New European recommendations on metabolic steatosis
New European recommendations on metabolic steatosis
New recommendations for clinical practice on the management of metabolic steatosis have been issued jointly by 3 European scientific societies bringing together specialists in hepatology (European Association for the Study of the Liver, EASL), diabetes (European Association for the Study of Diabetes, EASD) and obesity (European Association for the Study of Obesity, EASO), and published in June 2024 in the Journal of Hepatology.
Hepatologist Prof. Vlad Ratziu (IHU ICAN / AP-HP) contributed his expertise by taking part in the editorial committee for this update of clinical practice guidelines, which also takes stock of knowledge, prevention, screening, assessment and treatment of the disease.
Concepts: steatosis, steatohepatitis, cirrhosis and cancer
Metabolic steatosis (MASLD) is the accumulation of intrahepatic fat (steatosis) in the presence of one or more cardiometabolic risk factors.
The prevalence of this condition is constantly on the rise, affecting between 25% and 40% of individuals, depending on the country. Not everyone will develop a severe form of the disease. The presentation covers a wide spectrum, from benign conditions to much rarer forms that can have serious consequences for health:
- Isolated steatosis, which usually does not progress,
- Steatohepatitis (steatosis and inflammation of the liver) (formerly NASH), which can lead to fibrosis,
- Fibrosis, which builds up progressively and may, in the final stages, develop into cirrhosis,
- Cirrhosis,
- And liver cancer (hepatocellular carcinoma).
New European recommendations
Thanks to a rigorous procedure, known as the DELPHI method, and involving over 80 international experts, the new recommendations drawn up by the editorial board representing the three learned societies, EASL, EASD and EASO, offer an update of knowledge based on evidence-based medicine to better prevent and diagnose metabolic steatosis, and avoid severe complications.
In summary, the conclusions include the following key recommendations:
- Case-finding strategies for steatohepatitis with hepatic fibrosis, using non-invasive tests, should be applied in people with cardiometabolic risk factors (particularly in the presence of type 2 diabetes (T2DM) or overweight), abnormal liver tests or radiological signs of liver steatosis.
- A progressive approach using blood scores (such as FIB-4) and, sequentially, imaging techniques (such as Fibroscan® elastography) is recommended, to look for advanced fibrosis, which is a predictive factor for liver complications.
- In adults with metabolic steatosis, lifestyle modification is essential (weight loss, more balanced diet, exercise, cessation of alcohol consumption), coupled with optimal management of comorbidities, including the use of incretin-based therapies for type 2 diabetes, or obesity, if indicated.
- Bariatric surgery is also an option for people with severe obesity with multiple complications. According to certain criteria, adults with non-cirrhotic steatohepatitis and significant liver fibrosis can be treated with resmetirom, which has demonstrated histological efficacy on inflammation and fibrosis. It was launched in March 2024 in the United States and is expected to be launched in Europe.
- Unfortunately, no pharmacotherapy is available for patients who have reached cirrhosis, demonstrating the need to prevent the disease from progressing to this advanced stage.
The role of IHU ICAN in the management of MASLD and MASH
Since 2019, IHU ICAN has set up the 1st hospital structure for multi-organ diagnosis and comprehensive care dedicated to metabolic steatohepatitis, located at the heart of Hôpital de la Pitié-Salpêtrièrein Paris.
Directed by Dr Raluca Pais and Prof Vlad Ratziu, the MASH clinic is a unique care pathway designed to improve the diagnosis of this pathology and the management of patients suffering from it.
Successful world first for the PEGASE project: a heart transplant preserved for 12 hours
Successful world first for the PEGASE project: a heart transplant preserved for 12 hours
It’s a world first: Prof. Guillaume Lebreton has successfully performed the 1st heart transplant after transport across the Atlantic Ocean, keeping the heart for 12 hours instead of the usual maximum of 4. The heart transplant took place last January at the Hôpital de la Pitié-Salpêtrière (Paris).
Read the interview below with Prof. Guillaume Lebreton, cardiac surgeon in Prof. Pascal Leprince’s team (Cardiac Surgery Department at La Pitié-Salpêtrière – AP-HP, Sorbonne University, Inserm and IHU ICAN).
Professor Lebreton, could you tell us about this exceptional transplant?
“It all started with a call from the Agence de la Biomédecine, who informed us of the availability of a heart transplant in the French West Indies, and the good news that we had a compatible recipient at the Hôpital de la Pitié-Salpêtrière, awaiting a heart transplant and meeting the criteria of the PEGASE protocol.
Then it was a race against time to preserve the graft. We had to react very quickly to organize this cardiac sampling in overseas France. The team needed for the PEGASE study to run smoothly was flown from Orly to the West Indies on a standard commercial flight (Air France). The team includes a perfusionist and a cardiac surgeon. When we arrived in the West Indies, we were able to achieve the following in a very short time cardiac graft harvesting on the donor according to the usual procedures and position it with all the necessary precautions in the hypothermic and oxygenated preservation device (XVIVO Heart Assist Transport™) only 16 minutes after aortic clamping.
We then repatriated him to Paris on a scheduled flight the same day, and the transplant was carried out as soon as we arrived the following morning in the operating room of the cardiac surgery department at the Pitié-Salpêtrière Hospital, after more than 12 hours of preservation. Today the patient is doing well, discharged from hospital 30 days later, and has recovered his cardiac function perfectly well.”
“All these special logistics involving the Agence de la biomédecine, the West Indies university hospitals, Air France, the Paris and West Indies airports, and the various government departments had been carefully prepared and anticipated for several months.”
Which players were involved in this fine teamwork?
