Cotutelle internationale avec le Laboratoire Éducations et Promotion de la Santé (Santé publique - UR 3412) de l'Université Sorbonne Paris Nord. / L'autosurveillance glycémique est essentielle pour les personnes vivant avec un diabète afin d'évaluer leur glycémie et adapter leurs traitements ou comportements. En France, depuis 2017, le glucomètre connecté à mesure flash FreeStyle Libre est proposé aux personnes vivant avec un diabète à la condition de suivre une éducation spécifique au sein de structures coutumières de l’éducation thérapeutique et du diabète. La littérature scientifique a montré l'efficacité de l'autosurveillance avec ce système, mais il existe peu d'études sur son appropriation et son impact. Cette recherche vise à décrire et comprendre le phénomène d’appropriation du FreeStyle Libre en identifiant comment elle s’est déroulée, comment elle s’opérationnalise, selon quelles interventions, chez qui cela fonctionne, dans quels contextes, et quels sont les mécanismes en jeu. Une évaluation réaliste a été menée en se basant sur une théorie de moyenne portée. Cette recherche a été réalisée au sein de quatre terrains en région parisienne auprès de 48 personnes vivant avec un diabète et professionnels de santé. Tout d’abord, les résultats montrent qu’au cours du temps, les programmes ont évolué dans leurs modalités et contenus, dans la façon dont ils s’organisaient, mais aussi que les interventions éducatives réellement mises en œuvre diffèrent au regard des interventions qui sont censées avoir cours. Ensuite, pour expliquer l’appropriation du FreeStyle Libre, 114 chaînes de contexte-mécanismes et effets ont été construites et éclairent sur l’acceptation du FreeStyle Libre, les conditions et modalités d’utilisation et sur les effets produits grâce à celle-ci. Les chaînes de contextes-mécanismes-effets mettent en évidence des contextes plus favorables à l’appropriation (littératie numérique élevée, empowerment préexistant, engagement dans la démarche d’autogestion…) et des contextes moins favorables (trait de personnalité compulsive, littératie générale ou numérique faible, absence d’éducation et d’accompagnement…). Les mécanismes qui sont générés font appel aux connaissances, à l’absence de crainte sur la confidentialité et l’immixtion dans la vie privée, à la motivation, et aux normes personnelles. L’acceptation du FSL est forte et fait intervenir la perception que la technologie peut contribuer à la performance de l’autosurveillance glycémique et qu’elle est facile à utiliser. Ensuite, l’analyse a permis de discriminer plusieurs modalités d’utilisation suivant des indicateurs quantitatifs et qualitatifs de l’usage. Des effets de l’appropriation sont identifiés dans l’amélioration de la qualité de vie dans le diabète, l’amélioration de la relation interpersonnelle entre soignants et personnes soignées, dans la diminution d’une anxiété liée au diabète, dans l’adaptation des traitements et des comportements et enfin dans la connaissance de la maladie et le raisonnement des personnes. La théorie de moyenne portée finale constituée sur la base de ces résultats adresse un modèle global de l’appropriation du FreeStyle Libre. Cette étude montre qu’il existe de nombreuses variations de l’appropriation. Elle situe que l’éducation à l’utilisation du FreeStyle Libre est nécessaire pour en tirer davantage parti et identifie un manque d’intégration de la technologie connectée dans les programmes d’éducation thérapeutique, ce qui constitue un enjeu particulier pour l’avenir. / Self-monitoring of blood glucose is essential for people living with diabetes to assess their blood glucose levels and adapt their treatment or behaviour. In France, since 2017, the FreeStyle Libre (FSL) flash glucose meter has been offered to people living with diabetes on the condition that they attend a specific education program within facilities accustomed to diabetes and therapeutic education. The scientific literature has shown the efficacy of self-monitoring with this system, but there are few studies on its appropriation and impact. This research aims to describe and understand the phenomenon of appropriation of FreeStyle Libre by identifying how it has been implemented, how it is operationalized, according to which interventions, in whom it works, in which contexts, and what mechanisms are at work. A realist evaluation was carried out based on a middle-range theory. This research was conducted in four settings in the Paris area involving 48 people living with diabetes and healthcare professionals. First of all, the