References of "PAQUOT, Nicolas"
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See detailBariatric surgery in patients with Type 2 diabetes: benefits, risks, indications and perspectives.
Scheen, André ULg; De Flines, Jenny ULg; De Roover, Arnaud ULg et al

in Diabètes & Métabolism (2009), 35(6 Pt 2), 537-43

Obesity plays a key role in the pathophysiology of type 2 diabetes (T2DM), and weight loss is a major objective, although difficult to achieve with medical treatments. Bariatric surgery has proven its ... [more ▼]

Obesity plays a key role in the pathophysiology of type 2 diabetes (T2DM), and weight loss is a major objective, although difficult to achieve with medical treatments. Bariatric surgery has proven its efficacy in obtaining marked and sustained weight loss, and is also associated with a significant improvement in glucose control and even diabetes remission. Roux-en-Y gastric bypass appears to be more effective in diabetic patients than the restrictive gastroplasty procedure. This may be explained not only by greater weight reduction, but also by specific hormonal changes. Indeed, increased levels of glucagon-like peptide-1 (GLP-1) and glucose-dependent insulinotropic polypeptide (GIP) may lead to improved beta-cell function and insulin secretion as well as reduced insulin resistance associated with weight loss. The presence of T2DM in obese individuals is a further argument to propose bariatric surgery, and even more so when diabetes is difficult to manage by medical means and other weight-related complications may occur. Bariatric surgery is associated with a better cardiovascular prognosis and reduced mortality, even though acute and long-term complications are present. The observation that surgical rerouting of nutrients triggers changes in the release of incretin hormones that, in turn, ameliorate the diabetic state in the absence of weight loss has led to the recent development of innovative surgical procedures. Thus, bariatric surgery may be said to be progressing towards so-called 'metabolic surgery', which merits further evaluation in patients with T2DM within a multidisciplinary approach that involves both surgeons and endocrinologists. [less ▲]

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See detailUse of cannabinoid CB1 receptor antagonists for the treatment of metabolic disorders.
Scheen, André ULg; Paquot, Nicolas ULg

in Best Practice & Research. Clinical Endocrinology & Metabolism (2009), 23(1), 103-16

Abdominal obesity is associated with numerous metabolic abnormalities, including insulin resistance, impaired glucose tolerance/type-2 diabetes, and atherogenic dyslipidaemia with low high-density ... [more ▼]

Abdominal obesity is associated with numerous metabolic abnormalities, including insulin resistance, impaired glucose tolerance/type-2 diabetes, and atherogenic dyslipidaemia with low high-density lipoprotein (HDL) cholesterol, high triglycerides, and increased small dense low-density lipoprotein (LDL) cholesterol. A proportion of these metabolic disorders may be attributed to increased endocannabinoid activity. The selective cannabinoid 1 (CB1) receptor antagonist rimonabant has been shown to reduce body weight, waist circumference, insulin resistance, triglycerides, dense LDL, C-reactive protein (CRP), and blood pressure, and to increase HDL and adiponectin concentrations in both non-diabetic and diabetic overweight/obese patients. Besides an improvement in glucose tolerance in non-diabetic subjects, a reduction of 0.5-0.7% in haemoglobin A1C (HbA(1c)) levels was consistently observed in various groups of patients with type-2 diabetes. Almost half the metabolic changes could not be explained by weight loss, supporting direct peripheral effects of rimonabant. Ongoing studies should demonstrate whether improved metabolic disorders with CB1 receptor antagonists (rimonabant, taranabant, etc.) would translate into fewer cardiovascular complications among high-risk individuals. [less ▲]

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See detailQuelle est la nouvelle donne pour soigner les patients diabétiques de type 2 ?
Scheen, André ULg; Paquot, Nicolas ULg

in Médecine des Maladies Métaboliques (2009), 3(2), 141-146

Le traitement du diabète de type 2 est une tâche plus difficile qu’il n’y paraît en raison de la complexité de la maladie du point de vue physiopathologique, de l’adhésion imparfaite du patient aux ... [more ▼]

