References of "PAQUOT, Nicolas"
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See detailPhysiopathologie de l'hyperglycemie post-prandiale
Scheen, A. J.; Paquot, Nicolas ULg

in Journées Annuelles de Diabetologie de l'Hôtel-Dieu (2006)

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See detailLa place des micronutriments en medecine.
Paquot, Nicolas ULg; Scheen, André ULg

in Revue Médicale de Liège (2006), 61(5-6), 464-70

Adequate micronutrient intake throughout life course is essential for the maintenance of health. Micronutrients are necessary for the maintenance of intermediary metabolism, play a crucial role as co ... [more ▼]

Adequate micronutrient intake throughout life course is essential for the maintenance of health. Micronutrients are necessary for the maintenance of intermediary metabolism, play a crucial role as co-factors or co-enzymes in the activity of virtually all enzymes, and have important functions to neutralise the deleterious effects of oxidant species. Claims have been made for the benefits of micronutrient supplementation. Clinical benefit of a supplementation is obvious in those individuals who are severely depleted and at risk of complications. More recently, the concept of subclinical deficit has been developed, which essentially relies upon biochemical abnormalities the interpretation of which remains doubtful in most instances. Symptomatology related to such subclinical deficit is non specific and the potential advantages of micronutrient supplements remain marginal and largely not well-established. In contrast, provision of excess supplements to individuals who do not need them may be harmful. In the general population, a well-balanced diet supplies an adequate intake of micronutrient. Further research is needed to identify the best markers of micronutrient and antioxidant status, so that at risk patients can be identified and appropriate supplementation provided accordingly. New large-scale trials of different doses of micronutrients, based on precise outcome markers, are required to optimise intakes in different groups of patients as well as in the general population. [less ▲]

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See detailLe diabete de type 1 et la maladie coeliaque.
Mathieu, Sandrine ULg; Stassen, A.; Paquot, Nicolas ULg et al

in Revue Médicale de Liège (2006), 61(9), 637-42

Celiac disease is more prevalent in type 1 diabetic patients than in the general population. The exact reason for this association remains unknown. Two hypotheses are taken into consideration: either a ... [more ▼]

Celiac disease is more prevalent in type 1 diabetic patients than in the general population. The exact reason for this association remains unknown. Two hypotheses are taken into consideration: either a common genetic background or an immune response against Langerhans islets triggered by celiac disease. This review presents recent data about this association and its consequences in clinical practice. [less ▲]

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See detailEtiopathogenie et physiopathologie du diabete de type 2
Fery, Françoise; Paquot, Nicolas ULg

in Revue Médicale de Liège (2005), 60(5-6), 361-8

Etiopathogenesis of type 2 diabetes is complex and still partially unknown. Its etiology is determined by the interaction of genetic and environmental factors. The genetic contribution is important, but ... [more ▼]

Etiopathogenesis of type 2 diabetes is complex and still partially unknown. Its etiology is determined by the interaction of genetic and environmental factors. The genetic contribution is important, but has a polygenic origin. Obesity, especially when fat mass is preferably located in the abdomen, is the main predisposing factor for type 2 diabetes, and almost 80% of diabetic patients are overweight or obese. The diabetogenic effect of obesity is due to the capacity of excessive fat mass to induce or aggravate insulin resistance. Increasing lack of physical activity is also a contributing factor as it increases insulin resistance. As far as pathophysiology is concerned, the development of type 2 diabetes results from the coexistence of abnormalities of insulin secretion and insulin action. Insulin secretory dysfunction, whose underlying mechanism remains poorly understood, is characterized by a relative defect in circulating insulin levels of variable severity. Resistance to insulin action is located in the liver (increased hepatic glucose production), in the skeletal muscle (decreased muscular glucose uptake) and in the adipose tissue (exaggerated lipolysis with elevated plasma free fatty acids). Changes in life-style habits (weight reduction, regular physical activity) are able to prevent or delay the development of type 2 diabetes. [less ▲]

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See detailLes adipocytokines: lien entre obesite, diabete de type 2 et atherosclerose?
Paquot, Nicolas ULg; Tappy, L.