results show that over time, the programmes have evolved in their modalities and contents, in the way they were organized, but also that the implemented educational interventions differed from those that were supposed to take place. Next, to explain the appropriation of FreeStyle Libre, 114 context-mechanism-effect chains were constructed that shed light on the acceptance of FreeStyle Libre, the conditions and modalities of its use, and the effects produced through it. The context-mechanism-effect chains highlight contexts that are more favourable to appropriation (high digital literacy, pre-existing empowerment, commitment to self-management, etc.) and less favourable contexts (compulsive personality trait, low general or digital literacy, lack of education and support, etc.). The mechanisms that are generated involve knowledge, lack of fear about confidentiality and privacy, motivation, and personal norms. Acceptance of the FSL is strong and involves the perception that the technology can contribute to the performance of self-monitoring of blood glucose and that it is easy to use. Then, the analysis allowed us to distinguish several modalities of use according to quantitative and qualitative indicators of use. The effects of appropriation are identified in the improvement of the quality of life in diabetes, the improvement of the interpersonal relationship between caregivers and cared-for persons, the reduction of anxiety related to diabetes, the adaptation of treatments and behaviours, and finally in the knowledge of the disease and the reasoning of the persons. The final middle-range theory built on these results addresses a global model of the appropriation of FreeStyle Libre. This study shows that there are many variations of appropriation. It identifies that education in the use of FreeStyle Libre is needed to get more out of it, and identifies a lack of integration of connected technology into health education programmes, which is a particular challenge for the future.

<p>Aging erodes motivation, cognition, sensory modalities and physical capacities, effectively depleting quality of life. Declining sensory, cognitive and motor function are reliable biomarkers of aging and mortality risk. These declines are associated with dysregulation of systemic and cellular processes. We developed a complex dietary supplement (DSP) designed to ameliorate five mechanisms of aging (oxidative processes, inflammation, mitochondrial function, insulin resistance and membrane integrity). Remarkably, normal mice fed the DSP retained youthful functionality into old ages, reflecting slower aging rates. Marked improvements in motor function, memory capacity, spatial learning, muscle strength, visual acuity, olfaction, fecundity and important behavioral functions were observed in aging supplemented mice. Conversely, untreated control animals showed age-related declines in all of the above. Functional improvements were associated with reduced oxidative damage, elevated mitochondrial activity, positive cellular energy balance, improved glucose tolerance, boosted neurotransmitters, greater synaptic density and higher neuronal numbers throughout the brain. A 30% reduction in cancer rates was also documented for DSP treated p53+/- mice. The vast functional benefits greatly exceed the modest longevity extension (11%) in normal supplemented mice. For aging humans, maintaining functionality and performance into later years may provide greater socioeconomic and health benefits than simply prolonging lifespan. Implications of these findings extend to common age-related pathologies including dementia and neurodegenerative diseases, diabetes, cancer, sarcopenia and age-related macular degeneration. Although identifying the role of specific ingredients remains outstanding, results provide proof of principle that complex dietary cocktails can powerfully ameliorate biomarkers of aging and modulate mechanisms considered ultimate goals for aging interventions.</p> / Doctor of Philosophy (PhD)

