propose an innovative, integrated, cost-effective health system to combat major non-communicable diseases (NCDs), including cardiovascular, chronic respiratory, metabolic, rheumatologic and neurologic disorders and cancers, which together are the predominant health problem of the 21st century. This proposed holistic strategy involves comprehensive patient-centered integrated care and multi-scale, multi-modal and multi-level systems approaches to tackle NCDs as a common group of diseases. Rather than studying each disease individually, it will take into account their intertwined gene-environment, socio-economic interactions and co-morbidities that lead to individual-specific complex phenotypes. It will implement a road map for predictive, preventive, personalized and participatory (P4) medicine based on a robust and extensive knowledge management infrastructure that contains individual patient information. It will be supported by strategic partnerships involving all stakeholders, including general practitioners associated with patient-centered care. This systems medicine strategy, which will take a holistic approach to disease, is designed to allow the results to be used globally, taking into account the needs and specificities of local economies and health systems.
PMCID: PMC3221551  PMID: 21745417
4.  Is decision making really impaired in eating disorders? 
Neuropsychology  2010;24(6):808-812.
Decision-making has been reported to be reduced in eating disorders. However, studies are sparse and have been carried out in various selected populations. The current study was arranged to confirm previous observations and to assess the relationship between decision-making and dimensions relevant to eating disorders.
Patients suffering from anorexia nervosa (n=49), bulimia nervosa (n=38), and healthy controls (n=83) were assessed using the Iowa Gambling Task (IGT). All patients were euthymic and free of psychotropic medication. Self-questionnaires (EDI-2 and EAT) were used to assess clinical dimensions relevant to eating disorders.
No significant differences in IGT performance were observed between patients and healthy controls, or between restrictive and purging types of anorexia nervosa. No correlations were found between IGT performance and eating disorder questionnaires.
These results do not support reduced decision-making in patients with eating disorders, and suggest that previously reported alterations could be related to other clinical characteristics. This should stimulate new topic-related studies designed to reach a firm conclusion.
PMCID: PMC3074243  PMID: 20853958
Anorexia Nervosa; complications; psychology; Bulimia Nervosa; complications; psychology; Cognition Disorders; diagnosis; etiology; Decision Making; physiology; Female; Humans; Neuropsychological Tests; Questionnaires; anorexia nervosa; bulimia nervosa; Iowa Gambling Task; neuropsychology
5.  Effects of oral monosodium (l)-glutamate on insulin secretion and glucose tolerance in healthy volunteers 
To investigate the effects of glutamate on insulin secretion and glucose tolerance in humans.
Monosodium (l)-glutamate (10 g) was given orally in a double-blind placebo-controlled cross-over study to 18 healthy volunteers, aged 19–28 years, with an oral (75 g) glucose load.
The 75 min insulin response (AUC(0,75 min)), up to tmax of glutamate kinetics, was significantly correlated with the AUC(0,75 min) of glutamate concentrations (r = 0.485, P = 0.049). Glucose tolerance was not affected.
Oral (l)-glutamate enhances glucose-induced insulin secretion in healthy volunteers in a concentration-dependent manner.
PMCID: PMC1874333  PMID: 12047489
clinical investigation; glucose tolerance; glutamate; insulin secretion; insulin sensitivity

Results 1-5 (5)