in Revue Médicale de Liège (2005), 60(5-6, May-Jun), 369-73

Adipose tissue, in addition to the storage of lipids function for lipids, plays active roles in normal metabolic homeostasis and in the development of several diseases, such as type 2 diabetes ... [more ▼]

Adipose tissue, in addition to the storage of lipids function for lipids, plays active roles in normal metabolic homeostasis and in the development of several diseases, such as type 2 diabetes, dyslipaemia and atherosclerosis. These roles are mediated by adipocytokines, factors secreted by adipose tissue. These include tumor necrosis factors (TNF)-alpha, leptin, resistin, adiponectin or visfatin. Adipocytokines act in an autocrine, paracrine and endocrine manner. Adiponectin is a peculiar adipocytokine because in contrast to the markedly increased levels of leptin, resistin or TNF-alpha in obesity, its level is negatively correlated with body mass index, and is decreased in presence of insulin resistance and in type 2 diabetes. Adiponectin may play a crucial role in the development of diabetes mellitus and high adiponectin levels should protect against impairment of glucose metabolism. Moreover, adipocytokines are involved in the pathogenesis of vascular diseases and may represent a link between obesity, diabetes, inflammation and atherosclerosis. Weight loss, exercise and some antidiabetic drugs also influence plasma adipocytokines levels. For instance, thiazolidinediones treatment in patients with type 2 diabetes resulted in an increased in plasma adiponectin levels and a decrease in circulating TNF-alpha concentrations. [less ▲]

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See detailLe regime alimentaire chez le patient diabetique de type 2
Paquot, Nicolas ULg

in Revue Médicale de Liège (2005), 60(5-6, May-Jun), 391-4

The goal of medical nutrition therapy in type 2 diabetic patients is to achieve optimal metabolic control of blood glucose levels as well as of other cardiovascular risk factors, such as the the lipid ... [more ▼]

The goal of medical nutrition therapy in type 2 diabetic patients is to achieve optimal metabolic control of blood glucose levels as well as of other cardiovascular risk factors, such as the the lipid profile. Carbohydrate and monounsaturated fat together should provide 60-70% of energy intake. The monounsaturated fat content should be individualized according to the metabolic profile and the habits of the patient. The use of low-glycaemic index foods may be recommended. Less than 10% of energy intake should be derived from saturated fats. Diabetic patients with LDL cholesterol > or = 100 mg/dl may benefit from lowering saturated fat intake to < 7% of energy intake. [less ▲]

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See detailRecepteurs PPAR-gamma, nouvelle cible therapeutique dans les pathologies metaboliques et cardio-vasculaires.
Scheen, André ULg; Paquot, Nicolas ULg

in Revue Médicale de Liège (2005), 60(2), 89-95

PPARs ("Peroxisome Proliferator-Activated Receptors") belong to a superfamily of nuclear receptors with several isoforms, among which PPAR-alpha mainly located in the liver and PPAR-gamma mainly located ... [more ▼]

PPARs ("Peroxisome Proliferator-Activated Receptors") belong to a superfamily of nuclear receptors with several isoforms, among which PPAR-alpha mainly located in the liver and PPAR-gamma mainly located in the adipose tissue. These receptors are considered as major pharmacological targets since the discovery of their activation by specific agonists, which lead to various favourable metabolic effects. Improvement of lipid profile by fibrates is explained by the activation of liver PPAR-alpha receptors. However, PPAR-gamma receptors have focused most fundamental and clinical research in recent years after the demonstration of their activation by thiazolidinediones (pioglitazone, rosiglitazone), a new class of antidiabetic agents. Beyond their effects on insulin sensitivity, glitazones exert pleiotropic effects that may result in cardiovascular protection in high risk patients. It has been recently demonstrated that certain angiotensin AT1 receptor blockers (sartans) can also exert a partial agonist activity on PPAR-gamma. Among the molecules of this class, telmisartan appears to exert this effect at the lower concentrations. Thus, PPAR-y, as common pharmacological target, may, at least partially, explain some of the effects observed with both thiazolidinediones and inhibitors of the renin-angiotensin system, in particular the improvement in insulin sensitivity (in particular via an increase in adiponectin levels), the protection against type 2 diabetes, the reduction in arterial blood pressure and the prevention of cardiovascular complications. There is currently a major interest from the pharmaceutical industry in the development of new molecules able to activate both PPAR-alpha and PPAR-gamma. [less ▲]