Le diabète de type 1 (DT1) se caractérise par la destruction auto-immune des cellules ß des îlots de Langerhans du pancréas productrices d’insuline, entraînant un état d’hyperglycémie chronique. Malgré une prise en charge très fine de la maladie, s’appuyant sur l’insulinothérapie fonctionnelle, les personnes vivant avec le DT1 sont fréquemment sujettes à des épisodes hypoglycémiques et hyperglycémiques en raison de difficultés à adapter le traitement insulinique, notamment lors de l’activité physique. L’activité physique procure de nombreux bénéfices pour la santé que l’on ait ou non un diabète. Cependant, dans le cadre du DT1, les excursions glycémiques lors de l’activité physique peuvent conduire à des barrières à l’activité physique dans cette population ou peuvent limiter les performances sportives d’athlètes vivant avec le DT1. L’objectif de cette thèse était triple : 1) Étudier les barrières à l’activité physique chez les enfants et adultes vivant avec le DT1 et à leurs liens avec les excursions glycémiques réellement vécues dans la vie quotidienne et d’autant plus autour de l’activité physique, 2) Chez des enfants vivant avec le DT1, comparer deux types d’exercice (exercice aérobie continu vs. intermittent intense), représentatifs de leur activité physique spontanée, et explorer leurs effets sur les variations glycémiques à l’exercice et à la récupération précoce et tardive et, 3) Mesurer la glycémie en continu, à l’exercice et à la récupération, chez des sportifs en endurance qui n’ont pas de diabète, afin de comprendre les mécanismes impliqués dans la régulation de la glycémie lors d’épreuves d’ultra-endurance et de transposer ces résultats chez des sportifs vivant avec le DT1. Les résultats montrent que : 1) Chez les enfants, plus le temps passé <54 mg.dL-1 les nuits suivant les séances d'activités physiques augmente, plus la peur de l'hypoglycémie est importante. Chez les adultes, étonnamment, ceux qui déclarent le moins l’hypoglycémie comme une barrière à l’activité physique sont ceux qui ont le plus grand pourcentage de séances d’activités physiques entraînant une baisse de glycémie; 2) Le risque hypoglycémique n’est pas supérieur lors d’un exercice continu modéré représentatif de l’activité physique spontanée des enfants et, cet exercice semble efficace pour diminuer l’hyperglycémie retrouvée les jours inactifs sur la même période de temps; 3) Un risque hyperglycémique existe lors des phases intenses de la course et pendant 48 heures de récupération lors d’un ultra-trail réalisé chez des athlètes qui n’ont pas de diabète. Ce risque hyperglycémique à la récupération pourrait être en lien avec les dommages musculaires. / Type 1 diabetes (T1D) is characterized by the autoimmune destruction of the insulin-producing ß-cells of the islets of Langerhans in the pancreas, leading to a state of chronic hyperglycemia. Despite very sophisticated management of the disease, based on functional insulin therapy, people living with T1D are frequently subject to hypoglycemic and hyperglycemic episodes because of difficulties in adapting insulin treatment, particularly during physical activity. Physical activity has many health benefits, whether or not you have diabetes. However, in the context of T1D, glycemic excursions during physical activity may lead to barriers to physical activity in this population or may limit the sporting performance of athletes living with T1D. The aim of this thesis was threefold: 1) Investigate the barriers to physical activity in children and adults living with T1D and their links with the glycemic excursions actually experienced in daily life and all the more so around physical activity, 2) In children living with T1D, compare two exercise modalities (continuous aerobic exercise vs. intense intermittent), representative of their spontaneous physical activity, and explore their effects on glycemic variations during exercise and early and late recovery and, 3) Measure glycemia continuously, during exercise and recovery, in endurance athletes without diabetes in order to understand the mechanisms involved in regulating glycaemia during ultra-endurance events and transpose these results to athletes living with T1D. The results show that: 1) In children, the greater the time spent <54 mg.dL-1 on the nights following physical activity sessions, the greater the fear of hypoglycemia. Surprisingly, among adults, those who least reported hypoglycemia as a barrier to physical activity were those who had the highest percentage of physical activity sessions resulting in a drop in blood glucose levels; 2) The risk of hypoglycemia is no greater during continuous moderate exercise representative of the spontaneous physical activity of children, and this exercise appears to be effective in reducing the hyperglycemia found on inactive days over the same period of time; 3) A hyperglycemic risk exists during the intense phases of the race and during 48 hours of recovery during an ultra-trail run carried out in athletes who do not have diabetes. This hyperglycemic risk during recovery could be related to muscle damage.

