References of "SCHEEN, André"
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See detailRecommandations europeennes pour la prise en charge du diabete, du pre-diabete et des maladies cardio-vasculaire. 1ere partie. Gestion du diabete et des facteurs de risque cardio-vasculaire.
Scheen, André ULg; RADERMECKER, Régis ULg; PHILIPS, Jean-Christophe ULg et al

in Revue medicale de Liege (2013), 68(11), 585-92

The patient with prediabetes or diabetes has a high or very high risk of cardiovascular diseases.We summarize the recent guidelines jointly published by the European Society of Cardiology and the European ... [more ▼]

The patient with prediabetes or diabetes has a high or very high risk of cardiovascular diseases.We summarize the recent guidelines jointly published by the European Society of Cardiology and the European Society for the Study of Diabetes. In this first article, we focus mainly on the preventive approaches of cardiovascular diseases in patients with prediabetes or (type 1 or type 2) diabetes. The crucial importance of a global multifactorial strategy is emphasized and the target levels of various risk factors are updated. The management of these cardiovascular complications in presence of diabetes will be considered in a second article. [less ▲]

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See detailPrise en charge du diabete gestationnel.
Philips, J. C.; EMONTS, Patrick ULg; Pintiaux, Axelle ULg et al

in Revue medicale de Liege (2013), 68(9), 489-96

Pregnancy is associated with relative carbohydrate intolerance and insulin resistance. Gestational diabetes mellitus (GDM) is recognized as a risk factor for a number of adverse outcomes during pregnancy ... [more ▼]

Pregnancy is associated with relative carbohydrate intolerance and insulin resistance. Gestational diabetes mellitus (GDM) is recognized as a risk factor for a number of adverse outcomes during pregnancy, including excessive fetal growth, increased incidence of birth trauma and neonatal metabolic abnormalities. This recognition has led to recommendations to screen all pregnant women for GDM and to treat those whose glucose tolerance tests exceed threshold criteria. Numerous epidemiological studies show that GDM affects between 1 and 25% of pregnancies, depending on the ethnicity of the population studied and the diagnostic criteria. Intervention to change lifestyle and, if maternal hyperglycemia persists, treatment with additional oral medication or insulin injections have shown to improve perinatal outcomes. Patients with GDM have a high risk of developing type 2 diabetes in the years after delivery and these women are encouraged to practice specific health behaviours (dietary habits, physical activity) during the postpartum period. The present article discusses the management of GDM in the light of data from the latest studies and international recommendations. [less ▲]

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See detailL’enzyme11β-HSD1 : une nouvelle cible potentielle pour le traitement du diabète de type 2 et des maladies métaboliques liées à l’obésité
SCHEEN, André ULg; BECK, Emmanuel ULg

in Diabète et Obésité (2013), 8

The 11 beta-hydroxysteroid dehydrogenase type 1 (11βHSD1) enzyme promotes the local conversion from cortisone to cortisol, especially in the adipose tissue and the liver. It may play a role in the ... [more ▼]

The 11 beta-hydroxysteroid dehydrogenase type 1 (11βHSD1) enzyme promotes the local conversion from cortisone to cortisol, especially in the adipose tissue and the liver. It may play a role in the pathophysiology of abdominal obesity and the metabolic syndrome, both showing some similarities with the Cushing syndrome. Synthetic selective inhibitors of 11βHSD1 are currently in development with encouraging preliminary results that remain, however, to be further improved. Selective inhibitors of 11βHSD1 may represent an innovative approach in the pharmacological management of obesity, metabolic syndrome and type 2 diabetes. [less ▲]

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See detailLa metformine: une molecule antidiabetique dotee de proprietes anti-cancereuses.
BECK, Emmanuel ULg; Scheen, André ULg

in Revue medicale de Liege (2013), 68(9), 444-9

Numerous epidemiological cohort and case-control studies showed that type 2 diabetes is a risk factor for cancer and that metformin therapy is associated with a significant reduction in the incidence of ... [more ▼]

Numerous epidemiological cohort and case-control studies showed that type 2 diabetes is a risk factor for cancer and that metformin therapy is associated with a significant reduction in the incidence of cancer and cancer-related death when compared to other glucose-lowering agents. Such beneficial effect is observed whatever the type of cancer, but seems to be more prominent in case of gastrointestinal and breast cancers. In general, the protective effect was more evident in observational cohort studies (however, more exposed to bias due to confounding factors) than in case-control studies. However, the results of the rather rare controlled clinical trials available are not conclusive, but none of them was performed with the objective to specifically assess cancer risk. Several meta-analyses recently confirmed that metformin therapy reduces the incidence of cancers (including colorectal cancer, hepatocarcinoma, breast cancer) and cancer-related mortality. Metformin may exert its anti-cancer activity by a direct effect (insulin) and an indirect effect (AMPK and mTOR). Considering all promising clinical information in patients with type 2 diabetes, further clinical trials are currently ongoing with the aim of assessing the role of metformin in oncology, especially as adjuvant in breast cancer therapy. [less ▲]