“This exceptional teamwork was a success thanks to the upstream work of the teams from IHU ICAN and AP-HP, as well as the invaluable help of our various partners, including the Agence de la Biomédecine, which coordinated the organ retrieval, Air France, as well as on-site hospital teams in the West Indies, and here in Pitié-Salpêtrière (paramedical and medical-surgical teams, cardiologists, anesthetists, resuscitators and surgeons), who made this heart transplant possible as part of the PEGASE pilot study.
We would like to thank all those who have supported us and continue to support us in carrying out the PEGASE study: our partners and sponsors (Adicare, Air France, Bouygues), XVIVO and all the collectors and donors of the 2023 Heroes’ Race) and, more broadly, all the people who have been heavily involved in this project and without whom it would not be possible.”
What does the future hold for heart transplantation?
“This first transplant is a great success for the PEGASE pilot trial! It opens up major prospects for heart transplantation, by providing better access to eligible hearts that are currently unused.
In fact, this breakthrough comes at a very opportune time, given the shortage of heart transplants this year, with the number of heart transplants down on previous years. The PEGASE study will therefore make it possible to extend the number of grafts, increase the number of heart transplants, and thus save many lives.”
“However, PEGASE is not yet fully financed: we still need the public’s generosity to bring this project to fruition. A total of 7 patients are to be transplanted as part of this pilot study. I would like to thank all those who will be able to support this wonderful project!
Contact us to find out more!
Would you like to find out more about the PEGASE pilot trial? If you would like to join us in supporting this highly innovative project to accelerate advances in heart transplantation, please contact Francine Trocmé (Communications and Philanthropy Director) by e-mail at f.trocme@ihuican.org or by telephone on 06 81 64 97 88.
MEDITWIN: using digital twins to develop tomorrow's personalized medicine
MEDITWIN: using digital twins to develop tomorrow’s personalized medicine
How can the use of virtual twins improve the quality of care, making healthcare safer and more accessible for all? This is the mission of MEDITWIN, a consortium of 7 Instituts Hospitalo-Universitaires (IHUs) including IHU ICAN, from Nantes University Hospital, Inria, associated startups and Dassault Systèmes, announced on Monday, December 11, 2023 in the presence of French President Emmanuel Macron..
Thanks to personalized virtual twins of organs, metabolism and cancerous tumors, this innovative project will make it possible to diagnose the risk of cardiovascular disease for high-risk patients, and to help specialized physicians choose treatments for effective patient follow-up.
The MEDITWIN initiative will be developed over 5 years, from 2024 to 2029. The partners’ investment in this project will be financially supported by the French government as part of France 2030.
What medical need does MEDITWIN meet?
“Digital twins open up the prospect of a new form of precision and preventive medicine for cardiometabolic diseases, by establishing for each individual his or her future risk of developing cardiovascular disease, based on risk factors such as his or her genomic signature. Such a project requires a change of scale in research, which has now been achieved thanks to the project led by Dassault Systèmes, with all the MEDITWIN partners on board.”
Prof. Stéphane Hatem, General Director of the ICAN IHU and Director of UMR 1166 Cardiovascular and Metabolic Diseases
Cardiometabolic diseases, also known as cardiovascular-metabolic diseases, refer to a group of interconnected disorders affecting the heart and metabolic system. They mainly include: cardiovascular diseases affecting the heart and blood vessels (coronary heart disease, hypertension…) and metabolic disorders (type 2 diabetes, obesity, hypercholesterolemia, steatotic liver disease – MASH-(NASH)).
Cardiovascular disease is the world’s leading cause of death, accounting for almost 18 million deaths every year. In France, they represent the 2nd cause of death in the general population, with almost 150,000 deaths each year, and the 1st cause in women. More than 15 million people are treated in France for disease, cardiovascular risk or diabetes, at an annual cost of over 17 billion euros.
To date, all symptomatic and asymptomatic patients at risk are assessed for cardiovascular risk by their physicians.
The association between certain classic biological markers (classic lipid profile, LDL-cholesterol) and the risk of cardiovascular disease is indisputable. However, to date, the use of these markers in medical practice does not allow for fine stratification of this population.
Without predictive tools, it is difficult to individualize patient follow-up and choose the most appropriate treatments and optimal doses, while reducing the side effects associated with treatment (statins).
Technical advances not yet systematized
Scientific and biomedical research has made significant advances in this field, with plans to integrate other markers based on imaging and Omics data (metagenomics, metabolomics, lipidomics, proteomics).
Advances in imaging techniques, such as thoracic CT scans (large and small arteries), now enable non-invasive, detailed analysis of vascular damage in patients with no known cardiovascular disease.
By revealing the progression, stabilization or regression of the disease and predicting the quality of response to treatment, these new indicators become a concrete means of applying prevention and targeted therapies according to the patient’s profile and biology.
Familial hypercholesterolemia (FH) is a major cause of premature cardiovascular disease, and represents a model of accelerated pathological progression. Following the trajectory of these patients is therefore an opportunity to access risk prediction indicators within a limited timeframe.
Recent data have shown that, even in the case of familial hypercholesterolemia, the use of non-invasive coronary imaging can predict the incidence of cardiovascular events in asymptomatic subjects, with high predictive power over a follow-up of less than 3 years.
However, these techniques are not fully integrated into decision-making algorithms, and their use in clinical practice is not systematized.
Using virtual twins for a better treatment strategy
With this use case for virtual twins, the MEDITWIN consortium’s ambition is to develop a personalized predisposition diagnostic service for cardiovascular disease, and to select the best treatment strategies, while integrating the patient’s environment, such as gut microbiota and nutrition.
The predictions of such twins in terms of trajectories and their improvement could support the practitioner in the management of the patient, and also make more tangible the patient’s future in the absence of intervention in order to improve adherence to treatment. This will make it possible to measure the impact of proposed solutions in terms of reducing the number of patients with cardiovascular events (coronary, cerebrovascular, arterial…).
