References of "Lefebvre, Pierre"
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See detailNon-alcoholic steatohepatitis.
Luyckx, Françoise ULg; Scheen, André ULg; Lefebvre, Pierre ULg

in Lancet (1999), 354(9186), 1298-9

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See detailLong-term effects of oral estradiol and dydrogesterone on carbohydrate metabolism in postmenopausal women.
Gaspard, Ulysse ULg; Wery, Olivier ULg; Scheen, André ULg et al

in Climacteric : The Journal of the International Menopause Society (1999), 2(2), 93-100

OBJECTIVE: To determine in postmenopausal women the long-term effects on carbohydrate metabolism of the administration of oral micronized 17 beta-estradiol (2 mg/day continuously) and cyclical ... [more ▼]

OBJECTIVE: To determine in postmenopausal women the long-term effects on carbohydrate metabolism of the administration of oral micronized 17 beta-estradiol (2 mg/day continuously) and cyclical dydrogesterone (10 mg/day for 14 days per 28-day cycle). METHODS: A 2-year open-label prospective, non-comparative study was carried out of 13 healthy postmenopausal women receiving cyclical estradiol and dydrogesterone and serving as their own controls. Concentrations of blood glucose, plasma insulin, C-peptide, glucagon and free fatty acids (FFAs) were determined before treatment (base-line) and at 6, 12 and 24 months of hormone replacement therapy under fasting conditions and during a standard 75-g, 3-h, oral glucose tolerance test (OGTT). RESULTS: Fasting blood glucose levels were unchanged throughout the study, and the mean areas under the curves (AUCs) for glucose response increased slightly but non-significantly versus baseline; fasting plasma insulin levels tended a decrease, and AUCs for insulin responses to the glucose load fell by 23% from baseline (not significant); fasting C-peptide levels and AUCs were unchanged; plasma glucagon fasting levels and responses were in the normal range and stable throughout the study; and plasma FFA fasting levels decreased significantly, as well as FFA AUCs during OGTTs, at the 12th and 24th months of the study. CONCLUSIONS: During a 2-year treatment with oral estradiol and cyclical dydrogesterone, a direct progesterone derivative, tolerance to glucose was unchanged, fasting plasma insulin and insulin response to repeated glucose loads were decreased, and C-peptide levels remained unchanged, indicating a potential improvement in insulin sensitivity and clearance, as in younger women; additionally, a slightly enhanced antilipolytic activity of insulin was observed. [less ▲]

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See detailState of current therapy and patient care in Europe.
Lefebvre, Pierre ULg; Scheen, André ULg

in International Journal of Clinical Practice. Supplement (1999), 107

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See detailL'homeopathie est-elle superieure au placebo? Controverse a propos d'une meta-analyse des etudes controlees.
Scheen, André ULg; Lefebvre, Pierre ULg

in Bulletin et Mémoires de l'Académie Royale de Médecine de Belgique (1999), 154(7-9), 295-304304-7

At a time when scientists support Evidence-Based Medicine, the Parliament of Belgium has recently decided to recognize four alternative medicines, among which homeopathy. Whereas this discipline does not ... [more ▼]

At a time when scientists support Evidence-Based Medicine, the Parliament of Belgium has recently decided to recognize four alternative medicines, among which homeopathy. Whereas this discipline does not rely on any scientific basis, it appears to be popular, especially in general practice. The homeopaths have recently taken arguments from a meta-analysis published in 1997 in the Lancet of 89 placebo-controlled trials. This study indeed concluded that the results are not compatible with the hypothesis that the clinical effects of homeopathy are completely due to placebo. However, this meta-analysis contains several methodological flaws. Furthermore, it is recognized that results of a meta-analysis may not be confirmed in large well-performed clinical trials. Thus, homeopathy should still provide the evidence that conventional medicine has regularly brought during the last two decades in many fields of therapeutics, with the respect of the rigorous rules of "Good Clinical Practice", leading to "Evidence-Based Medicine". [less ▲]

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See detailLe diabete gestationnel: physiopathologie et signification pronostique pour la mere.
Geronooz, I.; Scheen, André ULg; Lefebvre, Pierre ULg

in Revue Médicale de Liège (1999), 54(5), 434-9

Pregnancy is associated with important changes in mother metabolism, especially in late gestation, among which a decreased glucose tolerance caused by insulin resistance. In some of these women, glucose ... [more ▼]

Pregnancy is associated with important changes in mother metabolism, especially in late gestation, among which a decreased glucose tolerance caused by insulin resistance. In some of these women, glucose intolerance is increased by a defect in B-cell function and diabetes mellitus occurs. These women who develop a gestational diabetes need a close follow-up because they are at high risk for further development of diabetes, especially type 2 diabetes. [less ▲]