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See detailCardiovascular risk factors and complications associated with albuminuria and impaired renal function in insulin-treated diabetes.
Doggen, Kris; Nobels, Frank; SCHEEN, André ULg et al

in Journal of Diabetes & its Complications (2013)

AIMS: To establish the association between albuminuria and cardiovascular risk factors as well as micro- and macrovascular complications in type 1 and insulin-treated type 2 diabetes, both in the presence ... [more ▼]

AIMS: To establish the association between albuminuria and cardiovascular risk factors as well as micro- and macrovascular complications in type 1 and insulin-treated type 2 diabetes, both in the presence and in the absence of reduced estimated glomerular filtration rate (eGFR). METHODS: Cross-sectional study including 7640 insulin-treated diabetic patients (33% type 1) treated in specialist diabetes centers. Albuminuria was defined as >/=30mg/g, 20mg/L, 20mug/min or 30mg/24h. Reduced eGFR was defined as <60mL/min/1.73m2 (CKD-EPI equations). RESULTS: Albuminuria, reduced eGFR or a combination was more prevalent in type 2 (21.5%, 15.9% and 16.5%) than in type 1 diabetes (16.1%, 4.7% and 4.0%, all P<0.001 vs. type 2). Albuminuria was associated with poorer control of blood pressure, blood lipids and glycemia as well as higher prevalence of retinopathy and macrovascular disease, regardless of preserved/reduced eGFR or diabetes type. Reduced eGFR was associated with higher prevalence of micro- and macrovascular complications especially in type 2 diabetes. Combined presence of albuminuria and reduced eGFR was associated with the worst cardiovascular outcomes. CONCLUSIONS: Albuminuria and impaired renal function are prevalent in type 1 and insulin-treated type 2 diabetes. Albuminuria, but also normoalbuminuric renal impairment, is associated with micro- and macrovascular complications. [less ▲]

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See detailUtilisation de la metformine chez le patient diabetique cardiaque: balance benefices-risques.
Scheen, André ULg; Paquot, Nicolas ULg

in Revue medicale suisse (2013), 9(395), 1527-33

Metformin is unanimously considered as the first-line glucose-lowering agent in type 2 diabetes. Theoretically, however, it cannot be prescribed in a large proportion of patients because of the presence ... [more ▼]

Metformin is unanimously considered as the first-line glucose-lowering agent in type 2 diabetes. Theoretically, however, it cannot be prescribed in a large proportion of patients because of the presence of numerous contraindications corresponding to situations that may increase the risk of lactic acidosis. Recent data suggest that type 2 diabetes patients who are considered as being "at risk" because of the presence of cardiac disease still take benefit from metformin therapy, with a reduction of morbidity and mortality compared with other glucose-lowering agents. The present review analyzes the benefit-risk balance of metformin therapy in special populations, namely patients with stable coronary artery disease, acute coronary syndrome or myocardial infarction, or congestive heart failure. [less ▲]

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See detailComment concilier medecine factuelle et medecine personnalisee?
Scheen, André ULg

in Revue medicale suisse (2013), 9(395), 1499-500

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See detailJentadueto, combinaison fixe linagliptine- metformine pour le traitement du diabete de type 2.
Scheen, André ULg; Van Gaal, L. F.

in Revue medicale de Liege (2013), 68(9), 479-85

In case of failure of metformin monotherapy, several pharmacological strategies may be considered for the treatment of type 2 diabetes. Among these, the addition of an inhibitor of the dipeptidyl ... [more ▼]

In case of failure of metformin monotherapy, several pharmacological strategies may be considered for the treatment of type 2 diabetes. Among these, the addition of an inhibitor of the dipeptidyl peptidase-4 (DPP-4) enzyme, a medication commonly named as gliptin, is increasingly used because of two main advantages over sulfonylureas, i.e. the absence of both hypoglycaemia and weight gain. The combination of a gliptin and metformin further improves glycaemic control compared to either monotherapy, due to complementary mechanisms of action. Most patients with type 2 diabetes are treated every day with numerous drugs because of the presence of comorbidities so that poor drug compliance is a major concern in such a population. The use of fixed-dose combinations (FDCs) may improve compliance and, therefore, several gliptin-metformin FDCs are now available. The most recent one is Jentadueto, which combines linagliptin, a selective DPP-4 inhibitor without renal excretion, and metformin, the first-line antidiabetic compound. This FDC is commercialized with two dosages of metformin, i.e. 2.5 mg linagliptin/850 mg metformin and 2.5 mg linagliptin/1.000 mg metformin, and should be administered twice daily with meal.While linagliptin may be prescribed whatever the renal function, the use of FDC should take into account classical restrictions imposed by the presence of metformin. [less ▲]