The benefits will be felt by patients, who will benefit from care tailored to their individual risk and directly linked to the progress of their disease, and by practitioners, who will be able to take advantage of tools for the early identification and management of chronic diseases.
MEDITWIN will therefore enable a digital twin model to be established to monitor the individualized cardiovascular risk of patients with familial hypercholesterolemia, thanks to a selection of relevant biomarkers.
Digital twins will help to clarify the cause-and-effect relationship between micro and macro-circulation in a healthy cardiovascular system, so that we can better understand the pathophysiological mechanisms of aging, hypertension, diabetes and other conditions.
IHU ICAN launches its barometer on cardiometabolic diseases with IFOP
Cardio-metabolic diseases: we’re all concerned!
To better inform and raise public awareness of one of the major causes of death in France, the IHU ICAN is launching its cardiometabolic barometer (IFOP / IHU ICAN study – September 2023), drawing on its extensive expertise in research and the fight against cardiometabolic diseases.
- What do the French know about cardiometabolism?
- How do they view these pathologies?
- Are they informed about causes and risk factors?
A veritable public health scourge, cardiometabolic diseases have been steadily on the rise in recent years. Today, they represent a major cause of death in France and the 1st cause of death worldwide (source: CépiDc/Inserm).
They include many diseases such as diabetes, obesity, cardiovascular disease (hypertension, thrombosis, cardiomyopathy, stroke, heart failure), liver disease (including hepatic metabolic steatosis or fatty liver disease), and hypercholesterolemia.
How these chronic diseases work is still too little known to the general public, as cardiometabolism is an emerging discipline that requires a high level of expertise. cutting-edge scientific and medical research to understand these complex, interconnected pathologies, linked to an imbalance in the individual’s metabolism and/or to genetic factors. They are very common and often diagnosed too late, as they develop silently in the body.
Yet cardiometabolic diseases concern us all.
A few figures (in France):
- Cardiovascular diseases: 5.3 million sufferers, more than 140,000 deaths per year
- Diabetes: 4 million people treated, 35,000 diabetes-related deaths
- Obesity: 17% of adults are obese, 47% overweight
- Hepatic metabolic steatosis (NASH): 18% of the population affected, almost 24% in 2030 (IHU ICAN estimate)
Sources : ameli, Santé publique France
Cardiometabolic diseases, a scourge still too little known
The first lesson to be learned from this study, cardiometabolic diseases are poorly identified by the French: only 38% have heard of them and 10% see exactly what it’s all about. Young women and donors to medical research – two audiences traditionally more aware of health issues – are slightly more likely to declare that they know about pathologies (45% and 55%).
The 38% of French people who say they know about these diseases have only a partial knowledge of them. If they rightly identify heart failure (85%), hypertension (76%) and stroke (67%) as diseases of the cardiometabolic system, they are less than 1 in 2 know that obesity (49%), hypercholesterolemia (47%) and diabetes (37%) also belong to this family of diseases. Non-alcoholic hepatic steatosis (20%) and cirrhosis (12%) are even less closely related to this family.
As a corollary to this poor understanding of cardiometabolic diseases, their contribution to deaths in France is underestimated: 15% of French people declare it as the main cause of death in France, whereas it is one of the main causes after cancer, and the 1st cause of death worldwide.
Cardiometabolic diseases perceived as serious and on the rise
After explaining to respondents what cardiometabolic diseases are, 82% of them agreed that they are serious pathologies, 73% that they have increased over the last ten years, and 73% that they are widespread in the French population. On the other hand, the chronic nature of these pathologies seems to be largely unknown, with 57% of those surveyed explaining that they can now be cured.
It’s also worth noting that 1 in 2 French people believe that cardiometabolic diseases are primarily a matter of individual responsibility (50%), a result that goes hand in hand with the fact that they are perceived as being caused solely by lifestyle.
Well-identified preventive measures and risk factors
Another finding of the study is that cardiometabolic diseases are widely perceived by the French as being caused by lifestyle, with this cause being cited first (51%), far ahead of genetic predisposition (13%) or environmental factors such as pollution (6%).
As a corollary to this, the French believe that public authorities should above all fight against cardiometabolic diseases through campaigns to raise public awareness of lifestyle changes (36%). Conversely, only 15% mention scientific research and 12% the improvement of diagnostic tools, which are essential levers in the knowledge and fight against these diseases.
The French identify preventive health and diet measures fairly well: they believe that a balanced diet (94%), regular physical activity (93%), not smoking (92%) and not drinking too much alcohol (88%) are effective in preventing the onset of cardiometabolic diseases.
They also largely agree on the risk factors, citing being overweight (87%), being a smoker (86%), having a diet rich in fat, salt and sugar (85%) or a stressful lifestyle (82%).
More French people fear cardiovascular disease
The results of the study also show that judgments about the various cardiometabolic pathologies are ambivalent, probably because representations diverge according to the type of disease.
Cardiovascular diseases are now better identified as diseases of the cardiometabolic system, and give rise to a great deal of concern. This type of disease is by far the most worrying (50%), far ahead of hypertension (14%), diabetes (16%), obesity (11%), non-alcoholic fatty liver disease (6%) or hypercholesterolemia (3%).
As a corollary to this, the French feel that these are the diseases that should receive priority attention from the public authorities (46%), ahead of obesity (26%), diabetes (15%), rare metabolic diseases (7%), hypercholesterolemia (3%) and non-alcoholic fatty liver disease (3%).
A lack of information about cardiometabolic diseases
Just over a third of French people say they have already been informed about cardiometabolic diseases (37%). In detail, slightly more people over 65 (42%), wealthier people (48%) and donors to medical research (50%) say they have been informed.
Doctors are the main source of information about these diseases (57%), ahead of family and friends (37%), the media (29%) and government communication campaigns.
Who we are?