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See detailComment je traite ... une obesite severe et ses anomalies metaboliques par une gastroplastie.
Luyckx, Françoise ULg; Scheen, André ULg; Letiexhe, Michel ULg et al

in Revue Médicale de Liège (1999), 54(3), 138-42

Severe obesity, defined as a body mass index > or = 35 kg/m2, is frequently associated with various biological abnormalities, particularly in the presence of intra-abdominal adiposity. The most important ... [more ▼]

Severe obesity, defined as a body mass index > or = 35 kg/m2, is frequently associated with various biological abnormalities, particularly in the presence of intra-abdominal adiposity. The most important disorders belong to the so-called insulin resistance syndrome, metabolic syndrome or syndrome X: hyperinsulinaemia, impaired glucose tolerance or type 2 diabetes, dyslipidaemias, hyperuricaemia, hyperfibrinogenaemia. All these metabolic abnormalities are considered as cardiovascular risk factors. They are also correlated with the severity of the liver steatosis which is commonly observed in individuals with severe obesity. We report our experience of the evolution of these metabolic abnormalities after a marked weight loss induced by gastroplasty. We will analyse the favourable effects of bariatric surgery on insulin sensitivity, biological components of the metabolic syndrome, type 2 diabetes and liver steatosis. [less ▲]

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See detailLe vieillissement s'accompagne-t-il d'une diminution de la sensibilite a l'insuline? Roles de l'IGF1 et de la dehydroepiandrosterone.
Paolisso, G.; Tagliamonte, M. R.; Rizzo, M. R. et al

in Journées Annuelles de Diabetologie de l'Hôtel-Dieu (1999)

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See detailL'obesite feminine: souci esthetique ou probleme medical?
Luyckx, Françoise ULg; Scheen, André ULg; Lefebvre, Pierre ULg

in Revue Médicale de Liège (1999), 54(4), 262-7

Women more and more frequently refer to medical doctors for treating weight excess. Even if the primum movens is usually a pure esthetic concern, medical aspects should not be neglected. Indeed, if ... [more ▼]

Women more and more frequently refer to medical doctors for treating weight excess. Even if the primum movens is usually a pure esthetic concern, medical aspects should not be neglected. Indeed, if obesity with gynoid adipose tissue distribution is less deleterious than android obesity from a metabolic point of view, severe obesity is frequently associated with cardiovascular risk factors which may hinder the prognosis of these female patients. Other complications are common in obese women, such as oestrogen-related cancers, osteoarticular problems and psychological disturbances. Various therapeutic approaches are available which permit an encouraging weight loss and a rapid improvement of risk factors. Unfortunately, long-term results are often disappointing, essentially because of the difficulty to follow on the long term a strict diet regimen and practice physical exercise and because of the usual unrealistic expectations of the obese women who consult medical doctors. [less ▲]

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See detailGlucotoxicite et lipotoxicite, deux complices impliques dans le cercle vicieux du diabete de type 2.
Scheen, André ULg; Paquot, Nicolas ULg; Lefebvre, Pierre ULg

in Revue Médicale de Liège (1999), 54(6), 535-8

Type 2 diabetes mellitus is a dynamic disease whose natural history is characterized by a progressive aggravation leading to a progressively severe hyperglycaemia, which generally requires a more complex ... [more ▼]

Type 2 diabetes mellitus is a dynamic disease whose natural history is characterized by a progressive aggravation leading to a progressively severe hyperglycaemia, which generally requires a more complex therapy as time progresses. Such an evolution results from a vicious circle where both glucotoxicity and lipotoxicity contribute to reduce insulin secretion and the action of insulin on cell glucose metabolism. These new concepts are able to modify the strategies of prevention and treatment of type 2 diabetes. [less ▲]

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See detailPharmacological treatment of obesity: present status.
Scheen, André ULg; Lefebvre, Pierre ULg

in International Journal of Obesity & Related Metabolic Disorders (1999), 23 Suppl 1

OBJECTIVE: Obesity poses a serious health hazard and its treatment is often disappointing. This review describes the present status of pharmacological treatment of obesity in man. DESIGN: Obesity ... [more ▼]

