Dyserythropoiesis thus leads to a reduction in hepcidin synthesis, which in turn increases intestinal absorption of this excess iron. This is very marked in Blackfan-Diamond anemia and the different forms of congenital dyserythropoiesis. Before the advent of erythropoietin EPO , patients undergoing chronic dialysis underwent repeated blood transfusions to correct anemia, with the risk of iron overload correlated with the number of transfusions. Since the advent of wide EPO use, the need for blood transfusions in these patients has clearly fallen. In , Rostoker et al. Click here to see the Library ].
Over a 3. The utility of iron supplementation in high-level athletes has not been scientifically demonstrated. How should clinicians proceed if they suspect HIO? Does the risk of iron overload depend on the genetic nature of the hyperferritinemia? On its cause? Its level? Or on the level of transferrin saturation? In HFE-4, the location of the iron overload within the macrophages explains the hypointense signal observed on MRI of the liver and spleen.
This stage is essential for enabling iron, released from cells, to bind to transferrin. The ceruloplasmin mutation leads to diffuse iron overload and is accompanied by cerebral damage causing neurological disorders cerebellar ataxia, extrapyramidal signs, and progressive dementia as well as retinal degeneration. While some of these genetic diseases result in iron overload, others, such as Gaucher disease and the l -ferritin mutation, do not Table I.
The genetic cause of a disease does not always mean that iron overload will develop. It is an inflammatory disease affecting, in particular, young women; it combines fever with daytime peaks, one or more forms of arthritis, and rash. We consider that these four diseases share clinical and laboratory signs as well as some of the same treatments corticosteroids, IV immunoglobulins, and plasma exchange.
Despite the extent of the increase in serum ferritin levels, HIO is not a risk in any of these conditions. It is generally considered that the higher the transferrin saturation coefficient, the greater the risk of HIO. If none of them is identified, possible diagnoses to be considered next include hyperthyroidism, porphyria cutanea tarda, Gaucher disease, the hyperferritinemia-cataract syndrome, or excess iron intake or infusions for dialysis patients and athletes.
In addition to a clinical examination, a simple work-up can be proposed for all patients with hyperferritinemia: complete blood count and hemogram, CRP, liver function tests, transferrin saturation, TSH, blood glucose, cholesterol, triglycerides, CPK, reticulocytes, and haptoglobin. This work-up enables detection of the most frequent causes of high ferritin concentrations. Numerous diseases can induce hyperferritinemia. The discovery of a cause does not mean that it is the cause of the hyperferritinemia. Very often, several causes are associated.
These various guidelines should facilitate the diagnostic procedure in cases of hyperferritinemia and detect as rapidly as possible a potential HIO that requires treatment. Journal page Archives Articles sous presse. Article Article Outline. Access to the text HTML. Access to the PDF text If you experience reading problems with Firefox, please follow this procedure.
Recommend this article. Save as favorites. Free Article! Disponible en ligne depuis le mercredi 22 novembre Diagnosis of hyperferritinemia in routine clinical practice. Outline Masquer le plan. Introduction and review of ferritin. The literature review was conducted in December We also searched non-indexed peer-reviewed publications in France to ensure that we did not omit any important sources. Studies presenting national data on prevalence, incidence, mortality, screening, treatment, outcomes, costs and complications in the French population were included.
Data and reports from governmental entities and professional societes were also reviewed. This evidence was complemented and confirmed by primary data obtained through personnal communication with French diabetes experts from the Assistance Publique-Hopitaux de Paris AP-HP. Literature review results. In the absence of an ongoing cohort or registry in France, the incidence of diabetes new cases per year is difficult to estimate. However, data from the SHI funds provide a precise picture of the patients currently treated for diabetes.
A type 1 diabetes registry was maintained from until and found an incidence rate of 9. Type 1 incidence has doubled in 30 years for the 0—15 age group and doubled in 15 years for the 0—5 age cohort. Incidence of combined type 1 and type 2 diabetes has been estimated based upon new admissions to the ALD program. The incidence rate of ALD admissions for diabetes reached per inhabitants in , which corresponds to approximately new cases [ 4 ].
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Since , diabetes has had the highest prevalence among all ALD conditions, and the number of patients covered has doubled in the past 10 years [ 8 ]. From — a national program for type 2 diabetes focused on prevention, screening, the quality and organization of treatment, epidemiology and patient education and led to ongoing initiatives [ 12 ]. In addition, a national plan to improve the quality of life of persons with chronic diseases — has emphasized therapeutic education and improved epidemiological data collection as priorities [ 13 ].
Based upon random samplings of adult SHI beneficiaries who had received at least three reimbursements for oral antidiabetic medications or insulin over a month period, the ENTRED studies supplemented these data with hospitalization records, telephone interviews of physicians, as well as postal surveys of diabetic patients and their treating physicians. Although the ENTRED studies were limited to patients who were treated pharmaceutically for diabetes, they have yielded important insights, particularly regarding the evolution of diabetes and related complications in France.