Created in 2011, IHU ICAN is a scientific cooperation foundation whose main objective is to develop tomorrow’s medicine to combat cardiometabolic diseases. Located in the heart of Europe’s largest public hospital, At the Pitié-Salpêtrière Hospital, the ICAN HCI draws on the expertise of its scientific community. (168 doctors, 261 researchers) and its 3 founders to carry out its missions: AP-HP (Assistance publique – Hôpitaux de Paris), Inserm (Institut national de la santé et de la recherche médicale) and Sorbonne University.
Any questions? Contact us:
- Francine TROCME
- Director of Communications and Patronage – IHU ICAN
- 06 81 64 97 88
- f.trocme@ihuican.org
TRUE or FALSE: how can your diet reduce the risk of cardiometabolic diseases?
TRUE or FALSE: how can your diet reduce the risk of cardiometabolic diseases?
On the occasion of the World Food Day 2023IHU ICAN (Foundation for Innovation in Cardiometabolism and Nutrition) invites you to test your knowledge about the impact of your diet on your health, and the consequences in the development of cardiometabolic diseases (diabetes, obesityliver disease, heart and vascular disease…).
Answer the 5 questions below proposed by Vittoria Zambon, Nutritionist at IHU ICAN.
Test your knowledge and discover the scientific answer below!
- Fructose is a sugar to be avoided in the diet, as it has harmful effects on health, particularly on the liver. TRUE OR FALSE?
- Coffee consumption is recommended for patients with metabolic steatosis of the liver or “fatty liver disease”. TRUE OR FALSE?
- Probiotics are living micro-organisms that can be used in the treatment of many cardiometabolic diseases. TRUE OR FALSE?
- Different types of cooking and degrees of meat processing have no impact on health. TRUE OR FALSE?
- Omega 3 and vitamin E are particularly beneficial nutrients for cardiovascular and liver metabolism. TRUE OR FALSE?
1. Fructose consumption: not good for the liver?
“Fructose is a sugar to be avoided in the diet because it has harmful effects on health, particularly on the liver.”
Answer: FALSE.
- Fructose is a sugar naturally present in certain foods (fruit, honey, certain vegetables…) or added to processed foods by the food industry (additives, corn syrup, artificial sweeteners…).
- It is estimated that around 90% of fructose is metabolized by the liver, making this organ particularly vulnerable to excessive intake of this sugar, which can lead to the early signs of excessive fat accumulation in the liver.
- However, the origin of the fructose consumed (natural or processed) is decisive in its nutritional contribution to health: the natural fructose brings a variety of micronutrients combined with dietary fiber, while the processed fructose provides high energy density combined with increased amounts of sugar and saturated fats.
- Consequently, the effect of fructose consumption on liver function would be more related to the excess fat provided by unhealthy eating habits, leading to metabolic abnormalities, than to fructose itself.
- To date, the ICAN IHU teams wish to continue their research to compare the impact of natural and processed fructose consumption on the development and progression of metabolic steatosis of the liver.
Good to know: the WHO recommends a maximum consumption of 50 grams of sugar per day (10 teaspoons), with an ideal threshold of 25 g/d (values for a 2,000 kcal/d diet).
2. 3 cups of coffee a day against metabolic steatosis of the liver?
“Coffee consumption is recommended for patients with NASH (metabolic fatty liver disease)”.
ANSWER: TRUE.
- Regular consumption of coffee, without added sugar, is associated with a significant reduction in the risk and progression of metabolic liver steatosis.
- Thus, coffee can be considered a means of prevention for patients with metabolic steatosis of the liver, if combined with a healthy diet and regular physical activity.
- The recommended dose of coffee has yet to be defined by scientific research using prospective trials, but studies suggest that consumption of 3 cups a day would reduce the progression of metabolic steatosis of the liver thanks to hepato-protective effects (liver protection).
- The beneficial effects are particularly noticeable when filter coffee is consumed, rather than espresso coffee, since the final composition of coffee differs according to the extraction method used. Filter coffee preparation seems to preserve chlorogenic acids (natural antioxidants found in coffee beans) better than espresso coffee.
Good to know: Excessive coffee consumption is generally associated with smoking. To limit your consumption and take care of your liver, don’t smoke!
3. Probiotics, allies for the intestinal microbiota?
“Probiotics are living microorganisms that can be used in the treatment of many cardiometabolic diseases.”
ANSWER: TRUE.
- Probiotics play a therapeutic role in certain cardiometabolic diseases (hypercholesterolemia, obesity, metabolic steatosis of the liver, other gastrointestinal diseases…), thanks to their positive interactions with the intestinal microbiota.
- Probiotics help reduce problems of intestinal permeability, oxidative damage (oxidative stress) and the inflammatory consequences of these metabolic imbalances.
- This underlines the importance of a balanced and diversified diet in maintaining a healthy microbiota and a healthy body.
4. Red meat: no impact on health?
“Different types of cooking and degrees of meat processing have no impact on health.”
Answer: FALSE.
- Cooking meat at high temperatures (over 100 – 130°C) for prolonged periods (frying, grilling, roasting…) induces the formation of aromatic heterocyclic amines (AHAs), compounds that are harmful to health and recognized carcinogens.
- AHAs are also associated with an increased risk of insulin resistance (leading to diabetes) and metabolic steatosis of the liver.
- These observations may be linked to dietary habits based on high consumption of saturated fatty acids and ultra-processed food products, leading to cholesterol and increased inflammatory responses and lipid storage in the liver.
Good to know: Dietary guidelines for cardiometabolic health encourage a diet low in red meats (1 to 2 servings/week of 100 g) and processed meats (1 serving/week of 50 g). These indications correspond in particular to the Mediterranean diet, which includes more plant-based proteins, and has beneficial effects on the prevention of cardiometabolic diseases.
