References of "SCHEEN, André"
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See detailCritical assessment of diabetic xerosis.
PIERARD, Gérald ULg; Franchimont, Claudine ULg; Scheen, André ULg

in Expert Opinion on Medical Diagnostics (2013), 7(2), 201-7

Introduction: Diabetes mellitus is commonly responsible for skin changes including discrete to mild xerosis. Areas covered: This review focuses on some selected relevant bioinstrumental methods assessing ... [more ▼]

Introduction: Diabetes mellitus is commonly responsible for skin changes including discrete to mild xerosis. Areas covered: This review focuses on some selected relevant bioinstrumental methods assessing diabetes xerosis. Peer-reviewed articles on objective non-invasive methods were scrutinized. The reviewed methods address i) the xerosis severity grading scale, ii) corneodynamics referring to the desquamation rate, iii) electrometric assessment of skin hydration including skin capacitance mapping and iv) implication of the imperceptible perspiration. The subjective clinical assessment often fails to disclose diabetic xerosis with confidence and precision. By contrast, a multipronged biometrological approach identifies a cluster of diabetic patients who experience alterations in the structural and functional maturation of the stratum corneum. Expert opinion: A multipronged biometrological approach helps identifying the changes in the stratum corneum of diabetic xerosis. There is a continuum between the 'dry skin' feeling, xerosis and ichthyosiform presentations, particularly on the shins and feet of diabetic patients. [less ▲]

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See detailMetformin revisited: A critical review of the benefit-risk balance in at-risk patients with type 2 diabetes.
SCHEEN, André ULg; Paquot, Nicolas ULg

in Diabètes & Métabolism (2013)

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

Metformin is unanimously considered a first-line glucose-lowering agent. Theoretically, however, it cannot be prescribed in a large proportion of patients with type 2 diabetes because of numerous contraindications that could lead to an increased risk of lactic acidosis. Various observational data from real-life have shown that many diabetic patients considered to be at risk still receive metformin and often without appropriate dose adjustment, yet apparently with no harm done and particularly no increased risk of lactic acidosis. More interestingly, recent data have suggested that type 2 diabetes patients considered at risk because of the presence of traditional contraindications may still derive benefit from metformin therapy with reductions in morbidity and mortality compared with other glucose-lowering agents, especially sulphonylureas. 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, congestive heart failure, renal impairment or chronic kidney disease, hepatic dysfunction and chronic respiratory insufficiency, all conditions that could in theory increase the risk of lactic acidosis. Special attention is also paid to elderly patients with type 2 diabetes, a population that is growing rapidly, as older patients can accumulate several comorbidities classically considered contraindications to the use of metformin. A review of the recent scientific literature suggests that reassessment of the contraindications of metformin is now urgently needed to prevent physicians from prescribing the most popular glucose-lowering therapy in everyday clinical practice outside of the official recommendations. [less ▲]

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See detailPharmacokinetic considerations for the treatment of diabetes in patients with chronic kidney disease.
SCHEEN, André ULg

in Expert Opinion on Drug Metabolism & Toxicology (2013)

Introduction: People with chronic kidney disease (CKD) of stages 3 - 5 (creatinine clearance < 60 ml/min) represent approximately 25% of patients with type 2 diabetes mellitus (T2DM), but the problem is ... [more ▼]

Introduction: People with chronic kidney disease (CKD) of stages 3 - 5 (creatinine clearance < 60 ml/min) represent approximately 25% of patients with type 2 diabetes mellitus (T2DM), but the problem is underrecognized or neglected in clinical practice. However, most oral antidiabetic agents have limitations in case of renal impairment (RI), either because they require a dose adjustment or because they are contraindicated for safety reasons. Areas covered: The author performed an extensive literature search to analyze the influence of RI on the pharmacokinetics (PK) of glucose-lowering agents and the potential consequences for clinical practice. Expert opinion: As a result of PK interferences and for safety reasons, the daily dose should be reduced according to glomerular filtration rate (GFR) or even the drug is contraindicated in presence of severe CKD. This is the case for metformin (risk of lactic acidosis) and for many sulfonylureas (risk of hypoglycemia). At present, however, the exact GFR cutoff for metformin use is controversial. New antidiabetic agents are better tolerated in case of CKD, although clinical experience remains quite limited for most of them. The dose of DPP-4 inhibitors should be reduced (except for linagliptin), whereas both the efficacy and safety of SGLT2 inhibitors are questionable in presence of CKD. [less ▲]