Le traitement du diabète de type 2 est une tâche plus difficile qu’il n’y paraît en raison de la complexité de la maladie du point de vue physiopathologique, de l’adhésion imparfaite du patient aux mesures hygiéno-diététiques, de la multiplicité croissante des médicaments disponibles, des imprécisions persistantes quant aux objectifs glycémiques et de la nécessité de proposer une stratégie de prévention cardio-vasculaire multirisques. Même si des directives générales peuvent être proposées, il convient d’individualiser le traitement en essayant d’obtenir le meilleur rapport bénéfices/risques, à un coût raisonnable. Cet article résume la nouvelle donne dans la prise en charge du diabète de type 2 au vu des résultats des dernières grandes études et du dernier document de consensus publié par l’American diabetes association (ADA) et l’European association for the study of diabetes (EASD). Il insiste sur l’importance d’une prise en charge globale individualisée et sur l’éducation thérapeutique à la fois des soignants et des soignés. [less ▲]

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See detailLe medicament du mois. Vildagliptine (Galvus) et combinaison fixe vildagliptine-metformine (Eucreas) dans le traitement du diabete de type 2.
Scheen, André ULg; Paquot, Nicolas ULg

in Revue Médicale de Liège (2009), 64(3), 161-7

Vildagliptin (Galvus) is a selective inhibitor of dipeptidylpeptidase-4, an enzyme involved in the metabolism of glucagon-like peptide-1 (GLP-1) secreted by L cells of the intestine. It potentiates the ... [more ▼]

Vildagliptin (Galvus) is a selective inhibitor of dipeptidylpeptidase-4, an enzyme involved in the metabolism of glucagon-like peptide-1 (GLP-1) secreted by L cells of the intestine. It potentiates the insulin secretory response (incretin effect) by enhancing the endogenous post-prandial response of GLP-1 (incretin enhancer) in a glucose-dependent manner. Vildagliptin is indicated in the treatment of type 2 diabetes. It improves blood glucose control (HbA1c) in patients treated by diet alone, metformin, sulfonylurea, glitazone or insulin. In patients not well controlled with metformin alone, the addition of vildagliptin is as effective in reducing HbA1c as the coadministration of glimepiride or pioglitazone. Tolerance of vildagliptin is excellent, with no weight gain and no hypoglycaemic episodes. Treatment is simple, with two doses of 50 mg per day, without need of titration or home blood glucose monitoring. In Belgium, vildagliptin is currently reimbursed for the treatment of type 2 diabetes after diet failure and monotherapy with metformin. Therapy can be administered separately or by using a fixed combination vildagliptin-metformin (Eucreas), which should improve drug compliance. [less ▲]

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See detailEstimation of GFR by different creatinine- and cystatin-C-based equations in anorexia nervosa.
Delanaye, Pierre ULg; Cavalier, Etienne ULg; Radermecker, Régis ULg et al

in Clinical Nephrology (2009), 71(5), 482-91

Background: Patients with anorexia nervosa (AN) are at high risk of renal failure. Glomerular filtration rate (GFR) is overestimated when estimated by the creatinine-based equations. We have studied the ... [more ▼]

Background: Patients with anorexia nervosa (AN) are at high risk of renal failure. Glomerular filtration rate (GFR) is overestimated when estimated by the creatinine-based equations. We have studied the accuracy and precision of cystatin C-based equations. Method: 27 AN patients were included. GFR was measured with the chromium-51-ethylenediaminetetraacetate (51Cr-EDTA) method. We have compared the accuracy and precision of creatinine-based equations (MDRD and Cockcroft) with those of different new cystatin C-based equations. Results: The creatinine-based equations overestimate measured GFR, especially the MDRD study equation. All the cystatin C-based equations also overestimate measured GFR. The Cockcroft and Gault formula and the cystatin C-based equation published by Rule have the best accuracy and precision, but these last performances remain unsatisfactory. Conclusion: Both creatinine and cystatin C-based equations strongly overestimate measured in patients with AN. [less ▲]

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See detailAmelioration du controle glycemique et perte de poids sous exenatide chez des patients diabetiques de type 2: resultats d'une etude retrospective observationnelle multicentrique belge.
De Block, C.; Paquot, Nicolas ULg; Daoudi, N. et al

in Revue Médicale de Liège (2009), 64(10), 488-95

This is a retrospective analysis of medical records in 4 Belgian diabetes centres of 3 cohorts of patients with type 2 diabetes, with data available, respectively, after 3 months < or =163 patients ... [more ▼]