OBJECTIVE: Obesity poses a serious health hazard and its treatment is often disappointing. This review describes the present status of pharmacological treatment of obesity in man. DESIGN: Obesity treatment may include drugs that reduce food intake, drugs that increase energy expenditure and drugs that affect nutrient partitioning or metabolism. The mode of action, efficacy and safety of each approach will be briefly discussed. RESULTS: All of the pharmacological possibilities have potential activities, but also serious limitations. While current anti-obesity pharmacotherapy essentially uses centrally-acting anorectic drugs, severe side-effects (more particularly pulmonary hypertension and valvular heart disease) have been reported, leading to the withdrawal of licensed fenfluramine and d-fenfluramine. New approaches have been recently proposed, such as sibutramine, an amine reuptake inhibitor which decreases food intake, and orlistat, an intestinal lipase inhibitor which decreases fat absorption. Obesity is a chronic disease and should be treated as such with reasonable expectations. Large-scale one-year placebo-controlled studies demonstrated that d-fenfluramine, sibutramine and orlistat significantly increased body weight loss by an average of 2-4 kg when compared to placebo and, more interestingly, multiplied by 2-3 the number of patients who succeeded in obtaining and maintaining a reduction of more than 10% of initial body weight. Interestingly, some of these compounds may also exert favourable effects on other vascular risk factors, independently of weight loss. CONCLUSIONS: Even if all anti-obesity pharmacological approaches can be helpful, they also have important limitations so that other strategies including either combined therapies or new drugs (peptides) are currently under investigation. [less ▲]

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See detailEffects of Regular Insulin or Insulin Lispro on Glucose Metabolism after an Oral Glucose Load in Patients with Type 2 Diabetes Mellitus
Paquot, Nicolas ULg; Roulin, D.; Schneiter, P. et al

in Diabètes & Métabolism (1998), 24(6), 523-8

Seven obese Type 2 diabetic patients were studied for two 4-h periods after ingestion of a glucose load to determine the effects of preprandial subcutaneous injection of Insulin Lispro (5 min before the ... [more ▼]

Seven obese Type 2 diabetic patients were studied for two 4-h periods after ingestion of a glucose load to determine the effects of preprandial subcutaneous injection of Insulin Lispro (5 min before the meal) or regular insulin (20 min before the meal) on glucose metabolism. Glucose production and utilisation were measured using a dual isotope method. After Lispro, the mean postprandial increase in plasma glucose was 29% lower and the increase in insulin concentration 25% higher than after regular insulin (p < 0.05). Suppression of endogenous glucose production was similar with both types of insulin. Thus, preprandial injection of Lispro reduced postprandial glucose increments in Type 2 diabetic patients as compared to regular insulin. This effect is best explained by the increased postprandial bioavailability of Lispro. [less ▲]

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See detailThe postprandial state and risk of cardiovascular disease.
Lefebvre, Pierre ULg; Scheen, André ULg

in Diabetic Medicine : A Journal of the British Diabetic Association (1998), 15 Suppl 4

Metabolism in man is regulated by complex hormonal signals and substrate interactions, and for many years the clinical focus has centred on the metabolic and hormonal picture after an overnight fast. More ... [more ▼]

Metabolism in man is regulated by complex hormonal signals and substrate interactions, and for many years the clinical focus has centred on the metabolic and hormonal picture after an overnight fast. More recently, the postprandial state, i.e. 'the period that comprises and follows a meal', has received more attention. The oral glucose tolerance test (OGTT), although highly non-physiological, has been used largely as a model of the postprandial state. Epidemiological studies have shown that, when 'impaired', oral glucose tolerance is associated with an increased risk of cardiovascular disease. Postprandial hyperlipidaemia has been investigated more recently in epidemiological, mechanistical and intervention studies, most of which indicate that high postprandial triglyceride levels, and particularly postprandial rich triglyceride remnants, constitute an increased risk for cardiovascular disease. Recent studies have shown that excessive postprandial glucose excursions are accompanied by oxidative stress and, less well known, activation of blood coagulation (increase in circulating D-dimers and prothrombin fragments). The mechanisms through which increased postprandial glucose levels and lipid concentrations may damage endothelial cells on blood vessel walls appear to be complex. These mechanisms include the activation of protein kinase C, increased expression of adhesion molecules, increased adhesion and uptake of leucocytes, increased production of proliferative substances such as endothelin, increased proliferation of endothelial cells, increased synthesis of collagen IV and fibronectin, and decreased production of nitric oxide (NO). In conclusion, the 'postprandial state' cumulatively covers almost half of the nycthemeral period, and its physiology involves numerous finely regulated motor, secretory, hormonal and metabolic events. Epidemiological and mechanistical studies have suggested that perturbations of the postprandial state are involved in cardiovascular disease. Correcting the abnormalities of the postprandial state must form part of the strategy for the prevention and management of cardiovascular diseases, particularly those that are associated with diabetes mellitus. [less ▲]