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See detailLes insulinosensibilisateurs.
Scheen, André ULg; Paquot, Nicolas ULg

in Revue Médicale de Liège (2005), 60(5-6), 409-13

Insulin resistance has a genetic background and its phenotypic expression is triggered by fat diet, lack of physical activity and obesity. It provokes a stress on B cells, tends to increase blood glucose ... [more ▼]

Insulin resistance has a genetic background and its phenotypic expression is triggered by fat diet, lack of physical activity and obesity. It provokes a stress on B cells, tends to increase blood glucose levels, is intimately associated with the metabolic syndrome and represents a major cardiovascular risk factor. Insulin resistance may be favourably influenced by simple life-style changes. If necessary, drugs may be prescribed, such as metformin, the first choice antidiabetic oral agent in overweight individuals, or thiazolidinediones (glitazones), new insulin sensitizers with promising effects. New molecules are currently developed, especially PPAR alpha/gamma or pan-agonists. Targeting insulin resistance has several objectives: reducing hyperglycaemia in type 2 diabetic patients, protecting B cells in order to prevent type 2 diabetes in at risk individuals and limiting the progressive metabolic deterioration in diabetic patients, finally, and perhaps most importantly, ameliorating the global cardiovascular prognosis. [less ▲]

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See detailHemochromatose et diabete sucre: approche diagnostique et evolution clinique.
Thielen, Vinciane ULg; Radermecker, Régis ULg; Philips, Jean-Christophe ULg et al

in Revue Médicale de Liège (2005), 60(5-6), 448-54

We report the characteristics of diabetes mellitus in 10 patients with a suspicion of hereditary hemochromatosis. The results of this personal series were compared to literature's data described in a ... [more ▼]

We report the characteristics of diabetes mellitus in 10 patients with a suspicion of hereditary hemochromatosis. The results of this personal series were compared to literature's data described in a recent article. Early diagnosis and treatment by phlebotomy can improve blood glucose control in the early stages of the disease. If diagnosis occurs later, when the patient already needs insulin therapy, diabetes will not be improved by phlebotomy anymore. [less ▲]

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See detailLe medicament du mois. L'insuline detemir (Levemir)
Scheen, André ULg; Radermecker, Régis ULg; Philips, Jean-Christophe ULg et al

in Revue Médicale de Liège (2005), 60(10), 814-9

Insulin detemir (Levemir) is a soluble long acting human insulin analogue acylated with a 14-carbon fatty acid. The fatty acid modification allows insulin detemir to reversibly bind to albumin, thereby ... [more ▼]

Insulin detemir (Levemir) is a soluble long acting human insulin analogue acylated with a 14-carbon fatty acid. The fatty acid modification allows insulin detemir to reversibly bind to albumin, thereby providing slow absorption and a prolonged metabolic effect (up to 24 hours) with low variability. Indeed, in patients with type 1 or type 2 diabetes mellitus, insulin detemir has a more predictable, protracted and consistent effect, with less intrapatient variability in glycaemic control (particularly fasting plasma glucose levels), compared with NPH (Neutral Protamine Hagedorn) insulin. Insulin detemir, is at least as effective as NPH insulin in maintaining overall glycaemic control, with a lower risk of nocturnal hypoglycaemia. It also provides the additional benefit of less body weight gain as compared to other basal insulins. Levemir, presented in cartridges for the pen device NovoPen 3 and administered preferably at bedtime (if necessary morning and evening), is a promising new option for basal insulin therapy in diabetic patients, especially those on a basal-bolus scheme. [less ▲]