This is a retrospective analysis of medical records in 4 Belgian diabetes centres of 3 cohorts of patients with type 2 diabetes, with data available, respectively, after 3 months < or =163 patients exposed), 6 months (n=77) and 9 months (n=28) with exenatide therapy. This analysis mainly focuses on the 3 and 6 month cohorts. The mean HbA1 level at baseline averaged 9% and decreased by -1.3% and -1.4% at 3 and 6 months, respectively (-1.5% at 9 months). Neither the duration of diabetes nor initial body weight did influence the metabolic response. The decrease in HbA(1c) at 6 months was greater in patients with higher baseline HbA(1c):-0.5%, -1.4% and -2.4% for a baseline HbA(1c) level <8%, 8-10% and >10%, respectively. At 6 months, the composite criterion of a reduction of HbA(1c) by >1% or a final level <7% was reached by 69% of the cohort. Body weight decreased continuously over time, with a mean reduction of -2.1 kg at 3 months and -3.0 kg at 6 months (-4.9 kg at 9 months). The greater the baseline body weight, the greater the weight loss at final evaluation. Minor nausea and more rarely vomiting were observed, essentially during the first months of exenatide treatment. According to this observational study in routine practice, exenatide may be a valuable alternative to insulin for intensification of treatment of patients with type 2 diabetes after failure of oral drug combination, independently of baseline HbA(1c), body weight and duration of diabetes. [less ▲]

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See detailL'etude clinique du mois. Controle glycemique et morbimortalite cardio-vasculaire chez le patient diabetique de type 2. Resultats des etudes ACCORD, ADVANCE et VA-Diabetes.
Radermecker, Régis ULg; Philips, Jean-Christophe ULg; Jandrain, Bernard ULg et al

in Revue Médicale de Liège (2008), 63(7-8), 511-8

Type 2 diabetes is associated with a high risk of complications, essentially macrovascular events. Surprisingly, the effect of improved glucose control on coronary and cerebrovascular complications in ... [more ▼]

Type 2 diabetes is associated with a high risk of complications, essentially macrovascular events. Surprisingly, the effect of improved glucose control on coronary and cerebrovascular complications in this population remains questionable. Furthermore, the target level of glycated haemoglobin (HbA1c) to minimise the risk of diabetic complications is controversial. We report the results of three recent randomised control trials (ACCORD, ADVANCE, Veterans Affairs Diabetes), which assessed the impact on cardiovascular events of intensive glucose-lowering therapy. None of these studies was able to demonstrate a significant reduction of cardiovascular events in the intensive group as compared to the standard group. On the contrary, in ACCORD, the study with the most ambitious goal (HbA1c < 6%), the overall and cardiovascular mortality was greater in the intensive group. In contrast, in the ADVANCE trial, the mortality and the incidence of cardiovascular events were not statistically different between the two treatment groups, whereas the risk of microangiopathic complications, especially nephropathy, was significantly decreased in the intensive group (HbA1c < or = 6.5%, with modified release gliclazide as main treatment). Finally, VA-Diabetes showed that the effect of better glucose control on cardiovascular complications disappeared with duration of the disease and that the risk of cardiovascular events increased in patients with severe hypoglycaemic episodes. In the three studies, the hypoglycaemic risk was indeed increased in the intensive group, which may contribute to reduce the positive impact of better glucose control on cardiovascular complications. The best way to protect type 2 diabetic patients against coronary and cerebrovascular disease is to target all cardiovascular risk factors. [less ▲]

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See detailSujets « métaboliquement obèses » de poids normal. Première partie: diagnostic, physiopathologie et prévalence
Beck, Emmanuel ULg; Paquot, Nicolas ULg; Scheen, André ULg

in Obésité (2008), 3(3), 184-193

Obesity, particularly abdominal obesity, is the main risk factor for metabolic syndrome. However, some non-obese individuals are metabolically abnormal and therefore probably have an increased risk of ... [more ▼]

Obesity, particularly abdominal obesity, is the main risk factor for metabolic syndrome. However, some non-obese individuals are metabolically abnormal and therefore probably have an increased risk of cardiovascular disease. The present review paper aims to describe the main characteristics of the metabolically obese normal-weight (MONW) syndrome, analyse its etiopathogenesis and pathophysiology and, finally, assess its prevalence in various populations. [less ▲]

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See detailSujets « métaboliquement obèses » de poids normal. Seconde partie: pronostic et prise en charge
Beck, Emmanuel ULg; Paquot, Nicolas ULg; Scheen, André ULg

in Obésité (2008), 3(4), 280-285

Metabolically obese normal-weight (MONW) individuals are frequently not detected because of a falsely reassuring body weight. However, they have most of the metabolic syndrome markers known to be ... [more ▼]