5. Omega-3 and vitamin E: health benefits?
“Omega-3 and vitamin E are particularly beneficial nutrients for preventing cardiometabolic, cardiovascular and hepatic (liver) diseases.”
ANSWER: TRUE.
- Omega-3 unsaturated fatty acids (found in seeds, nuts, certain fish such as salmon, sardines, tuna…) and vitamin E (found in vegetable oils, nuts, avocado…) are substances associated with improved health.
- This is due to the anti-inflammatory and antioxidant effects of these nutrients, which can reduce the risk of cardiovascular and metabolic diseases such as fatty liver.
Promote a balanced diet to prevent cardiometabolic diseases
Diseases linked to an unbalanced diet include in recent years. In addition to the individual context of each person, a better nutrition education and access to clear information on the composition of foods are measures that can help foster healthy eating habits.
Legislation on food labelling, known as “Nutriscore“, aims to educate and sensitize consumers when making food choices, and to regulate the marketing of products that are potentially harmful to health.
Good to know: According to the World Health Organization (WHO), a healthy diet is one that meets an individual’s nutritional needs, providing sufficient, varied and wholesome foods to maintain an active life and reduce the risk of disease.
The recommended diet consists of fruits, vegetables, legumes (lentils, beans), nuts and wholegrain cereals (oats, wheat, rice), and is low in fat (especially saturated fat), sugar and salt.
Scientific research to combat obesity and related diseases
The scientific and medical teams at IHU ICAN are developing research projects to better understand and treat cardiometabolic diseases, particularly those linked to diet.
In particular, you can consult our nutritional recommendations in the booklet for patients with metabolic steatosis of the liver.
The daily life of Aude, Advanced Practice Nurse in Diabetes
The daily life of Aude, Advanced Practice Nurse in Diabetes
On the occasion of World Nurses Day 2023, discover the portrait of Aude Bourgery Djongang, Advanced Practice Nurse in the Diabetology – Metabolism Department at the Pitié-Salpêtrière Hospital.
With the support of IHU ICAN, it is developing a paramedical and medical project to improve self-care for diabetic patients returning home. Find out more below!
The job of Advanced Practice Nurse (APN) in diabetology
Aude’s job is to provide comprehensive care for diabetic patients, who are hospitalized in other departments of the Pitié-Salpêtrière hospital group thanks to the Unité Mobile de Diabétologie.
- On arrival at the hospital: patient interview, clinical examination, assessment and adjustment of diabetes treatments,
- During hospitalization: shared educational assessment, implementation of the therapeutic education needed for a safe return home, answering questions from patients and their caregivers,
- On leaving hospital :organizing the diabetes care pathway (day or weekday hospital), prescribing additional tests to monitor diabetes, remote monitoring to adjust diabetes treatment, maintaining the link with the patient between the time of discharge and the next diabetes appointment, answering questions from the patient and caregivers.
As an Advanced Practice Nurse in Diabetes, it acts as a link between outpatient medicine and the hospital : general practitioner, private nurses, diabetologist, pharmacist, chiropodist… In relation with the CPTS Paris 13 (Communauté Professionnelle Territoriale de Santé), it can guiding patients with unbalanced diabetes and need to be followed up in consultation or hospitalized.
At the same time, Aude is also developing a paramedical research activity, taking part in local and national projects. She is currently working on a project linked to therapeutic patient education (TPE).
A project to improve self-care for diabetic patients returning home
“How did the idea for this project come about? It’s by listening to patients that we find possible solutions to their needs. When I explained how to perform self-measurement of blood sugar or insulin injections, many asked to film my demonstrations so they could watch them again and reproduce the correct gesture. So I came up with the idea of setting up a program of educational videos so that patients could develop self-care skills and those around them could also learn.”
Therapeutic patient education (TPE) carried out in a mobile diabetes unit needs to be extended to the home, in view of increasingly short hospital stays and outpatient care.
Supported by the SFD Ypsomed 2023 grant, this innovative digital learning project complements existing face-to-face therapeutic education.
- Via a QR code accessible on prescriptions, flyers and posters in the department, patients can follow a simple, fun digital learning program consisting of 6 educational videos.
- At the end of each video, an interactive game will measure the improvement in knowledge and reinforce the educational messages.
“We want to offer patients a useful tool that will take into account their level of digital literacy, to ensure it’s easy to use for everyone. To date, the videos are almost complete. We’re now moving on to the phase of creating the interactive tool, with the aim of having it operational by the end of 2023 for patients, their carers, but also by carers wishing to complete their training.”
Support the development of this project
To take things a step further, Aude and the medical team want to combine the use of educational video and augmented reality to put the patient in a real-life situation. This technology will reinforce the patient’s commitment to the use of the “offloading shoe”, a medical device prescribed for the care of diabetic foot wounds.
- This project is carried out in the Diabetology – Metabolism Department of Pr. Agnès HARTEMANN, Groupe Hospitalier Pitié-Salpêtrière, Institut IE3M
- Aude DJONGANG BOURGERY, Advance Practice Nurse
- Dr Georges HA VAN, Diabetologist
This project needs support to finance its development: contact Francine Trocmé (Director of Patronage and Communications at IHU ICAN) for more information.
Heart failure: the UTHop'IA project reinforces therapeutic education during hospitalization
Heart failure: the UTHop’IA project reinforces therapeutic education during hospitalization
Heart failure is a chronic disease that requires lifelong monitoring. As with all chronic diseases, therapeutic education plays a major role in the management of the disease, by involving patients and their families in the care process. It means better compliance with treatment, fewer hospitalizations and a better quality of life.
Led by IHU ICAN, the UTHop’IA project aims to support heart failure patients from hospitalization to their return home, using digital tools and artificial intelligence.
Find out more about the 5 projects included in UTHop’IA, involving CapGemini and students from the ECE engineering school, Polytech and Pantheon-Sorbonne University.