Les prématurés subissent un stress oxydant qui résulte d’une défense antioxydante faible et/ou d’une charge oxydante. Des données suggèrent qu’un stress oxydant peut affecter le métabolisme énergétique et mener au syndrome métabolique. Hypothèse: Une faible défense antioxydante tôt dans la vie est suffisante pour affecter le métabolisme énergétique à long terme. Méthodes: Quatre groupes de cobayes (n=21) ont reçu entre leurs 3e et 7e jours de vie une diète standard (C-1sem, C-14sem) ou une diète déficiente (DC-1sem, DC-14sem). À 7 jours, les groupes C-1sem et DC-1sem ont été sacrifiés, le plasma et le foie collectés. Les groupes C-14sem et DC-14sem ont reçu la diète standard jusqu’à 14sem de vie. La glycémie et les triglycérides plasmatiques ont été mesurés à 1, 3, 11, et 13-14sem. La tolérance au glucose a été évaluée à 13sem. Les antioxydants hépatiques et les protéines régulant le métabolisme énergétique ont été analysés à 1 et 14sem. Résultats: Un statut redox oxydé du glutathion était associé avec la diète déficiente et était maintenu oxydé au moins jusqu’à 14sem (p<0.01). Les faibles niveaux de triglycérides plasmatiques et de glycémies, ainsi qu’une meilleure tolérance au glucose à 14sem (p<0.05) étaient associés avec un statut redox plus oxydé. Conclusion: Le faible taux de glutathion observé chez les prématurés a été reproduit dans notre modèle. Puisque nos données suggèrent un rôle protecteur d’un redox plus oxydé et que l’environnement redox est un important régulateur métabolique influençant le développement, il faudrait faire attention avant d’initier des traitements antioxydants agressifs chez les prématurés. / Preterm infants are faced to oxidative stress resulting from a low antioxidant defence and/or a high oxidant load. Datas suggest that an oxidative stress may impair energy metabolism leading to metabolic syndrome development. Hypothesis: A weak antioxidant defence early in life such as observed in preterm newborns is sufficient to impair energy metabolism later in life. Methods: Four groups of guinea pigs (n=21) received between their 3rd and 7th days of life a control diet (C-1week, C-14weeks) or antioxidant deficient diet (DC-1week, DC-14weeks). At 7 day-old, 1week-groups were sacrificed for plasma and liver sampling whereas 14week-groups were fed with the control diet until 14 week-old. Blood glucose and plasma triacylglycerol were determined at 1, 3, 11 and 13-14 week-old. Glucose tolerance test was performed at 13 week-old. Hepatic antioxidant defences and key proteins regulating lipid and glucose metabolism were measured at 1 and 14 weeks. Results: The oxidized redox status of glutathione associated with the neonatal deficient diet was maintained until at least 14 week-old (p<0.01). The low plasma triacylglycerol, low blood glucose and better tolerance to glucose at 14 weeks (p<0.05) were associated with an oxidized redox status. Conclusion: The low glutathione observed in newborn preterm infants has been reproduced in our animal model. Since the oxidized redox state observed here seems to be protective against impaired energy metabolism and since the cellular redox environment is known to be an important rheostat of metabolism influencing development, it suggests being careful before adopting aggressive antioxidant treatments in preterm infants.