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See detailRole limite des medicaments hypoglycemiants oraux dans le diabete de type 1.
SCHEEN, André ULg

in Revue Médicale de Liège (2013), 68(1), 16-21

Management of type 1 diabetes essentially relies upon intensive insulin therapy adjusted according to careful home blood glucose monitoring. The potential role of oral antidiabetic agents is controversial ... [more ▼]

Management of type 1 diabetes essentially relies upon intensive insulin therapy adjusted according to careful home blood glucose monitoring. The potential role of oral antidiabetic agents is controversial and what so ever is limited in type 1 diabetes. Nevertheless, metformin may still be useful in the presence of obesity and/or insulin resistance while acarbose could reduce the amplitude of glycaemic fluetuations, namely postprandial hyperglycaemia and late postmeal glycaemic nadir. Both drugs may also minimize weight gain that results from intensive insulin therapy. Finally, inhibitors of dipeptidyl peptidase-4 (glitpins), by inhibiting glucagon secretion, and inhibitors of renal SGLT2 cotransporters, thus promoting glucosuria independently of insulin, might also be beneficial in type 1 diabetes, although specific studies are still ongoing to verify this hypothesis. [less ▲]

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See detailEfficacy and safety of Jentadueto(R) (linagliptin plus metformin).
SCHEEN, André ULg

in Expert Opinion on Drug Safety (2013), 12(2), 275-89

INTRODUCTION: Metformin is the first-choice drug in the management of type 2 diabetes. However, most patients require a combined therapy to reach and/or maintain targets of glucose control. Dipeptidyl ... [more ▼]

INTRODUCTION: Metformin is the first-choice drug in the management of type 2 diabetes. However, most patients require a combined therapy to reach and/or maintain targets of glucose control. Dipeptidyl peptidase-4 (DPP-4) inhibitors offer new options for combined therapy with metformin. Linagliptin shares a similar pharmacodynamic (PD) profile with other gliptins, but has a unique pharmacokinetic (PK) profile characterized by negligible renal excretion. AREAS COVERED: An extensive literature search was performed to analyze the potential PK/PD interactions between linagliptin and metformin. They are not prone to PK drug-drug interactions. The two compounds may be administered together, either separately or using a fixed-dose combination (FDC) as shown by bioequivalence studies. The addition of linagliptin in patients not well controlled with metformin alone has proven its efficacy in improving glucose levels with a good safety profile. Initial co-administration of linagliptin plus metformin improves glucose control more potently than either compound separately, without hypoglycemia, weight gain or increased metformin-related gastrointestinal side effects. EXPERT OPINION: The linagliptin plus metformin combination may offer some advantages over the classical sulfonylurea-metformin combination. Even if linagliptin is safe in patients with renal impairment, the use of metformin (and thus of the linagliptin plus metformin FDC) is still controversial in this population. [less ▲]

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See detailLinagliptin plus metformin: a pharmacokinetic and pharmacodynamic evaluation.
SCHEEN, André ULg

in Expert Opinion on Drug Metabolism & Toxicology (2013), 9(3), 363-77

INTRODUCTION: The first-choice drug therapy in the management of type 2 diabetes is metformin . However, most patients require a combined therapy to reach and/or maintain targets of glucose control ... [more ▼]

INTRODUCTION: The first-choice drug therapy in the management of type 2 diabetes is metformin . However, most patients require a combined therapy to reach and/or maintain targets of glucose control. Dipeptidyl peptidase-4 (DPP-4) inhibitors, commonly referred to as gliptins, offer new options for combined therapy with metformin. Linagliptin is the most recently launched gliptin, with a unique pharmacokinetic (PK) profile characterized by negligible renal excretion and is now also available as a fixed-dose combination (FDC) with metformin. AREAS COVERED: An extensive literature search was performed to analyze the potential PK and pharmacodynamic interactions between linagliptin and metformin. Linagliptin and metformin may be administered together, either separately or as FDC supported by bioequivalence studies. Linagliptin and metformin are not prone to PK drug-drug interactions. Their coadministration improves blood glucose control more potently than either compound separately, without hypoglycemia and without increasing metformin-related gastrointestinal side effects. EXPERT OPINION: The combination linaglitpin plus metformin, if not contraindicated (renal failure), may be used as first-line or second-line therapy in the management of type 2 diabetes. That being said, the durability of the glucose-lowering effect of this combination needs to be further explored in long-term controlled trials. [less ▲]

