Latest database descriptions

To conduct gene-environment studies on a large scale, with a "data driven" methodology (GWAS for the genetic portion, questionnaires with no preconceived ideas and French environmental databases for the environmental portion), in order to identify risk factors of type 1 diabetes as well as its acute (severe hypoglycaemia, ketoacidosis) and chronic (retinopathy, nephropathy) complications. To conduct epigenetic studies by investigating methylation development (candidate genes or the entire genome) according to different phenotypic traits (glycaemic control, onset of complications, insulin dosage).To be the basis of immune modulation studies for all early diabetes, or for patients resistant to autoimmune attack, and to keep a significant reserve of functional beta cells for 1-5 years (European project DF-IL2, through collaboration with D. Klatzman, funded by FP7 clinical trial tender).
ISIS provides the infrastructure to enable the recruitment of newly diagnosed diabetes cases (149 new cases of diabetes recruited in 2008, 136 in 2009, 143 in 2010 and 191 in 2011). To investigate the beginning of microangiopathic complications in a significant number of children and to study the medical, genetic, epigenetic and environmental determinants of these complications by an integrated and multi-factorial approach. Patients currently in the ISIS cohort have had diabetes for an average of 10.8 years and a mean HbA1c of 8.4%. Background retinopathy is expected in approximately 20% of those that have had diabetes over 10 years (at present: 1,581 cohort patients have had diabetes for more than 10 years, approximately 300 patients are expected to develop complications). We also wish to initiate a strategy for prospective primary prevention trials for retinopathy in 2012 in collaboration with Prof. P. Massin. To conduct studies on conventional treatment and improvements that can be initiated. Our main focus is to test therapeutic education procedures that can limit inequalities in treatment quality and promote "minimally disruptive" medical practice (May C, Montori VM, Fair FS: We need minimally disruptive medicine, BMJ 2009; 339: b2803) capable of minimising the therapeutic burden added to chronic disease, in contrast with the rampant intensification of treatment practised by some that we believe now threatens the quality of psychological development of a significant proportion of young children with diabetes.
To conduct prospective studies on sudden death syndrome, "dead in bed" characteristics of adolescents with diabetes (O'Reilly M, O'Sullivan EP, Davenport C, Smith D: « Dead in bed » : a tragic complication of type 1 diabetes mellitus, Ir J Med Sci 2010, 179 (4): 585-7), risk factors for mortality and morbidity in severe ketoacidosis (special youth complications). Such studies do not exist in the literature: important case-based reasoning is necessary to answer these two questions. This explains the limited nature of the studies in the literature that relied on a small series of anecdotal and retrospective cases.
To conduct humanities and social science studies in the field of psychological consequences of childhood diabetes, including the frequency of depressive syndromes (patients and parents) and to analyse health care access disparities (incorporating geographical, medical and sociological analyses).
To broaden the scope of cohort-related work by screening case families for diabetes (there are about 5,200 brothers or sisters under 7 years of age related to diabetic children already included in ISIS).

To define early diagnostic criteria for Behcet's Disease for patients under 16 years old.

To investigate early growth phases (foetal growth, birth weight and postnatal growth) in relation to elements of metabolic syndrome and insulin resistance. Secondary objective: to investigate growth and body composition, metabolic and hormonal profiles from birth until 4 years of age with regard to birth weight and foetal growth velocity.

General objective: to demonstrate in a prospective open and multricentric cohort study that aortic valve sparing for patients with aortic root aneurysms and/or dystrophic aortic insufficiency is associated with a 45% increase of 3 year, 5 year, 10 year, 15 year and 20 year-survival rate without increased mortality or morbidity events when compared to mechanical valve replacement (surgical treatment reference). Morbidity and mortality is defined as the occurrence of at least one of the composite endpoint events: death, re-operation and/or re-hospitalisation for infection, bleeding event, thromboembolic event or heart failure Secondary objectives: - To evaluate and compare between both patient groups: the rate of immediate post-operation complications associated with a 3 year, 5 year, 10 year, 15 year and 20 year-survival rate without mortality or morbidity events when evaluated on composite criteria, the changes in quality of life during follow-up using a standardised questionnaire, validated by cardiac surgery, modified SF12 Questionnaire - to evaluate the impact of a teaching programme for a new standardised surgical technique on morbidity and mortality from each investigating surgeon's learning curve and on long-term outcomes (programme combining theoretical and video-assisted surgical procedure training on heart anatomy, first patient surgical mentoring) - To set predictive sonographic criteria: the feasibility of valve repair with promising immediate and long-term postoperative results from early diagnosis of criteria composite outcome: To evaluate the sensitivity and specificity of ultrasound parameters, notably on the risk of reoperation and valvular complications - To assess the impact of clinical monitoring and imaging on operated patients with aortic root dystrophy in order to propose a post-operative care protocol that meets cost-benefit objectives