What medical problems does the UTHop’IA project address?
Heart failure affects around 1 million people in France, and 120,000 new cases are diagnosed every year. This chronic disease is responsible for 200,000 hospitalizations and 70,000 deaths every year. It mainly affects people over the age of 75, but can also affect much younger people. Malgré les progrès de la prise en charge, un patient sur deux meurt dans les cinq ans suivant le diagnostic.
Since 2006, doctors in the cardiology department at Hôpital de la Pitié-Salpêtrière have been running a therapeutic education program (ETP) for heart failure patients after discharge from hospital, which includes several group workshops.
Unfortunately, these workshops are not always well attended by patients, who are not sufficiently aware of the seriousness of their disease and the changes it implies in their daily lives. 50% of patients relapse and are readmitted to hospital 6 months after discharge. It is therefore vital to reduce this figure.
The UTHop’IA project aims to raise patients’ awareness of the importance of therapeutic education from the moment of hospitalization for cardiac decompensation, in order to improve patient follow-up and avoid further hospitalization.
What is the UTHop’IA project?
One of the aims of the UTHop’IA project is to set up a therapeutic education program for patients hospitalized for a heart failure attack, using digital tools and artificial intelligence.
Thanks to this innovative program, hospitalized patients will be able to discover and assimilate “key” information to help them understand their illness: What treatments and new habits can you incorporate into your daily routine? How do I apply the salt-controlled diet? What are the warning signs of impending decompensation?
The UTHop’IA project, which will continue to develop for a few more years before it becomes available, aims to support patients from their hospitalization to their return home:
- While the patient is in hospital, information is delivered interactively by a humanoid robot,
- Once discharged from hospital and back at home, the patient’s awareness continues via a computer or smartphone, where he or she can find the same interface used during hospitalization. The artificial intelligence remembers previous interactions with the patient.
- In the weeks that follow, voice-mediated telemonitoring is set up (via computer or smartphone) to monitor the patient’s new disease-related habits.
An innovative project structured into 5 research sub-projects
The UTHop’IA project is structured into 5 research sub-projects to develop the various pedagogical and technical aspects of the therapeutic education program:
- ROB’EDUC: creation of a therapeutic education program (quizzes, advice, etc.). This sub-project benefited from the institutional support of AstraZeneca and the collaboration of students from the ECE engineering school. Find out more about the ROB’EDUC sub-project.
- ROBMAP: research into the autonomous navigation of the humanoid robot, called Charlie, within the hospital ward to visit patients, with the help of students from
- ROBARM: design of an automated arm for the Charlie robot’s autonomy in opening service doors, with the help of Polytech students in collaboration with Capgemini Engineering.
- CAP BOT VOCAL: development of a “voice bot” assistant using artificial intelligence, with the help of students from Pantheon Sorbonne University.
- CAP BOT DESIGN: development of a connected speaker to complement the existing tablet, with the help of students from Polytech Sorbonne.
They support the UTHop’IA project
The UTHop’IA project is led by Dr Françoise Pousset, Prof Richard Isnard and Dr Lise Legrand (IHU ICAN). “We are convinced that this highly innovative project will support the work of our medical teams. The Charlie robot will reinforce our teams, not to replace human contact, which is essential, but to free up more time for patient care and follow-up during hospitalization.
“This innovation will give medical teams a real break from the frenetic pace of care. The benefits will be felt not only by caregivers, but also by patients, who will be better equipped to deal with their illness. “Aurélie Foucher, Scientific Operations Manager on the UTHop’AI project.
For its ROB’EDUC sub-project, the UTHop’IA project benefited from the institutional support of AstraZeneca, as well as from the mobilization of IHU ICAN employees who raised funds during the 2022 Heroes’ Run.
What is the status of medical research to combat type 2 diabetes (T2D)?
What is the status of medical research to combat type 2 diabetes (T2D)?
An increasingly common chronic disease, type 2 diabetes (T2D) is characterized by elevated blood sugar levels, also known as hyperglycemia. It concerns 92% of diabetic patients, i.e. about 3.6 million French people, and generally affects people over 40 years old.
Thanks to many years of active medical research, scientific advances have made it possible to better understand this disease and to develop treatments for the benefit of patients. What is the status of medical and scientific research on type 2 diabetes?
Discover below the testimony of the Prof. Fabrizio Andreelliwhich contributes to the research work of the Diabetes-Metabolism Department of the Pitié-Salpêtrière Hospital, and of the Nutriomics unit (INSERM / IHU ICAN).
What role does the gut microbiota play in T2D?
The intestinal microbiota is the set of micro-organisms (including bacteria) present in the intestines. Our research teams are interested in the link between microbiota and type 2 diabetes.
They noted that overweight populations show an imbalance in the composition of these intestinal bacteria and an impoverishment of the diversity (variety) of the intestinal flora. This phenomenon is intensified for overweight patients with T2D, who show more alterations in the diversity of their flora.
Can an impoverished gut microbiota promote obesity and type 2 diabetes?
In our laboratory, our research teams therefore contribute to analyze these bacterial species in order to better understand them and to restore a balanced flora in our patients, in order to limit their weight gain and improve their blood sugar levels (blood sugar level), in case of type 2 diabetes.
What impact does bariatric surgery have in T2D?
Research has shown that weight loss improves type 2 diabetes. In fact, physical activity and a balanced diet are part of the hygienic and dietary measures that make it possible to treat T2DM in the first instance, before oral or injectable medication.
In some populations, bariatric surgery to lose weight (gastric banding or more complex surgery that creates an intestinal bypass) helps to normalize blood sugar levels of the patient postoperatively, and even in some cases to make disappear type 2 diabetes. This phenomenon has been observed quickly after the operation (days or weeks)long before the patient begins to lose weight.