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See detailComment j’explore …Une différence de risque de survenue d’un événement dans les études cliniques
SCHEEN, André ULg; ERNEST, Philippe ULg; JANDRAIN, Bernard ULg

in Revue Médicale de Liège (2012), 67(11), 597-602

Evidence-based medicine often requires the comparison of two therapeutic interventions in controlled clinical trials with the demonstration of a superiority (versus a placebo or an active comparator) or ... [more ▼]

Evidence-based medicine often requires the comparison of two therapeutic interventions in controlled clinical trials with the demonstration of a superiority (versus a placebo or an active comparator) or at least a non-inferiority (versus an active reference) concerning a primary endpoint that has been defined a priori (occurrence of a major clinical event, for instance). The difference in the occurrence of such an event between two treatments may be statistically analyzed by absolute risk reduction, relative risk reduction, hazard ratio or odds ratio. The present article discusses the nuances, sometimes of importance, concerning the significance of these various indices and analyses the cautions to be taken and the pitfalls to be avoided in their interpretation and use in practice. The clinician is, indeed, increasingly confronted to results of clinical trials, but is generally poorly informed regarding the nuances of these various statistical analyses. [less ▲]

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See detailAgonistes des récepteurs du GLP-1 ou inhibiteurs de la DPP-4 : comment orienter le choix du clinicien ?
SCHEEN, André ULg

Conference given outside the academic context (2012)

Le traitement pharmacologique du diabète de type 2 s’est enrichi, ces dernières années, de l’apport des médicaments à effet incrétine ciblant le glucagon-like peptide-1 (GLP-1). Ces médicaments ... [more ▼]

Le traitement pharmacologique du diabète de type 2 s’est enrichi, ces dernières années, de l’apport des médicaments à effet incrétine ciblant le glucagon-like peptide-1 (GLP-1). Ces médicaments comprennent soit des agonistes des récepteurs au GLP-1, à courte (injection 1 ou 2 x par jour : exénatide, liraglutide, lixisénatide) ou longue durée d’action (injection hebdomadaire : exénatide à libération prolongée, albiglutide, dulaglutide, taspoglutide) ; soit des agents inhibant l’enzyme inactivant le GLP-1, la dipeptidyl peptidase-4 (DPP-4), actifs par voie orale, les gliptines (sitagliptine, vildagliptine, saxagliptine, linagliptine, alogliptine). Bien que ces approches pharmacologiques ciblent toutes deux le GLP-1, elles se différencient par leur mode d’administration (injection sous-cutanée versus prise orale), leur efficacité (meilleure avec les GLP-1 agonistes), leurs effets sur le poids corporel et sur la pression artérielle systolique (diminution avec les agonistes versus neutralité avec les gliptines), leur profil de tolérance (risque de nausées ou vomissements avec les agonistes) et leur coût (supérieur avec les agonistes du GLP-1). Toutes deux pourraient être bénéfiques sur le plan cardiovasculaire. Il apparaît qu’une gliptine est une excellente alternative à un sulfamide ou une glitazone après échec d’une monothérapie par metformine alors qu’un analogue des récepteurs au GLP-1 est une bonne alternative à l’insuline (surtout chez les sujets obèses) après échec d’une bithérapie orale. Ce schéma est sans doute trop restrictif et les modalités d’utilisation sont nombreuses, à quasi tous les stades du diabète de type 2. Le choix pourra s’orienter selon les caractéristiques cliniques, les objectifs fixés ou simplement les préférences du patient. [less ▲]

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See detailVignette thérapeutique de l'étudiant. Quelles cibles tensionnelles viser chez un patient diabétique de type 2?
Krzesinski, Jean-Marie ULg; Scheen, André ULg

in Revue Médicale de Liège (2012), 67

L'hypertension artérielle est fréquemment observée chez le patient diabétique de type 2 et aggrave le pronostic cardio-vasculaire et rénal. Abaisser la pression artérielle représente donc un objectif ... [more ▼]

L'hypertension artérielle est fréquemment observée chez le patient diabétique de type 2 et aggrave le pronostic cardio-vasculaire et rénal. Abaisser la pression artérielle représente donc un objectif essentiel dans cette population. Cependant, les valeurs de pression systolique et diastolique à atteindre restent controversées et la cible doit sans doute être ajustée en fonction des caractéristiques individuelles du patient ("médecine personnalisée"). Cette vignette clinique résume les principaux arguments à propos du choix des cibles tensionnelles, en termes de rapport bénéfices/risques, selon que le patient diabétique présente un syndrome métabolique sans complications, une néphropathie ou une insuffisance coronaire. [less ▲]

