Gender and biological sex impact the pathogenesis of numerous diseases, including metabolic disorders such as diabetes. In most parts of the world, diabetes is more prevalent in men than in women, especially in middle-aged populations. In line with this, considering almost all animal models, males are more likely to develop obesity, insulin resistance and hyperglycaemia than females in response to nutritional challenges. As summarised in this review, it is now obvious that many aspects of energy balance and glucose metabolism are regulated differently in males and females and influence their predisposition to type 2 diabetes. During their reproductive life, women exhibit specificities in energy partitioning as compared with men, with carbohydrate and lipid utilisation as fuel sources that favour energy storage in subcutaneous adipose tissues and preserve them from visceral and ectopic fat accumulation. Insulin sensitivity is higher in women, who are also characterised by higher capacities for insulin secretion and incretin responses than men; although, these sex advantages all disappear when glucose tolerance deteriorates towards diabetes. Clinical and experimental observations evidence the protective actions of endogenous oestrogens, mainly through oestrogen receptor α activation in various tissues, including the brain, the liver, skeletal muscle, adipose tissue and pancreatic beta cells. However, beside sex steroids, underlying mechanisms need to be further investigated, especially the role of sex chromosomes, fetal/neonatal programming and epigenetic modifications. On the path to precision medicine, further deciphering sex-specific traits in energy balance and glucose homeostasis is indeed a priority topic to optimise individual approaches in type 2 diabetes prevention and treatment.
Contexte Au cours de l’épidémie de COVID-19, les questions des patients insuffisants surrénaliens chroniques (ISC) sur leur risque de contracter le COVID-19 étaient nombreuses. Objectif Évaluer, dans un groupe de patients ISC, la fréquence de l’infection au COVID-19 ainsi que le niveau d’anxiété par rapport à la crise sanitaire. Patients et méthodes Étude descriptive, monocentrique, ayant proposé un questionnaire téléphonique du 21/04/2020 au 11/05/2020, aux 121 patients ISC ayant participé à un programme d’éducation thérapeutique sur l’ISC. Ce questionnaire standardisé évaluait la présence d’un diagnostic d’infection au COVID-19 ou d’une symptomatologie compatible, ainsi que le niveau d’anxiété sur la situation sanitaire. Résultats 96 patients (60 % de femmes), insuffisants surrénaliens (49,5 % périphérique), âgés de 50 ± 16,5 ans, ont répondu au questionnaire. 56 patients (58,3 %) présentaient des facteurs de risque de développer une infection sévère au COVID-19 : obésité ( n = 23 ; 24 %), diabète ( n = 9 ; 9,4 %), pathologie pulmonaire ( n = 20 ; 21 %), hypertension artérielle ( n = 21 ; 22,1 %), âge > 70 ans ( n = 7 ; 7,2 %). Aucun patient n’a contracté d’infection avérée au COVID-19, 14 patients (14,7 %) ont eu une symptomatologie compatible spontanément résolutive sans hospitalisation. Le niveau d’anxiété était à 3,8 ± 2,8/10, et était majoré par l’ISC chez 36 patients (38,2 %). Cette anxiété a justifié 34,6 % des adaptations de traitement (9/26). Aucune décompensation surrénalienne aiguë n’a été rapportée. Conclusion L’insuffisance surrénalienne chronique ne semble pas être un facteur de risque d’infection sévère au COVID-19. Elle majore en revanche l’anxiété des patients par rapport à la crise sanitaire.
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