What mechanism(s) improve blood glucose after bariatric surgery, before any significant weight loss? Is it the operation itself that induces new signals to wake up the cells that secrete insulin in the pancreas?
In our laboratory, these questions were addressed using a mouse model, recreating the same context as in human patients. In mice and humans, it has been shown that bariatric surgery can awaken the endocrine pancreas, that is, the part of the pancreas that secretes insulin, a hormone that is crucial for controlling blood sugar levels (glucose). Thus, in humans as well as in operated rodents, an increase in insulin secretion is observed, allowing the improvement of blood sugar levels, and even the disappearance of type 2 diabetes.
Analysis of the mechanisms involved in the improvement of diabetes after bariatric surgery revealed involvement of the pancreatic beta cell (endocrine pancreas)which will regain optimal functionality, making it capable of secreting insulin according to the body’s needs in order to regulate blood sugar levels.
Our teams are now working to identify substances that could be released from the operated intestine and that target the endocrine pancreas, thus making it possible to explain how the operated intestine improves the functionality of the pancreas on the basis of the communication between these two organs. The identification of these substances could lead to the creation of new drugs or nutritional solutions to balance the blood sugar levels of patients with type 2 diabetes without bariatric surgery.
What impact does T2D have on the intestinal system?
In patients with type 2 diabetes and who are overweight, the hormonal functioning of the intestinal system is altered. In fact, the intestine has other functions than just absorbing food. Some intestinal cells are specialized in the secretion of hormones that are mainly secreted during meals. These hormones have a double function: to reach the pancreas in order to secrete more insulin to balance blood sugar during meals; and to induce satiety. The production of these hormones called incretin hormones is defective in obesity and type 2 diabetes, which prevents the endocrine pancreas from releasing more insulin and also reduces the satiety message to the brain.
The classic functioning of the intestinal system
- The microbiota (intestinal bacteria), in contact with food, will interact with the intestine which will release intestinal hormones, or incretin hormones (such as GLP-1), which will circulate in the blood and warn the body that the meal is about to arrive.
- Upon receiving these hormones, on the one hand the pancreas will secrete more insulin, and on the other hand the brain is informed that satiety must be prepared.
How can we improve the secretion of the missing incretin hormones to increase the secretion of insulin needed to control blood sugar levels?
The identification of one of the incretin hormones, called the GLP-1, has recently allowed research teams to develop a medication to treat type 2 diabetes. This treatment comes in the form of a pre-filled pen of GLP-1, allowing a weekly subcutaneous injection. It will allow to restore this important hormone to the bodywhich is no longer or poorly manufactured by the intestine.
This medication is available for patients with T2DM, and is increasingly recommended when lifestyle modifications are not enough (physical activity, diet…).
A new generation of drugs is expected to be available in 2023-2024, with pens that include 2 or even 3 different gut hormones to enhance the effects on satiety and endocrine pancreas secretion.
“This is a huge hope for all patients. It will prevent diabetes from becoming unbalanced, reduce the risk of complications, and allow for better health,” says Professor. Fabrizio Andreelli, Department of Diabetology, Pitié-Salpêtrière Hospital.
World Diabetes Day 2022: How to diagnose and treat type 2 diabetes?
Comment le diabète de type 2 est-il diagnostiqué et traité ?
In France, more than 4 million people live with diabetes. Worldwide, it is estimated that it affects 1 in 10 adults between the ages of 20 and 79, or 537 million people.
A major public health issue, diabetes is a chronic disease characterized by an excess of sugar in the blood (hyperglycemia), caused by a malfunction of the pancreas. More precisely, it is an imbalance between the glucose storage hormone, insulin, and the hormone that releases it, glucagon.
There are 2 forms of diabetes: “type 1” diabetes (T1D) which is an autoimmune disease affecting about 6% of diabetics, and “type 2” diabetes (T2D) which generally occurs after age 40.
On the occasion of World Diabetes Day on November 14, 2022, the medical and research teams of the ICAN IHU inform you about type 2 diabetes, which affects 92% of diabetic patients and has increased considerably in France in recent years.
What is type 2 diabetes?
Insulin is a hormone naturally secreted by the pancreas, whose role is to regulate blood sugar levels at normal values, for the proper functioning of the body.
Sometimes the body’s cells misuse insulin. The individual has insulin resistance, where the pancreas is no longer able to adjust and secrete insulin normally. This causes an increase in blood sugar levels (hyperglycemia), and the development of type 2 diabetes (T2D).
- 3.5 million patients have T2D in France,
- About 1 million people would be undiagnosed in France.
What causes type 2 diabetes?
This disease can be induced by multiple causes:
- Family environment, with a history of diabetes in the family,
- Environmental factors, depending on the level of physical activity and sedentary lifestyle,
- Diet and weight gain,
- Age, aging is a risk factor for developing type 2 diabetes.
How is type 2 diabetes diagnosed?
Type 2 diabetes often develops very gradually, silently over many years. Most of the time, elevated blood sugar levels do not cause any noticeable symptoms for the patient.
The diagnosis is made by a simple blood test to measure the blood sugar level, when the general practitioner considers it necessary, depending on the patient’s risk factors. Certain symptoms can also lead to a check-up:
- Feeling of thirst
- Regular urge to urinate
- Weight loss
How is type 2 diabetes treated?
Treatments for type 2 diabetes are designed to help insulin work better to regulate blood sugar, or to increase the ability of the pancreas to produce insulin.
In recent years, scientific advances have made it possible to develop several types of treatment, resulting in personalized medicine based on each patient’s: lifestyle, existing pathology(ies), appetite for the proposed treatment, etc.
1. Hygienic and dietary measures
In the treatment of type 2 diabetes, the first step is to respect hygienic and dietary measures to improve the evolution of the disease:
- Weight reduction and control through a balanced diet,
- Regular physical activity,
- Stop smoking.