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See detailLa place de la transplantation pancreatique dans le traitement du diabete
De Roover, Arnaud ULg; Detry, Olivier ULg; Coimbra Marques, Carla ULg et al

in Revue Médicale de Liège (2005), 60(5-6, May-Jun), 350-4

Pancreas transplantation has now become an established option in the treatment of diabetic complications. It normalizes glucose metabolism, prevents, stabilizes and improves the evolution of diabetes ... [more ▼]

Pancreas transplantation has now become an established option in the treatment of diabetic complications. It normalizes glucose metabolism, prevents, stabilizes and improves the evolution of diabetes-associated lesions. Improvements in surgical procedure and in immunosuppression have better defined its indications. Combined kidney-pancreas transplantation appears today as the best treatment for the diabetic patient with end stage renal disease. Isolated pancreas transplantation is reserved to non-uremic patients with severe diabetic complications or with hyperlabile glycaemic control and severe impairment of quality of life. [less ▲]

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See detailFatty liver in the intensive care unit
Paquot, Nicolas ULg; Delwaide, Jean ULg

in Current Opinion in Clinical Nutrition & Metabolic Care (2005), 8(2), 183-187

PURPOSE OF REVIEW: Non-alcoholic steatohepatitis is a liver disease characterized by steatosis and steatohepatitis in subjects whose alcohol consumption is negligible. The primary form is associated with ... [more ▼]

PURPOSE OF REVIEW: Non-alcoholic steatohepatitis is a liver disease characterized by steatosis and steatohepatitis in subjects whose alcohol consumption is negligible. The primary form is associated with insulin resistance whereas secondary non-alcoholic steatohepatitis occurs notably during total parenteral nutrition or in patients in the intensive care unit. This review is mainly focused on recent developments in the understanding of the pathogenesis of this disease. RECENT FINDING: Pathogenesis involves the direct role of fatty acids in liver injury, oxidative stress, cytokines, genetic susceptibility or mitochondrial dysfunction. An increased delivery of free fatty acids to the liver contributes to the first hit, originating liver steatosis. The process may undergo a second hit, characterized by inflammation and hepatocellular degeneration. Mitochondrial dysfunction plays a key role by leading to abnormal generation of reactive oxygen species, which cause lipid peroxidation. The peroxidation products and cytokines favor progression from steatohepatitis to fibrosis. Fatty liver disease may also be encountered in the intensive care unit in patients receiving parenteral nutrition. However, an adapted glucose-lipid ratio as source of non-protein calories prevents the development of fatty liver. Moreover, recent evidence suggests the importance of the type of lipid infused (structured lipid emulsion or fish oils). The acute phase response associated with severe disease can also lead to the development of fatty liver in spite of adequate nutritional support. SUMMARY: The pathogenesis of non-alcoholic steatohepatitis is multifactorial, but there is growing evidence that mitochondrial dysfunction always plays a key role. Adapted nutrition may prevent in part fatty liver in the intensive care unit. [less ▲]

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See detailHemochromatose et diabete.
Thielen, Vinciane ULg; Paquot, Nicolas ULg; Scheen, André ULg

in Revue Médicale de Liège (2004), 59(1), 29-31

Nowadays, haemochromatosis is often diagnosed when the patient is monosymptomatic. Diabetes is frequently the first expression of the disease. So, it is important to know the clinical and biologic ... [more ▼]

Nowadays, haemochromatosis is often diagnosed when the patient is monosymptomatic. Diabetes is frequently the first expression of the disease. So, it is important to know the clinical and biologic characteristics to evoke diagnosis as early as possible. Uncommon presentations request systematic screening. [less ▲]

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See detailThe impact of reimbursement criteria on the appropriateness of 'statin' prescribing.
Autier, Philippe; Creplet, Jean; Vansant, Greet et al

in European Journal of Cardiovascular Prevention & Rehabilitation (2003), 10(6), 456-62

BACKGROUND: In Belgium, regulations restrict the reimbursement of statins to patients with total serum cholesterol above 250 mg/dl (6.41 mmol/l) after a three-month lipid-lowering diet. We investigated ... [more ▼]