Metabolically obese normal-weight (MONW) individuals are frequently not detected because of a falsely reassuring body weight. However, they have most of the metabolic syndrome markers known to be associated with a higher risk of type 2 diabetes, cardiovascular disease and mortality. The present review paper aims to describe the clinical consequences to which MONW people are exposed and the main principles of managing this syndrome [less ▲]

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See detailInhibition des recepteurs CB1 et metabolisme du glucose: rimonabant dans le diabete de type 2.
Scheen, André ULg; Paquot, Nicolas ULg; Van Gaal, Luc F

in Revue Médicale Suisse (2008), 4(168), 1812-7

Endocannabinoid system is overactivated in individuals with abdominal obesity. CBI receptors, first individualized in the brain, are also expressed in the adipocyte, the skeletal muscle, the liver, the ... [more ▼]

Endocannabinoid system is overactivated in individuals with abdominal obesity. CBI receptors, first individualized in the brain, are also expressed in the adipocyte, the skeletal muscle, the liver, the gut, and the pancreas. Their blockade improves glucose tolerance and lipid profile, thanks increased insulin sensitivity and adiponectin levels. Rimonabant, a selective antagonist of CBI receptors, improves glucose control in patients with type 2 diabetes, treated with diet alone, metformin, sulfonylurea or insulin, while it also reduces body weight and other risk factors. Ongoing studies aim at further demonstrating the potential of rimonabant in the management of type 2 diabetes, in the prevention of type 2 diabetes and in the protection against cardiovascular complications in (diabetic) patients with abdominal obesity. [less ▲]

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See detailInhibitors of cannabinoid receptors and glucose metabolism.
Scheen, André ULg; Paquot, Nicolas ULg

in Current Opinion in Clinical Nutrition & Metabolic Care (2008), 11(4), 505-11

PURPOSE OF REVIEW: Abdominal obesity is closely related to type 2 diabetes and overactivity of the endocannabinoid system. The present review aims at evaluating the role of endocannabinoid system in ... [more ▼]

PURPOSE OF REVIEW: Abdominal obesity is closely related to type 2 diabetes and overactivity of the endocannabinoid system. The present review aims at evaluating the role of endocannabinoid system in glucose dysregulation and the effects of cannabinoid 1 receptor blockade on glucose metabolism in both animal models and overweight/obese humans, especially with type 2 diabetes. RECENT FINDINGS: Cannabinoid 1 receptors have been identified not only in the brain, but also in the adipose tissue, the gut, the liver, the skeletal muscle and even the pancreas, all organs playing a key role in glucose metabolism and type 2 diabetes. Rimonabant, the first selective cannabinoid 1 receptor blocker in clinical use, has been shown to reduce body weight, waist circumference, glycated haemoglobin, triglycerides, insulin resistance index, and to increase HDL cholesterol and adiponectin concentrations in patients with type 2 diabetes, confirming data on nondiabetic overweight/obese patients. Almost half of the metabolic changes, including glycated haemoglobin reduction, could not be explained by weight loss, in agreement with direct peripheral effects. SUMMARY: Cannabinoid 1 blockade reduces food intake and body weight and improves metabolic regulation beyond just weight loss. Because of its positive effect on glucose metabolism, rimonabant deserves consideration in the treatment of overweight/obese patients with type 2 diabetes. [less ▲]

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See detailL'etude clinique du mois. United Kingdom Prospective Diabetes Study: 10 ans plus tard.
Scheen, André ULg; Paquot, Nicolas ULg; Lefebvre, Pierre ULg

in Revue Médicale de Liège (2008), 63(10), 624-9

A 10-year post-trial monitoring of patients with newly diagnosed type 2 diabetes randomised in the "United Kingdom Prospective Diabetes Study" (UKPDS) demonstrated a continued reduction in microvascular ... [more ▼]