2. Oral and injection treatments
If these measures are not sufficient, 2 types of treatment exist:
- Oral treatments: anti-diabetic drugs in tablet form,
- Insulin injection treatments: insulin pump, refillable insulin pen, pre-filled pen, insulin syringe…
What are the complications of type 2 diabetes?
Failure to manage the disease can lead to serious long-term complications in:
- The eye: development of diabetic retinopathy or “diabetes in the eye”, which can lead to blindness if not treated,
- Kidney: development of diabetic glomerulopathy, which can lead to chronic kidney disease, renal failure and, in advanced stages, the need for dialysis (artificial blood purification),
- Vessels in the heart, brain or leg arteries: possibility of developing a heart attack, stroke, or arteritis in the legs.
- Feet: severe complications of diabetic foot wounds, which can lead to ulceration and amputation of the lower limbs.
These severe complications usually appear after 5 to 10 years of untreated diabetes.
Do you have risk factors? If in doubt, talk to your doctor. A simple blood test allows the diagnosis.
What about type 1 diabetes?
More rare than type 2 diabetes, type 1 diabetes often appears in childhood or early adulthood. It affects less than 10% of patients with diabetes.
“Diabetes has lived with me for a very long time, more than 30 years. The announcement of a disease, no matter what it is, is an upheaval in one’s life. You wonder why it’s happening to you. You ask a lot of questions, you’re a bit angry, disoriented (…) I’ve had to adapt as technological advances have come along, and at different times in my life.” (birth of a child, travel, professional activities…).“This is what it’s like to live with diabetes.” Testimony of Betina, a patient in the diabetes department of the Pitié-Salpêtrière Hospital
“With the huge technological advances of the last few years, the mental burden is decreasing tremendously, and the quality of life is improving incredibly (…) The doctor is a partner, he is involved in our life. When things don’t work out, he’s there to listen and support me. And when it does work, he’s going to be there to rejoice with me too!” Betina, patient in the diabetology department of the Pitié-Salpêtrière Hospital
What consensus in the diagnosis and management of atrial fibrillation?
What consensus in the diagnosis and management of atrial fibrillation?
Strongly involved in research on atrial fibrillation, Professor Stéphane HATEM (Director General of the ICAN IHU and Director of the UMR 1166) participated in the 8th AFNET/EHRA Consensus Conference the Atrial Fibrillation NETwork (AFNET) and the European Heart Rhythm Association (EHRA), where 83 international experts brought together their expertise to support improved AF risk management through prevention, individualized care and research strategies.
Discover below the main results of this consensus!
Atrial fibrillation
Despite major progress in its management, the Atrial Fibrillation (AF) remains associated with significant morbidity and mortality. A major public health issue, it is the 1st cardiac cause of vascular embolic accidents (CVA) and decompensation of heart disease, and is a factor of cognitive decline and epidemic character with the aging of the population.
To combat this scourge, it is necessary to identify patients at risk of AF, those with paroxysmal and clinically silent episodes of AF before the onset of a stroke, and to invent new personalized upstream therapeutic treatments.
Management of atrial fibrillation: what advances?
To improve risk assessment of atrial fibrillation (AF) and to guide treatment of the arrhythmia, further scientific and clinical translational research is needed to better understand the various underlying mechanisms reflected by the electrocardiographic (ECG) pattern of AF.
Prof. Stéphane HATEM, Director of the IHU ICAN
Published on July 27, 2022 in EP Europace, the scientific publication “Early diagnosis and better rhythm management to improve outcomes in patients with atrial fibrillation : the 8th AFNET/EHRA consensus conference” presents the the main results of these interdisciplinary discussions, based on recently published or unpublished scientific observations.
Further improvements for the patient are possible with continued efforts to identify and target atrial cardiomyopathy and associated cognitive impairment, which can be facilitated by Artificial Intelligence (AI).
The main results are as follows:
- Every effort should be made to control the heart rhythm through the individualized use of various drug or interventional anti-arrhythmic therapies, combined with aggressive management of cardiovascular and metabolic risk factors,
- Better characterization of the atrial cardiomyopathy underlying AF is a challenge to improve identification of patients at risk and to implement prevention,
- Standardized assessment of cognitive function in patients with AF is necessary to improve the quality of life of patients,
- Artificial intelligence (AI) has the potential to achieve all of the above, but requires advanced interdisciplinary knowledge and collaboration as well as a better forensic framework,
- New, simple and applicable means of AF detection for the general population.
The IHU ICAN participates in research against atrial fibrillation
MAESTRIA, a highly innovative project to better detect atrial cardiomyopathy
The IHU ICAN participes in MAESTRIA (Machine Learning and Artificial Intelligence for Early Detection of Stroke and Atrial Fibrillation), an ultra-innovative project to better detect atrial cardiomyopathy, which is a major cause of atrial fibrillation and embolic strokes.
The MAESTRIA project is a consortium of 18 partners from Europe, the United States and Canada and responds to an H2020 call for proposals on digital diagnostics. This project is promoted by Sorbonne-University and coordinated by Professor Stéphane HATEM, Director of the IHU ICAN.
The CT-AF study, imaging as a decision aid in atrial ablation?
The CT-AF study, coordinated by Prof. Estelle GANDJBAKHCH and Dr. Mikaël LAREDO (Institute of Cardiology, Rhythmology Unit of the Pitié-Salpêtrière Hospital in Paris) should make it possible to define the criterion vessels to select the patients who could benefit the most from the ablation of Atrial Fibrillation (AF) tissue.
“Indeed, predictive factors for success of atrial ablation remain insufficient, whereas they are necessary for the selection of patients who could benefit the most from this invasive procedure.” Pr Estelle GANDJBAKHCH