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See detailAdverse effect of hyperinsulinemia on cardiovascular risk profile in middle-aged belgian population
Saint-Remy, Annie ULg; Scheen, André ULg; Jeanjean, Michel et al

in Acta Cardiologica (1998), 53(5), 299

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See detailTraitement ultime du diabete de type 2: insulinotherapie intensive ou chirurgie bariatrique?
Scheen, André ULg; Paquot, Nicolas ULg; Triches, K. et al

in Journées Annuelles de Diabetologie de l'Hôtel-Dieu (1998)

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See detailComment j'explore ... la nephropathie diabetique. Premiere partie: micro- et macro-albuminurie.
Weekers, Laurent ULg; Scheen, André ULg; Lefebvre, Pierre ULg

in Revue Médicale de Liège (1998), 53(8), 494-8

Diabetic nephropathy (DN) appears in about 30% of patients with type 1 diabetes (D1) and 15 to 60% of patients with type 2 diabetes (D2). It is preceded by microalbuminuria. Microalbuminuria is defined as ... [more ▼]

Diabetic nephropathy (DN) appears in about 30% of patients with type 1 diabetes (D1) and 15 to 60% of patients with type 2 diabetes (D2). It is preceded by microalbuminuria. Microalbuminuria is defined as an albumin excretion rate between 30 and 300 mg/24 h (on a 24-hour urine collection) or between 20 and 200 micrograms/min (on an overnight collection) in at least two out of three consecutive collections made within a 6-month period. Alternative screening techniques use either dipstick (Micral-Test II) or the albumin to creatinine ratio on an early morning urine sample (30-300 mg/g creatinine). Once persistent microalbuminuria is confirmed, 80% of type 1 diabetic patients and 20 to 50% of type 2 diabetic patients will progress to DN. In D2, microalbuminuria also represents a powerful predictor of early mortality from cardiovascular disease. Macroalbuminuria (AER > 300 mg/24 h, corresponding to a total protein excretion > 500 mg/24 h) will eventually lead to a end-stage renal insufficiency within 10 to 20 years. In D2, numerous patients will die from cardiovascular disease before reaching end-stage renal failure. Angiotensin-converting enzyme inhibitors can slow down the evolution toward DN when prescribed when microalbuminuria appears. Screening for microalbuminuria should therefore be a part of the annual clinical assessment in every diabetic patient. [less ▲]

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See detailOral antidiabetic agents. A guide to selection.
Scheen, André ULg; Lefebvre, Pierre ULg

in Drugs (1998), 55(2), 225-36

Type 2 diabetes mellitus (formerly named non-insulin-dependent diabetes mellitus or NIDDM) is a heterogeneous disease resulting from a dynamic interaction between defects in insulin secretion and insulin ... [more ▼]

Type 2 diabetes mellitus (formerly named non-insulin-dependent diabetes mellitus or NIDDM) is a heterogeneous disease resulting from a dynamic interaction between defects in insulin secretion and insulin action. Various pharmacological approaches can be used to improve glucose homeostasis via different modes of action: sulphonylureas essentially stimulate insulin secretion, biguanides (metformin) act by promoting glucose utilisation and reducing hepatic-glucose production, alpha-glucosidase inhibitors (acarbose) slow down carbohydrate absorption from the gut and thiazolidinediones (troglitazone) enhance cellular insulin action on glucose and lipid metabolism. These pharmacological treatments may be used individually for certain types of patients, or may be combined in a stepwise fashion to provide more ideal glycaemic control for most patients. Selection of oral antihyperglycaemic agents as first-line drug or combined therapy should be based on both the pharmacological properties of the compounds (efficacy and safety, profile) and the clinical characteristics of the patient (stage of disease, bodyweight, etc.). Mildly hyperglycaemic patients should preferably be treated with metformin, acarbose or thiazolidinediones (which are not associated with any hypoglycaemic risk), while more severely hyperglycaemic individuals should receive a sulphonylurea. In moderately hyperglycaemic patients, sulphonylureas should be preferred in nonobese patients while metformin, and probably also thiazolidinediones, should have priority in obese insulin-resistant type 2 diabetic patients. Acarbose is mainly indicated to reduce post-prandial glucose fluctuations and improve glycaemic stability. Each antihyperglycaemic agent may also be combined with insulin therapy to improve glycaemic control and/or reduce the insulin requirement of diabetic patients after secondary failure to oral treatment. Finally, safety should be taken into account in elderly patients and/or those with renal impairment, especially as far as the use of sulphonylureas (higher risk of hypoglycaemia) and metformin (higher risk of lactic acidosis) is concerned. [less ▲]