BACKGROUND: In Belgium, regulations restrict the reimbursement of statins to patients with total serum cholesterol above 250 mg/dl (6.41 mmol/l) after a three-month lipid-lowering diet. We investigated the possible impact of these regulations on characteristics of Belgian patients receiving a lipid-lowering drug. DESIGN: From 1998 to 2000, standard questionnaires on coronary risk factors and treatments with lipid-lowering drugs were completed by 301 GPs sampled at random in the 11 Belgian Provinces. Questionnaires had to be completed for 18 consecutive patients 35 years old or more attending GPs' practices, irrespective of the underlying motive for attendance. RESULTS: Of the 5511 patients included in the study, 1519 (28%) had established coronary disease or diabetes mellitus, or > or = 2 non-cholesterol coronary risk factors. Most (70%) of these patients were not treated with a lipid-lowering drug. Only 22% of patients with established coronary disease, 10% of patients with diabetes mellitus and 9% of patients with > or = 2 coronary risk factors were treated with a statin. Fifty-nine percent of fibrate users and 50% of statin users had a pre-treatment cholesterol level above 250 mg/dl, but had no or only one non-cholesterol coronary risk factor. CONCLUSIONS: In Belgium, the majority of patients at higher risk of coronary event do not benefit from lipid-lowering drugs, particularly the statins. In contrast, one of two statin users and three of five fibrate users should probably not receive the drug prescribed. Regulation based on blood cholesterol level encourages the overlooking of other risk factors relevant for selecting patients having the greatest chance to benefit from statin treatment. [less ▲]

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See detailRole specifique du controle glycemique dans la prevention de l'angiopathie du patient diabetique de type 2.
Scheen, André ULg; Paquot, Nicolas ULg

in Revue Médicale de Liège (2003), 58(5), 265-70

Even if type 2 diabetes is a complex disease combining hyperglycaemia and various other metabolic abnormalities. Reduction of chronic hyperglycemia, assessed by glycated haemoglobin (HbA1c), allows the ... [more ▼]

Even if type 2 diabetes is a complex disease combining hyperglycaemia and various other metabolic abnormalities. Reduction of chronic hyperglycemia, assessed by glycated haemoglobin (HbA1c), allows the prevention or the delay of vascular complications. Evidence-based medicine already provided numerous data regarding the risk of microangiopathy, especially retinopathy and nephropathy but also neuropathy. The evidence is less obvious as far as macroangiopathy, especially coronary artery disease, is concerned. This observation should encourage a global approach of the type 2 diabetic patient, taking into account all vascular risk factors. It also provides further arguments in favour of alternative therapeutic modalities, such as the use of hypoglycaemic agents that improve postprandial hyperglycaemia and/or insulin resistance. This latter approach appears to be promising in view of the favourable results with metformin in the United Kingdom Prospective Diabetes Study. It should be confirmed in large prospective ongoing clinical trials with new insulin sensitizers like thiazolidinediones. [less ▲]

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See detailPrevention cardio-vasculaire chez le patient diabetique de type 2.
Paquot, Nicolas ULg; Scheen, André ULg

in Revue Médicale de Liège (2003), 58(5), 271-4

It is estimated that 80% of individuals with type 2 diabetes die of cardiovascular diseases. Several factors account for the accelerated atherosclerosis present in diabetic patients. These include ... [more ▼]

It is estimated that 80% of individuals with type 2 diabetes die of cardiovascular diseases. Several factors account for the accelerated atherosclerosis present in diabetic patients. These include hyperglycaemia, dyslipidaemia, hypertension and prothrombotic state. Hypoglycaemic agents, statin or fibrates that improve dyslipidaemia, anti-hypertensive agents, aspirin and healthy lifestyle can modify these factors and have been shown to reduce morbidity and mortality caused by coronary heart disease in diabetic patients. It was recently demonstrated that a multifactorial intervention on modifiable risk factors of cardiovascular disease in type 2 diabetic patients dramatically reduces the incidence of cardiovascular events. Thus, an intensified intervention aimed at multiple risk factors should be recommended in patients with type 2 diabetes. [less ▲]