Previous studies that utilized sodium lactate infusion did not use resistance exercise protocol or analyzed muscle biopsies, or performed sex specific analysis. Aim: We initiated a project where resistance exercise was performed with low and high levels of lactate, acquired by venous lactate infusion where the specific aim of this study was to investigate and chart the physiological characteristics of sodium lactate infusion during a bout of resistance exercise on whole group level and sexes separated Method: A randomized, placebo controlled, cross-over design was implemented where male (n = 8) and female (n = 8) subjects accustomed to resistance exercise visited the laboratory three times for preliminary testing and training familiarization. In the following two experimental trials subjects arrived in an overnight fasted state. A resting state muscle biopsy was extracted from m. vastus lateralis and repeated blood samples were initiated which followed by 20 minute of baseline infusion of either infusate in resting state at 0.05 mmol/kg/min infusion rate with additional bolus doses during subsequent exercise. Following a brief warm up, unilateral knee-extensions (6 x 8-10 reps at 75% of 1-RM) were performered with or without venous infusion of sodium lactate, with volume matched saline as control. Exercise load and volume were matched between trials. Four additional biopsies were extracted at post-exercise, recovery period, and 24-hour post-exercise. Results: Sodium lactate infusion vs saline infusion respectively during resistance exercise yielded significantly higher blood lactate with sodium lactate (6.78 ± 0.33 mmol/l vs 2.99 ± 0.17 mmol/l), plasma lactate (8.86 ± 0.39 mmol/l vs 4.39 ± 0.22 mmol/l), blood sodium (143 ± 0.4 mmol/l vs 142 ± 0.3 mmol/l), blood pH (7.42 ± 0.01 vs 7.34 ± 0.01), but lower blood potassium (3.9 ± 0.1 mmol/l vs 4.2 ±  0.1 mmol/l), all  immediately following exercise. Sodium lactate infusion elicited main effect of trials and muscle lactate increased from baseline (8.5 ± 0.9 mmol·kg-1 dw vs 7.0 ± 0.6 mmol·kg-1 dw) to post-exercise (31.5 ± 2.8 mmol·kg-1 dw vs 26.9 ± 3.2 mmol·kg-1 dw) with sodium lactate and saline infusion respectively. Blood glucose, hemoglobin and muscle pH was not affected by sodium lactate infusion. Conclusions: Utilization of the sodium lactate infusion method during a bout of resistance exercise may be used as tool to effectively increase blood/plasma lactate and, to lesser extent, muscle content of lactate. However, a concomitant slightly alkalizing effect of blood likely will occur. / Tidigare studier som använt natriumlaktat infusion använde inte styrketräningsprotokoll, eller analyserade muskelbiopsier eller utförde könsspecifika analyser. Syfte och frågeställningar: Vi initierade ett projekt där styrketräning utfördes med låga eller höga nivåer av laktat som erhölls genom venös natriumlaktat infusion med det specifika syftet att undersöka och kartlägga fysiologisk karakteristiska av naturiumlaktat infusion under styrketräningsövning på helgrupps- och könsseparerad nivå. Följande frågeställningar inrättades; hur påverkar natriumlaktat infusion under styrketräning helblod- och plasma laktat, glukos, natrium, kalium, plasma volym genom hemoglobin och hematokrit, blod pH, muskellaktat- och muskel pH samt om skillnader i respons finns efter att könsspecifika analyser utförts på dessa variabler. Metod: En randomiserad, placebokontrollerad cross-over design implementerades där styrketräningsvana män (n = 8) och kvinnor (n = 8) besökte laboratoriet tre gånger för preliminäraför tester och träningsfamiliarisering. I efterföljande två experimentella försök anlände försökspersonerna i ett över nattligt fastande tillstånd. En baslinje biopsi extraherades från m. vastus lateralis och repeterade blodprover initierades med efterföljande 20 minuter av baslinje infusion av endera infusat i vilotillstånd med 0.05 mmol/kg/min infusionshastighet med ytterligare bolusdoser under efterföljande träning. Efter en kort uppvärmning utfördes unilaterala knäextensioner (6 x 8-10 reps vid 75% av 1-RM) med eller utan venös infusion av natrium laktat, med volymmatchande saltlösning som kontroll. Träningsbelastning och volym matchades mellan försök. Ytterligare fyra biopsier extraherades vid