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See detailRecommandations 2012 en diabetologie Prise en charge de l’hyperglycémie dans le diabète de type 2 : une approche centrée sur le patient
SCHEEN, André ULg; Mathieu, Chantal

in Revue Médicale de Liège (2012), 67(12), 623-631

The pharmacological therapy of type 2 diabetes has become increasingly complex and the goals are now more diverse and, in general, more stringent. The glycaemic target (glycated haemoglobin or HbA1c ) and ... [more ▼]

The pharmacological therapy of type 2 diabetes has become increasingly complex and the goals are now more diverse and, in general, more stringent. The glycaemic target (glycated haemoglobin or HbA1c ) and the medications to be prescribed to reach it should be selected according to the individual characteristics of the patient and, if possible, in agreement with him/her. The most relevant criteria to be taken into account are the glucose-lowering efficacy, the risk of hypoglycaemia, the effect on body weight, the side effects and the costs. We summarize here the strategy proposed in the joint «position statement» published in 2012 by the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD). We will more particularly focus our attention on the practical aspects useful for the clinician [less ▲]

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See detailInfluence du poids corporel sur l'histoire naturelle et les approches therapeutiques du diabete de type 1.
Franck, M.; Paquot, Nicolas ULg; SCHEEN, André ULg

in Revue Médicale de Liège (2012), 67(9), 461-7

Obesity, whose prevalence is increasing in industrialized countries, is recognized as a major risk factor for the development of type 2 diabetes. In contrast, the role of excess adiposity in the natural ... [more ▼]

Obesity, whose prevalence is increasing in industrialized countries, is recognized as a major risk factor for the development of type 2 diabetes. In contrast, the role of excess adiposity in the natural history of type 1 diabetes (T1DM) and its impact on therapeutic approaches are by far less known and most probably largely underestimated. The following items will be most particularly considered: 1) the accelerator role of obesity in the development of T1DM in young predisposed individuals; 2) the difficult diagnosis in presence of hybrid or double diabetes combining insulin secretory defect and insulin resistance; 3) the problem of managing both body weight and glucose control, especially in young females and adolescents; 4) the possible deleterious effects of intensive insulin therapy on body weight and some markers of the metabolic syndrome; 5) the worse cardiovascular prognosis of T1DM patients when obesity is present; 6) the possible role of other medications as adjunct therapy to insulin in insulin resistant obese T1DM patients; and finally 7) the expected benefit of bariatric surgery in some well selected T1DM patients with severe obesity. [less ▲]

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See detailY a-t-il encore une place pour la double inhibition du système rénine-angiotensine en 2012?
Krzesinski, Jean-Marie ULg; Scheen, André ULg

in Revue Médicale Suisse (2012), 8(351), 1598-1603

The blockade of the renin-angiotensin system (RAS) improves the prognosis of patients with complications related to diabetes, hypertension or, in general, atherosclerosis. Several observational studies ... [more ▼]

The blockade of the renin-angiotensin system (RAS) improves the prognosis of patients with complications related to diabetes, hypertension or, in general, atherosclerosis. Several observational studies have suggested the use of a dual blockade of the RAS to benefit from a better cardiorenal protection. However, recent randomized controlled studies failed to demonstrate that a dual blockade exert a better protection than single blockade, but showed a higher risk for renal complications and hyperkalemia. To decrease the residual risk, other opportunities may be recommended such as reinforcement of low salt diet, use of supraphysiological dose of a monotherapy inhibiting the RAS (perhaps prescribed at the evening) or addition of an aldosterone antagonist. However, all these approaches, as dual therapy, may also increase the risk of hypotension and renal insufficiency and thus require to be used under strict medical supervision. [less ▲]

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See detailChirurgie metabolique: une place croissante dans le traitement du diabete.
De Flines, J.; Franck, M.; Rorive, M. et al

in Revue Médicale Suisse (2012), 8(351), 1621-41626-7

Bariatric surgery becomes more and more important in the management of the obese patient with type 2 diabetes, especially in case of failure of medical approaches. Metabolic improvement results not only ... [more ▼]

Bariatric surgery becomes more and more important in the management of the obese patient with type 2 diabetes, especially in case of failure of medical approaches. Metabolic improvement results not only from weight loss and the subsequent reduction in insulin resistance, but also from modifications of digestive hormones (especially incretins) that contribute to promote insulin secretion. This new paradigm, moving from bariatric surgery to metabolic surgery, opens new perspectives. The present article briefly describes innovative surgical techniques focusing on endocrine and metabolic improvement rather than on weight loss, the preliminary results of metabolic surgery in patients with type 2 diabetes and a body mass index <35 kg/m2 and, finally, some data regarding the surgical management of obese patients with type I diabetes not well treated with classical medical means. [less ▲]