A 10-year post-trial monitoring of patients with newly diagnosed type 2 diabetes randomised in the "United Kingdom Prospective Diabetes Study" (UKPDS) demonstrated a continued reduction in microvascular risk (-24%, p = 0.001) and emergent risk reductions for myocardial infarction (-15%, p = 0.01) and death from any cause (-13%, p = 0.007), despite an early loss of glycaemic differences ("legacy effect"). A continued benefit after metformin therapy was evident during the ten-year post-trial follow-up among overweight patients (-33%, p = 0.005 for myocardial infarction and -27%, p = 0.002 for death from any cause). In contrast, the benefits of previously improved blood pressure control were not sustained when between-groups differences in blood pressure were lost during follow-up, except for a reduced risk for peripheral vascular disease. These observations are strong arguments in favour of an early optimisation of blood glucose control and of a sustained control of blood pressure in patients with type 2 diabetes. [less ▲]

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See detailCystatin C or Creatinine for Detection of Stage 3 Chronic Kidney Disease in Anorexia Nervosa.
Delanaye, Pierre ULg; Cavalier, Etienne ULg; Radermecker, Régis ULg et al

in Nephron. Clinical Practice (2008), 110(3), 158-163

Background: Patients with anorexia nervosa (AN) are at a high risk of renal failure. Chronic kidney disease (CKD) is often missed in these patients because the serum creatinine is a poor marker of kidney ... [more ▼]

Background: Patients with anorexia nervosa (AN) are at a high risk of renal failure. Chronic kidney disease (CKD) is often missed in these patients because the serum creatinine is a poor marker of kidney function. We studied the utility of cystatin C to detect renal failure in this population. Method: Twenty-seven AN patients were studied. Glomerular filtration rates (GFR) were measured with the chromium-51- ethylenediaminetetraacetate ((51)Cr-EDTA) method. We compared the ability of creatinine and cystatin C to detect stage 3 CKD (GFR below 60 ml/min) by ROC curve analysis. Results: In this cohort, there is no correlation between GFR and serum creatinine, but there is a significant correlation between cystatin C and GFR. By ROC analysis, the cystatin C concentration is better than the serum creatinine concentration for the detection of stage 3 CKD (area under the curve of 0.86 vs. 0.61, p = 0.05). Conclusion: Plasma cystatin C is better than serum creatinine in detecting stage 3 CKD in patients with AN. [less ▲]

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See detailLe cerveau, un organe gluco-dependant. Effets deleteres de l'hypoglycemie et de l'hyperglycemie.
Radermecker, Régis ULg; Philips, Jean-Christophe ULg; Jandrain, Bernard ULg et al

in Revue Médicale de Liège (2008), 63(5-6), 280-6

Glucose is almost the only energy substrate for the brain. Such glucose dependence explains why any large variation of plasma glucose levels could lead to cerebral dysfunction, which may be severe and ... [more ▼]

Glucose is almost the only energy substrate for the brain. Such glucose dependence explains why any large variation of plasma glucose levels could lead to cerebral dysfunction, which may be severe and progress to a coma. Hypoglycaemic coma, the most common one, has a pure metabolic origin (neuroglucopenia) whereas hyperglycaemic coma is more complex and mainly due to osmotic disturbances. Besides acute changes of plasma glucose concentrations, it is generally recognized that more subtle chronic or recurrent glucose abnormalities could also result in brain dysfunction. However, such clinical consequences are more difficult to assess in clinical practice. Nevertheless, learning perturbations in young patients with type 1 diabetes and memory losses, sometimes severe and subject to progress to dementia ("diabetic encephalopathy") in older type 1 or type 2 diabetic patients, have been reported, although with some controversy. The present paper summarizes the current knowledge of both acute and chronic cerebral dysfunctions following perturbations of blood glucose levels in diabetic patients. [less ▲]

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See detailLe traitement du diabète de type 2: entre insulinosensibilisateurs et insulinosécrétagogues
SCHEEN, André ULg; RADERMECKER, Régis ULg; Philips, J. C. et al

in Revue Médicale de Liège (2007), 62 Spec No

Type 2 diabetes is a complex disease characterized by a dual defect of insulin secretion and insulin sensitivity, which may vary from patient to patient, but also along the natural history of the disease ... [more ▼]

Type 2 diabetes is a complex disease characterized by a dual defect of insulin secretion and insulin sensitivity, which may vary from patient to patient, but also along the natural history of the disease in a particular patient. Besides the lifestyle changes, the treatment strategy comprises the administration of agents that promote insulin secretion and/or that improve insulin sensitivity. Drugs facilitating weight loss also improve glucose control by reducing insulin resistance. A global approach should be recommended to reduce the high cardiovascular risk of diabetic patients. The present article aims at summarizing our contribution to the development of drugs designed for the treatment of type 2 diabetes. [less ▲]

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