efter-träning, återhämtningsperiod, och efter 24 timmar. Resultat: Natriumlaktat respektive saltlösnings infusion under styrketräning gav signifikant högre blodlaktat med natriumlaktat infusion (6.78 ± 0.33 mmol/l mot 2.99 ± 0.17 mmol/l), plasmalaktat (8.86 ± 0.39 mmol/l mot 4.39 ± 0.22 mmol/l), blodnatrium (143 ± 0.4 mmol/l mot 142 ± 0.3 mmol/l), blod pH (7.42 ± 0.01 mot 7.34 ± 0.01), men lägre blod kalium (3.9 ± 0.1 mmol/l mot 4.2 ± 0.1 mmol/l), alla direkt efter träning. Natriumlaktat infusion framkallade huvudeffekt av försök och muskellaktat ökade från baslinje (8.5 ± 0.9 mmol·kg-1 dw mot 7.0 ± 0.6 mmol·kg-1 dw) till efter-träning (31.5 ± 2.8 mmol·kg-1 dw mot 26.9 ± 3.2 mmol·kg-1 dw) med natriumlaktat respektive saltlösnings infusion. Blodglukos, hemoglobin och muskel pH påverkades inte av natriumlaktat infusion. Slutsats: Användande av natriumlaktat infusion som metod under styrketräning kan effektivt användas som verktyg för att höja blod/plasma laktat, och i mindre utsträckning, muskellaktat. Emellertid är samtidig alkalisering av blod en sannolik följd. / Potential sex differences in the molecular response to resistance exercise with lactate infusion

Der Gestationsdiabetes betrifft etwa 5 von 100 Schwangeren. In unserer prospektiven, randomisierten Studie mit Crossover-Design untersuchten wir den Einfluß der Kohlenhydrataufnahme auf den Glukosestoffwechsel Schwangerer. 18 Gestationsdiabetikerinnen, 9 Frauen mit eingeschränkter Glukosetoleranz und 25 Kontrollen haben jeweils eine Woche eine kohlenhydratarme (35 Energieprozent) und eine kohlenhydratreiche (55 Energieprozent) Diät durchgeführt. Auswirkungen wurden anhand des konventionellen BZTPs und des kontinuierlich messenden Glukosesensors CGMS® untersucht. Die KH-Aufnahme wurde mittels einer Ernährungsberatung deutlich beeinflußt, und lag bei 39 % in der KH-reduzierten, und bei 49 % in der KH-reichen Woche. Nach DDG-Kriterien hatte der KH-Anteil bei keiner Gruppe einen signifikanten Einfluß bezüglich der Insulinpflicht. Dagegen waren der BZTP-Mittelwert und die AUC (area under the curve des CGMS®) der GDMs und der Kontrollen signifikant niedriger in der KH-armen Woche. In dieser Woche nahmen die Probandinnen auch eine niedrigere Energiemenge zu sich. Bei einer selektierten Untergruppe konnten wir diesen Einfluß ausgrenzen, und für die Kontrollgruppe eine signifikante Erniedrigung bezüglich der BZTP-Mediane und der AUCs nachweisen. Diese Beobachtungen belegen, daß ein höherer Kohlenhydratanteil mit erhöhten Blutzuckerwerten assoziiert ist. Außerdem wurde ein größerer Einfluß einer kohlenhydratarmen Ernährung auf die postprandialen als auf die Nüchternwerte festgestellt. Wegen der Auswirkungen auf das fetale Wachstum soll man bei Gestationsdiabetikerinnen eine kohlenhydratarme Ernährung empfehlen. / Gestational diabetes affects about 5 % of pregnancies. In our randomized prospective study with crossover design we examined the influence of carbohydrate intake on the glucose metabolism of pregnant women. 18 women with gestational diabetes, 9 with impaired glucose tolerance and 25 controls were put on a low (35 energy %) carbohydrate diet for one week and a high (55 energy %) carbohydrate diet for another. Blood glucose levels were recorded by self-monitoring and with a continuous glucose monitoring sensor (CGMS ®). Carbohydrate intake was strongly influenced by dietary advice, amounting to 39% into the low carbohydrate and 49% in the high carbohydrate week. According to DDG criteria, carbohydrate intake had no significant influence on insulin requirements. In contrast, mean blood glucose levels and the AUC (area under of the curve of the CGMS ®) were significantly lower for both gestational diabetics and controls in the low carbohydrate week. During this week, the average caloric intake was also reduced. We could exclude this influence for a selected subgroup, in which the controls displayed a significant reduction in median glucose levels and the AUCs. We could thus show that a higher carbohydrate content is associated with raised blood glucose levels. Furthermore, the influence of a low carbohydrate diet was greater on postprandial than on fasting levels. Because of the effects on fetal growth, one should recommend a low carbohydrate diet for gestational diabetics.