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See detailLa sitagliptine dans le traitement du diabete de type 2: le point, cinq ans apres sa commercialisation.
Scheen, André ULg; Van Gaal, L. F.

in Revue medicale de Liege (2013), 68(10), 504-10

Sitagliptin (Januvia) was the first selective inhibitor of dipeptidyl peptidase-4 commercialized for the management of type 2 diabetes. It is also available as a fixed-dose combination with meformin ... [more ▼]

Sitagliptin (Januvia) was the first selective inhibitor of dipeptidyl peptidase-4 commercialized for the management of type 2 diabetes. It is also available as a fixed-dose combination with meformin (Janumet). Almost 5 years after its launch in Belgium, the present review summarizes the most recent data regarding the clinical efficacy of this antidiabetic agent, the controversy about its safety profile, its use at lower dosage in case of moderate to severe renal insufficiency, the various indications that have been successively accepted and reimbursed, and, finally, the perspectives offered by a large ongoing cardiovascular outcome trial (TECOS). [less ▲]

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See detailLa vignette diagnostique de l'etudiant. L'anamnese medicale, etape initiale capitale pour l'orientation diagnostique.
Scheen, André ULg

in Revue medicale de Liege (2013), 68(11), 599-603

Medicine combines the characteristics of both a science and an art. The main objective is to cure the patient (or at least to alleviate symptoms). The first step of the global medical approach is to make ... [more ▼]

Medicine combines the characteristics of both a science and an art. The main objective is to cure the patient (or at least to alleviate symptoms). The first step of the global medical approach is to make a diagnosis, which will determine the therapy. Since Hippocrates, semiology, i.e. the study of both symptoms and signs, is crucial to make or guide the disease diagnosis. The development of more and more sophisticated medical technologies may lead to believe that semiology is not useful anymore in medical practice. It is absolutely not true because a careful semiology can provide precise diagnoses in a majority of cases or, at least, can lead to a limited differential diagnosis that helps in the selection of a few well defined complementary investigations. The aim of this article targeting mainly medical students is to emphasize the key rules of a well done medical interviewing, which should progress from an "analytical" approach to a "syndromic" approach, combining knowledge, know-how and self-management skills. [less ▲]

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See detailRationnel en faveur d'une combinaison insuline basale-incretine pour traiter le diabete de type 2.
Scheen, André ULg; Paquot, Nicolas ULg

in Revue medicale de Liege (2013), 68(11), 562-8

Type 2 diabetes is characterized by an insulin secretory defect that cannot compensate for insulin resistance. Such relative defect is present in the fasting state (insufficient basal insulin levels) and ... [more ▼]

Type 2 diabetes is characterized by an insulin secretory defect that cannot compensate for insulin resistance. Such relative defect is present in the fasting state (insufficient basal insulin levels) and contributes to overnight hyperglycaemia; it is even more pronounced in the postprandial state when it is then the main responsible factor for hyperglycaemia following meals. An original approach to correct these two disturbances is to propose a therapy combining the injection of a basal insulin (most commonly at bedtime to better control fasting glycaemia) and the administration of an incretin-based medication to potentiate insulin response to the three main meals, without inducing hypoglycaemia. This latter effect can be obtained either by blocking the degradation of incretin hormones with an oral inhibitor of dipeptidyl peptidase-4 (gliptin), or by injecting an agonist of glucagon-like peptide-1 (GLP-1) receptors. These basal insulin-incretin combined therapies are well validated in various controlled trials and observational studies. Lixisenatide is the first GLP-1 receptor agonist being reimbursed in this specific indication of combination with basal insulin in Belgium. [less ▲]

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See detailLe praticien face aux addictions dans tous leurs etats.
SCHEEN, André ULg; Pitchot, William

in Revue medicale de Liege (2013), 68(5-6), 209-10

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See detail((workaholism)): la dependance au travail, une autre forme d'addiction.
SCHEEN, André ULg

in Revue medicale de Liege (2013), 68(5-6), 371-6

Workaholism belongs to the behavioural addictions, also called ((without substances)) addictions, and is rather common in our society. The differential diagnosis must distinguish a hard worker, who has ... [more ▼]

Workaholism belongs to the behavioural addictions, also called ((without substances)) addictions, and is rather common in our society. The differential diagnosis must distinguish a hard worker, who has pleasure in his/her job, still profits from leisure time and maintains an excellent quality of life, from a true workaholic, who is prisoner of this compulsive behaviour that has negative consequences on his mental and physical health, his social and familial relationships and finally, his work performance itself. We describe here the various typologies of this mental disorder, its mode of evolution, its diagnostic approach, its multiple negative consequences for both patient and family as well as the main principles of management based on cognitive-behavioural therapy of this disorder that may be considered as a true addiction. [less ▲]