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See detailOutcomes and lessons from the PROactive study.
SCHEEN, André ULg

in Diabetes Research & Clinical Practice (2012), epub ahead of print

Beyond improvement of glucose control, thiazolidinediones exert pleiotropic effects, which may contribute to some cardiovascular protection. PROactive ("PROspective pioglitAzone Clinical Trial In ... [more ▼]

Beyond improvement of glucose control, thiazolidinediones exert pleiotropic effects, which may contribute to some cardiovascular protection. PROactive ("PROspective pioglitAzone Clinical Trial In macroVascular Events") has provided valuable, although controversial, information on the impact of pioglitazone on cardiovascular outcomes in a high-risk population of patients with type 2 diabetes and established macrovascular disease. Since 2005, there has been much debate on the relative value of the statistically non-significant 10% reduction in the quite challenging primary composite endpoint (combining cardiovascular disease-driven and procedural events in all vascular beds) versus the statistically significant 16% decrease in the more robust and conventional main secondary endpoint (all-cause mortality, myocardial infarction, and stroke) observed with pioglitazone. Revisiting PROactive deserves much interest following the report of inconclusive results on cardiovascular efficacy and safety of rosiglitazone in RECORD, the withdrawal (limitation) of rosiglitazone because of cardiovascular safety concern, the recent publication of a statement positioning pioglitazone in type 2 diabetes and the near availability of cheaper generics of pioglitazone. Although subanalyses may have more limited value from a statistical viewpoint, they nonetheless can provide valuable information on the drug efficacy/safety profile and clinical insights into which patients might benefit most (in terms of cardiovascular outcomes) from pioglitazone therapy. [less ▲]

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See detailUtilisation des antidiabetiques oraux en cas d'insuffisance renale.
SCHEEN, André ULg

in Revue Médicale Suisse (2012), 8(351), 1614-20

People with chronic kidney disease (CKD) of stages 3-4 (creatinine clearance <50 ml/min) represent 25-30% of type 2 diabetic patients, but the problem is often underrecognized or neglected in clinical ... [more ▼]

People with chronic kidney disease (CKD) of stages 3-4 (creatinine clearance <50 ml/min) represent 25-30% of type 2 diabetic patients, but the problem is often underrecognized or neglected in clinical practice. However, most of oral antidiabetic agents have limitations in case of renal impairment, either because they require a dose adjustment, or because they are contra-indicated for safety reasons. It is the case for metformin (risk of lactic acidosis) and for most sulfonylureas (risk of hypoglycaemia). New antidiabetic agents are better tolerated in case of CKD. However, the daily dose of dipeptidyl peptidase-4 inhibitors should be adjusted (except for linagliptin). Concerning new inhibitors of renal SGLT2 cotransporters, they have a reduced efficacy and their safety remains to be demonstrated in presence of CKD. [less ▲]

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See detailLes maladies chroniques complexes. Du nouveau paradigme medical au gigantesque defi societal!
SCHEEN, André ULg

in Revue Médicale Suisse (2012), 8(351), 1579-80

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See detailGliptin versus a sulphonylurea as add-on to metformin.
SCHEEN, André ULg; Paquot, Nicolas ULg

in Lancet (2012), 380

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See detailControversy about the relative efficacy of dipeptidyl peptidase IV inhibitors.
SCHEEN, André ULg

in Diabetologia (2012), 55

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See detailLa comorbidite psoriasis-syndrome metabolique, une maladie multigenique complexe.
Franchimont, Claudine ULg; Quatresooz, Pascale ULg; PIERARD, Gérald ULg et al

in Revue Médicale de Liège (2012), 67(5-6), 337-40

Psoriasis is a common chronic inflammatory dermatitis mediated by cytokines released by dendritic plasmacytoid cells in combination with Th1- and Th17-cells. This complex and multifactorial condition is ... [more ▼]

Psoriasis is a common chronic inflammatory dermatitis mediated by cytokines released by dendritic plasmacytoid cells in combination with Th1- and Th17-cells. This complex and multifactorial condition is commonly associated with some comorbidities. The complexity of a coordinated management of such intricated pathologies is obvious. It calls for the so-called medicine "centered around the patient" which tops off the evidence-based medicine. Vitamin D by its immunomodulatory effect on T helper cells exerts a therapeutic benefit on psoriasis and some of its comorbidities including the metabolic syndrome. A vitamin D oral treatment was proposed in order to reduce the cardiovascular risk, and the ensuing morbidity and mortality. [less ▲]

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