Les prématurés subissent un stress oxydant qui résulte d’une défense antioxydante faible et/ou d’une charge oxydante. Des données suggèrent qu’un stress oxydant peut affecter le métabolisme énergétique et mener au syndrome métabolique. Hypothèse: Une faible défense antioxydante tôt dans la vie est suffisante pour affecter le métabolisme énergétique à long terme. Méthodes: Quatre groupes de cobayes (n=21) ont reçu entre leurs 3e et 7e jours de vie une diète standard (C-1sem, C-14sem) ou une diète déficiente (DC-1sem, DC-14sem). À 7 jours, les groupes C-1sem et DC-1sem ont été sacrifiés, le plasma et le foie collectés. Les groupes C-14sem et DC-14sem ont reçu la diète standard jusqu’à 14sem de vie. La glycémie et les triglycérides plasmatiques ont été mesurés à 1, 3, 11, et 13-14sem. La tolérance au glucose a été évaluée à 13sem. Les antioxydants hépatiques et les protéines régulant le métabolisme énergétique ont été analysés à 1 et 14sem. Résultats: Un statut redox oxydé du glutathion était associé avec la diète déficiente et était maintenu oxydé au moins jusqu’à 14sem (p<0.01). Les faibles niveaux de triglycérides plasmatiques et de glycémies, ainsi qu’une meilleure tolérance au glucose à 14sem (p<0.05) étaient associés avec un statut redox plus oxydé. Conclusion: Le faible taux de glutathion observé chez les prématurés a été reproduit dans notre modèle. Puisque nos données suggèrent un rôle protecteur d’un redox plus oxydé et que l’environnement redox est un important régulateur métabolique influençant le développement, il faudrait faire attention avant d’initier des traitements antioxydants agressifs chez les prématurés. / Preterm infants are faced to oxidative stress resulting from a low antioxidant defence and/or a high oxidant load. Datas suggest that an oxidative stress may impair energy metabolism leading to metabolic syndrome development. Hypothesis: A weak antioxidant defence early in life such as observed in preterm newborns is sufficient to impair energy metabolism later in life. Methods: Four groups of guinea pigs (n=21) received between their 3rd and 7th days of life a control diet (C-1week, C-14weeks) or antioxidant deficient diet (DC-1week, DC-14weeks). At 7 day-old, 1week-groups were sacrificed for plasma and liver sampling whereas 14week-groups were fed with the control diet until 14 week-old. Blood glucose and plasma triacylglycerol were determined at 1, 3, 11 and 13-14 week-old. Glucose tolerance test was performed at 13 week-old. Hepatic antioxidant defences and key proteins regulating lipid and glucose metabolism were measured at 1 and 14 weeks. Results: The oxidized redox status of glutathione associated with the neonatal deficient diet was maintained until at least 14 week-old (p<0.01). The low plasma triacylglycerol, low blood glucose and better tolerance to glucose at 14 weeks (p<0.05) were associated with an oxidized redox status. Conclusion: The low glutathione observed in newborn preterm infants has been reproduced in our animal model. Since the oxidized redox state observed here seems to be protective against impaired energy metabolism and since the cellular redox environment is known to be an important rheostat of metabolism influencing development, it suggests being careful before adopting aggressive antioxidant treatments in preterm infants.