In , Overweight increases the risk of developing type 2 diabetes three times, and obesity increases that risk seven times. In addition to addressing overweight and obesity, the expert committee for PNNS — has proposed more aggressive screening of persons with pre-diabetes, in particular those with glucose intolerance [ 16 ].
Currently, oral glucose testing fasting or non fasting in France is generally limited to pregnant women in order to diagnose gestational diabetes. The French government has recognized the critical role of the patient in managing chronic diseases such as diabetes.
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The project, which began as a pilot in and was expanded nationwide in early , has to date provided services to patients Participation is voluntary, and the services offered include telephone advice by specially-trained nurses as well as Internet-based support to ensure regular contacts with patients. While such educational programs have been offered by a number of diabetes provider networks in France, the programming, financing and participation are heterogeneous.
Only 2. The law sets standards for TPE programs, which are now subject to authorization by the regional health agencies. The education itself can take place one-on-one or in a group setting or both and must be evaluated to ensure that the objectives are met. However, the financing mechanism for this initiative has not yet been defined.
The National health authority is developing new tools for health professionals and patients with chronic diseases to facilitate the design of personalized patient pathways [ 21 ]. To date, guides and associated tools for four chronic diseases have been published and another four are being prepared, although diabetes is not among them. In France, screening for type 2 diabetes is done based on clinical signs e. Screening is done via a fasting serum glucose test. The overall opportunistic screening rate over two years was Among those over age 45, the screening rate increased to Populations that may be missed by this targeted screening approach include those who do not use medical services and at-risk populations, such as homeless people.
Treating diabetes is complicated because of the need to normalize the glycemic level and to address any cardiovascular risk factors or existing complications, while taking into consideration the individual needs and characteristics of the patient. Clinical treatment recommendations for type 2 diabetes have existed in France since , with the most recent revision issued in January [ 24 ]. The general philosophy behind the guidelines is that treatment should be individualized and thus evolve over time based on regular re-evaluation of all aspects of treatment: life style, therapeutic education and medication.
Physicians appear to have a good awareness of the recommendations, [ 25 ] but they do not strictly apply them in managing their patients with type 2 diabetes [ 26 ]. Thus regular monitoring is essential to ensure appropriate and timely treatment of diabetes and its complications. There are only 1. The majority of endocrinologists In addition, pay-for-performance P4P incentives have been implemented to promote quality and efficiency in primary care. They do not change the basis of fee-for-service payment but offer additional remuneration to GPs meeting defined objectives.
Access to paramedical professionals appears to be limited. Such visits were generally related to insulin treatment and thus late in the evolution of type 2 diabetes. Dietitian visits are not covered by SHI, and consultations with podiatrists have only recently become covered for patients with grade 2—3 lesions [ 29 ]. There are no nurse practitioners in France.
With respect to diabetic eye disease, there is a lack of qualified professionals for ophthalmological screening, in part because there are no optometrists in France [ 30 ]. In , there were only 5 ophthalmologists, which equates to one for every persons with diabetes [ 27 ]. The growing number of people with diabetes and the decreasing number of ophthalmologists able to perform fundoscopic examinations has been cited as a contributing factor to access problems [ 31 ].
Nonetheless, regional variations in access to ophthalmological screening remain [ 34 ].
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Screening for foot disease does not require referral to a specialist. Indeed, the French diabetes society recommends a clinical examination of the feet of diabetic patients at each visit, even in the absence of symptoms [ 35 ]. The control of vascular risk factors improved between and , likely due to the intensification of pharmacological treatment with antihypertensive and cholesterol-lowering medications [ 37 ]. Renal complications are likely underestimated and thus under-screened due to the fact that patients tend to remain asymptomatic for a long time.
National Institute of Health. Retrieved 2 June Part 2. Current Pharmaceutical Biotechnology. Trends in Parasitology.
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The American Journal of Cardiology. A prospective population study in eastern Finnish men. Journal of Epidemiology and Community Health. J Applied sciences. Archives of Internal Medicine. The New England Journal of Medicine. Retrieved 10 November Clinical Chemistry. Journal of Lipid Research. Journal of Clinical Lipidology. Archived from the original on 8 February Retrieved 14 November September Archived from the original PDF on 3 December National Institutes of Health. May Tietz fundamentals of clinical chemistry. Louis, MO: Saunders Elsevier.
Arteriosclerosis, Thrombosis, and Vascular Biology. Retrieved Journal of the American College of Nutrition. Archived from the original on The American Journal of Clinical Nutrition. Archives of Physical Medicine and Rehabilitation.
The burden and treatment of diabetes in France | Globalization and Health | Full Text
HMG CoA Reductase is an important enzyme in lipid and cholesterol metabolism, but it is not the only one. Advances in Therapy.
Retrieved 12 August The Tohoku Journal of Experimental Medicine. Retrieved 25 June Fatty Acids and Atherosclerotic Risk. In Arnold von Eckardstein Ed. Atherosclerosis: Diet and Drugs. Medicinal Research Reviews. Alcohol and Alcoholism. A controlled diet study". The American Journal of Medicine. The New Zealand Medical Journal. Current Opinion in Lipidology. Bryan 27 December Bryan Brewer, Jr, MD". Current Medical Research and Opinion.