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See detailPrevention des hypoglycemies chez le patient diabetique de type 1.
Radermecker, Régis ULg; Jandrain, Bernard ULg; Paquot, Nicolas ULg et al

in Revue Médicale de Liège (2003), 58(6), 361-8

Hypoglycaemia is the most common metabolic disorder in type 1 diabetic patients. It is rarely dangerous, but significantly alters the quality of life and hinders the achievement of "normoglycaemia". Even ... [more ▼]

Hypoglycaemia is the most common metabolic disorder in type 1 diabetic patients. It is rarely dangerous, but significantly alters the quality of life and hinders the achievement of "normoglycaemia". Even if hypoglycaemia is impossible to be avoided, both its frequency and severity may be reduced if patients follow several practical recommendations. After having defined hypoglycaemia, we shall briefly describe its pathophysiology and its main causes in type 1 diabetic patients. Afterwards, the different approaches of prevention of hypoglycaemia will be discussed. We will particularly stress the need to revise the glycaemic target in high-risk patients, the role of optimising insulin therapy, the valuable help of blood glucose monitoring, the critical support of diet adjustments, and the appropriate management in case of physical activity. There is no doubt that patient's education plays a crucial role in such a strategy that aims at preventing severe hypoglycaemia in type 1 diabetic individuals. [less ▲]

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See detailL'adiponectine: une nouvelle adipocytokine.
Lebas, Eglantine ULg; Paquot, Nicolas ULg; Scheen, André ULg

in Revue Médicale de Liège (2003), 58(9), 554-8

Adipose tissue is not simply a store of excess energy, but also secretes a variety of proteins into circulating blood that influence systemic metabolism. These include tumor necrosis factor (TNF-alpha ... [more ▼]

Adipose tissue is not simply a store of excess energy, but also secretes a variety of proteins into circulating blood that influence systemic metabolism. These include tumor necrosis factor (TNF-alpha), plasminogen activator inhibitor type 1 (PAI-1), leptin, resistine and adiponectin. These are collectively known as adipocytokines. Adiponectin (also referred to as AdipoQ, Acrp 30, apM1 or GBP28) is a novel adipose-specific protein. A recent genome study mapped a susceptibility locus for type 2 diabetes and the metabolic syndrome on chromosome 3q27, where the adiponectin gene is located. Adiponectin is a peculiar adipocytokine because in contrast to the markedly increased levels of many others, as leptin or TNF-alpha, its level is reduced in obesity and type 2 diabetes. The administration of thiazolidinediones, which are synthetic PPARs-gamma ligands, significantly increases the plasma adiponectin concentrations, an effect that could improve insulin sensitivity. Thus, the administration of adiponectin may provide a novel treatment modality for insulin resistance and type 2 diabetes. [less ▲]

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See detailApproches pharmacologiques de prévention du diabète de type 2.
SCHEEN, André ULg; PAQUOT, Nicolas ULg; LETIEXHE, Michel ULg et al

in Médecine et Hygiène (2002), 60

L’augmentation rapide de la prévalence du diabète de type 2 impose la mise en place de stratégies de prévention. Outre les mesures hygiéno-diététiques, essentielles, diverses approches pharmacologiques ... [more ▼]

L’augmentation rapide de la prévalence du diabète de type 2 impose la mise en place de stratégies de prévention. Outre les mesures hygiéno-diététiques, essentielles, diverses approches pharmacologiques ont apporté récemment la preuve d’une certaine efficacité chez les sujets à risque de par la présence d’un excès pondéral et/ou d’une diminution de la tolérance au glucose. C’est le cas de plusieurs antidiabétiques oraux comme la metformine, l’acarbose ou encore la troglitazone. C’est également le cas de médicaments anti-obésité comme l’orlistat et, peut-être aussi, la sibutramine. L’inhibition du système rénine-angiotensine par un inhibiteur de l’enzyme de conversion ou par un antagoniste sélectif des récepteurs AT1 peut aussi, outre protéger contre les complications cardiovasculaires, prévenir l’apparition d’un diabète de type 2. Enfin, le rôle des médicaments hypolipidémiants reste controversé. De nouvelles études prospectives sont en cours pour confirmer ces résultats. [less ▲]

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