Preface - Biotechnology is generally considered to be the wave of the future. To facilitate accurate and rapid development of medication and treatments, it is critical that we are able to simulate the human body. One section of this complex model would be the human energy system. Pharmaceutical companies are currently pouring vast amounts of capital into research regarding general simulation of cellular structures, protein structures and bodily processes. Their aim is to develop treatments and medication for major diseases. Some of these diseases are epidemics like cancer, cardiovascular diseases, stress, obesity, etc. One of the most important causes of these diseases is poor blood glucose control. Current management methods for insulin dependent diabetes are limited to trial and error systems: clearly ineffective and prone to errors. It is critical that better management systems be developed, to ease the diabetic epidemic. The blood glucose control system is one of the major systems in the body, as we are in constant need of energy to facilitate the optimum functioning of the human body. This study makes use of a developed simulation model for the human energy system to ease the management of Diabetes mellitus, which is a malfunction of the human energy system. This dissertation is presented in two parts: The first part discusses the human energy simulation model, and the verification thereof, while the second presents possible applications of this model to ease the management of Diabetes. The human energy system simulation model - This section discusses the development and verification of the model. It also touches on the causes, and current methods, of managing diabetes, as well as the functioning of the human energy system. The human energy model is approached with the conservation of energy in mind. A top down model is developed, using data from independent studies to verify the model. Application of human energy simulation model - The human energy simulation model is of little use if the intended audience cannot use it: people suffering from malfunctioning energy systems. These include people having trouble with obesity, diabetes, cardiovascular disease, etc. To facilitate this, we need to provide a variety of products useable by this group of people. We propose a variety of ways in which the model can be used: Cellular phone applications, Personal digital assistants (PDAs) applications, as well as computer software. By making use of current technology, we generate a basic proof-of-concept application to demonstrate the intended functionality. / MIng (Mechanical Engineering) North-West University, Potchefstroom Campus, 2004

Preface - Biotechnology is generally considered to be the wave of the future. To facilitate accurate and rapid development of medication and treatments, it is critical that we are able to simulate the human body. One section of this complex model would be the human energy system. Pharmaceutical companies are currently pouring vast amounts of capital into research regarding general simulation of cellular structures, protein structures and bodily processes. Their aim is to develop treatments and medication for major diseases. Some of these diseases are epidemics like cancer, cardiovascular diseases, stress, obesity, etc. One of the most important causes of these diseases is poor blood glucose control. Current management methods for insulin dependent diabetes are limited to trial and error systems: clearly ineffective and prone to errors. It is critical that better management systems be developed, to ease the diabetic epidemic. The blood glucose control system is one of the major systems in the body, as we are in constant need of energy to facilitate the optimum functioning of the human body. This study makes use of a developed simulation model for the human energy system to ease the management of Diabetes mellitus, which is a malfunction of the human energy system. This dissertation is presented in two parts: The first part discusses the human energy simulation model, and the verification thereof, while the second presents possible applications of this model to ease the management of Diabetes. The human energy system simulation model - This section discusses the development and verification of the model. It also touches on the causes, and current methods, of managing diabetes, as well as the functioning of the human energy system. The human energy model is approached with the conservation of energy in mind. A top down model is developed, using data from independent studies to verify the model. Application of human energy simulation model - The human energy simulation model is of little use if the intended audience cannot use it: people suffering from malfunctioning energy systems. These include people having trouble with obesity, diabetes, cardiovascular disease, etc. To facilitate this, we need to provide a variety of products useable by this group of people. We propose a variety of ways in which the model can be used: Cellular phone applications, Personal digital assistants (PDAs) applications, as well as computer software. By making use of current technology, we generate a basic proof-of-concept application to demonstrate the intended functionality. / MIng (Mechanical Engineering) North-West University, Potchefstroom Campus, 2004

Thesis (Ph. D.)--University of South Florida, 2008. / Title from PDF of title page. Document formatted into pages; contains 133 pages. Includes vita. Includes bibliographical references.