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See detailGLP-1 receptor agonists or DPP-4 inhibitors: How to guide the clinician?
SCHEEN, André ULg

in Annales d'Endocrinologie (2013)

Pharmacological treatment of type 2 diabetes has been enriched during recent years, with the launch of incretin therapies targeting glucagon-like peptide-1 (GLP-1). Such medications comprise either GLP-1 ... [more ▼]

Pharmacological treatment of type 2 diabetes has been enriched during recent years, with the launch of incretin therapies targeting glucagon-like peptide-1 (GLP-1). Such medications comprise either GLP-1 receptor agonists, with short (one or two daily injections: exenatide, liraglutide, lixisenatide) or long duration (one injection once weekly: extended-released exenatide, albiglutide, dulaglutide, taspoglutide); or oral compounds inhibiting dipeptidyl peptidase-4 (DPP-4), the enzyme that inactives GLP-1, also called gliptins (sitagliptin, vildagliptin, saxagliptin, linagliptin, alogliptin). Although both pharmacological approaches target GLP-1, important differences exist concerning the mode of administration (subcutaneous injection versus oral ingestion), the efficacy (better with GLP-1 agonists), the effects on body weight and systolic blood pressure (diminution with agonists versus neutrality with gliptins), the tolerance profile (nausea and possibly vomiting with agonists) and the cost (higher with GLP-1 receptor agonists). Both agents may exert favourable cardiovascular effects. Gliptins may represent a valuable alternative to a sulfonylurea or a glitazone after failure of monotherapy with metformin while GLP-1 receptor agonists may be considered as a good alternative to insulin (especially in obese patients) after failure of a dual oral therapy. However, this scheme is probably too restrictive and modalities of using incretins are numerous, in almost all stages of type 2 diabetes. Physicians may guide the pharmacological choice based on clinical characteristics, therapeutic goals and patient's preference. [less ▲]

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See detailQuels benefices antitumoraux attendre de la metformine ?
Beck, Emmanuel; SCHEEN, André ULg

in Annales d'Endocrinologie (2013), 74(2), 137-47

With the better management of cardiovascular risk factors, cancer plays an increasing role in the causes of death among patients with type 2 diabetes. Numerous epidemiological cohort and case-control ... [more ▼]

With the better management of cardiovascular risk factors, cancer plays an increasing role in the causes of death among patients with type 2 diabetes. Numerous epidemiological cohort and case-control studies showed that type 2 diabetes is a risk factor for cancer and that metformin therapy is associated with a significant reduction in the incidence of cancer and cancer-related death when compared to other glucose-lowering agents (sulfonylureas, insulin). Such beneficial effect is observed almost whatever the type of cancer, but seems to be more prominent in case of gastrointestinal and breast cancers. Several studies showed a significant relationship between the amplitude of the protection against cancer, on the one hand, and the daily dose of metformin and the duration of exposure, on the other hand. In general, the protective effect was more evident in observational cohort studies (however, more exposed to bias due to confounding factors) than in case-control studies. Several meta-analyses recently confirmed that metformin therapy reduces the incidence of cancers and cancer-related mortality. However, the results of the rather rare controlled clinical trials available are not conclusive, but none of them was performed with the objective to specifically assess cancer risk. Considering all promising clinical information in patients with type 2 diabetes, further clinical trials are currently ongoing with the aim of assessing the role of metformin in oncology, independently of the presence of diabetes. [less ▲]

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See detailChirurgie bariatrique chez le patient diabétique de type 1 : résultats d’une expérience limitée.
FRANCK, Marie ULg; DE FLINES, Jenny ULg; PAQUOT, Nicolas ULg et al

in Diabète & Métabolisme (2013), 39(suppl), 102

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See detailLa vignette diagnostique de l'etudiant. Mise au point d'un patient consultant pour obesite.
De Flines, J.; Rorive, M.; Esser, Nathalie ULg et al

in Revue Médicale de Liège (2013), 68(3), 148-53

Obesity is increasingly prevalent in our society and medical consultations for evaluation and management of weight excess are frequent. Before considering a therapeutic strategy, a careful initial ... [more ▼]

Obesity is increasingly prevalent in our society and medical consultations for evaluation and management of weight excess are frequent. Before considering a therapeutic strategy, a careful initial clinical assessment is mandatory. The diagnostic approach of an obese person should be similar as for any other chronic pathology. The objectives of the present clinical description are to report the main steps of an exhaustive anamnesis, the signs to be more specifically detected at the clinical examination and the other useful investigations to be programmed at first glance in a person who is visiting his/her medical doctor because of obesity. Based upon the data collected during this careful evaluation, therapeutic modalities may be defined, ideally in the frame of a multidisciplinary approach. [less ▲]

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