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See detailEffects of gastroplasty on body weight and related biological abnormalities in morbid obesity.
Luyckx, Françoise ULg; Scheen, André ULg; Desaive, Claude ULg et al

in Diabètes & Métabolism (1998), 24(4), 355-61

Obesity is a prevalent metabolic disorder associated with high morbidity and mortality rates. Medical treatment rarely succeeds, and bariatric surgery has been proposed as an alternative therapy. The ... [more ▼]

Obesity is a prevalent metabolic disorder associated with high morbidity and mortality rates. Medical treatment rarely succeeds, and bariatric surgery has been proposed as an alternative therapy. The purpose of this non-controlled retrospective study was to evaluate time-course changes in body weight in severely obese patients who underwent vertical ring gastroplasty or adjustable silicone gastric banding, and to assess the prevalence and potential reversibility of several of the biological abnormalities associated with morbid obesity. From an initial cohort comprising 658 patients, regular body weight measurements and biological data were obtained in 505 patients [419 females, 86 males; age 36 +/- 11 years; body mass index 42.7 +/- 6.9 kg/m2; (mean +/- SD)] with a mean follow-up of 26 +/- 14 months. Mean weight loss was 32 +/- 16 kg. Most weight reduction occurred within the first 6 months, followed by near-stabilisation or even slight weight regain. Most biological parameters were obtained before surgery and after at least 6 months of follow-up. The high prevalence and severity of metabolic disturbances associated with the insulin resistance syndrome (hyperglycaemia, hyperinsulinaemia, decreased HDL cholesterol, hypertriglyceridaemia, elevated fibrinogen levels and hyperuricaemia) before gastroplasty were significantly decreased after weight loss. No major biological deficiencies were observed following gastroplasty, except low iron serum levels. It is concluded that marked weight loss associated with gastroplasty involved a remarkable reduction in the prevalence and severity of several biological abnormalities classically considered as cardiovascular risk factors. [less ▲]

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See detailLe cas clinique du mois. Une nephropathie galopante chez un patient diabetique de type 2.
Philips, Jean-Christophe ULg; Scheen, André ULg; Firre, E. et al

in Revue Médicale de Liège (1998), 53(4), 171-4

We report the case of a patient with insulin-requiring type 2 diabetes who exhibited a rapid deterioration of his renal function leading to haemodialysis in a few months. Various diagnosis were considered ... [more ▼]

We report the case of a patient with insulin-requiring type 2 diabetes who exhibited a rapid deterioration of his renal function leading to haemodialysis in a few months. Various diagnosis were considered to explain this rapid deterioration, excluding diabetic nephropathy as major etiology. The exploration, especially renal biopsy, demonstrated the presence of a glomerulonephritis due to the deposition of immune complexes associated to active hepatitis C rather than diabetic glomerulosclerosis. A treatment with interferon-alpha allowed to partially restore renal function, this recovery permitting the interruption of hemodialysis, with a current follow-up of more than 6 months. [less ▲]

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See detailPharmaco-economie du diabete de type 2.
Scheen, André ULg; Lefebvre, Pierre ULg

in Revue Médicale de Liège (1998), 53(5), 285-9

Type 2 diabetes has long been considered as a benign disease, whereas it is in fact associated with an enormous socio-economic cost. The major part of the burden of diabetes results from the management of ... [more ▼]

Type 2 diabetes has long been considered as a benign disease, whereas it is in fact associated with an enormous socio-economic cost. The major part of the burden of diabetes results from the management of complications (both direct and indirect costs), rather than from the various components of the antihyperglycaemic treatment itself. Solutions include a better prevention of the disease, an earlier diagnosis among individuals at risk, and an optimized management of diabetes, particularly in primary care settings, in order to avoid or retard the development of severe micro- or macroangiopathic complications which are particularly expensive. [less ▲]

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See detailImplications virales dans l'etiopathogenie du diabete de type 1: donnees actuelles.
Radermecker, Régis ULg; Scheen, André ULg; Letiexhe, Michel ULg et al

in Revue Médicale de Liège (1998), 53(10), 597-602

Type 1 diabetes mellitus results from autoimmune destruction of pancreatic beta cells. After having described genetic, immunological and metabolic factors, some researchers have hypothezised that ... [more ▼]

Type 1 diabetes mellitus results from autoimmune destruction of pancreatic beta cells. After having described genetic, immunological and metabolic factors, some researchers have hypothezised that environmental factors might trigger the autoimmune process. Based on epidemiological, anatomoclinical and animal studies, they suggest a role for virus infections. [less ▲]

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