References of "SCHEEN, André"
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See detailCardiovascular effects of gliptins.
SCHEEN, André ULg

in Nature Reviews. Cardiology (2013), 10(2), 73-84

Dipeptidyl peptidase 4 (DPP-4) inhibitors (commonly referred to as gliptins) are a novel class of oral antihyperglycaemic agents with demonstrated efficacy in the treatment of type 2 diabetes mellitus ... [more ▼]

Dipeptidyl peptidase 4 (DPP-4) inhibitors (commonly referred to as gliptins) are a novel class of oral antihyperglycaemic agents with demonstrated efficacy in the treatment of type 2 diabetes mellitus (T2DM). Preclinical data and mechanistic studies have indicated a possible beneficial action on blood vessels and the heart, via both glucagon-like peptide 1 (GLP-1)-dependent and GLP-1-independent effects. DPP-4 inhibition increases the concentration of many peptides with potential vasoactive and cardioprotective effects. Clinically, DPP-4 inhibitors improve several risk factors in patients with T2DM. They improve blood glucose control (mainly by reducing postprandial glycaemia), are weight neutral (or even induce modest weight loss), lower blood pressure, improve postprandial lipaemia, reduce inflammatory markers, diminish oxidative stress, and improve endothelial function. Some positive effects on the heart have also been described in patients with ischaemic heart disease or congestive heart failure, although their clinical relevance requires further investigation. Post-hoc analyses of phase II-III, controlled trials suggest a possible cardioprotective effect with a trend for a lower incidence of major cardiovascular events with gliptins than with placebo or active agents. However, the actual relationship between DPP-4 inhibition and cardiovascular outcomes remains to be proven. Major prospective clinical trials with predefined cardiovascular outcomes and involving various DPP-4 inhibitors are now underway in patients with T2DM and a high-risk cardiovascular profile. [less ▲]

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See detailGliptins (dipeptidyl peptidase-4 inhibitors) and risk of acute pancreatitis.
SCHEEN, André ULg

in Expert Opinion on Drug Safety (2013), 12(4), 545-57

Introduction: Dipeptidyl peptidase-4 (DPP-4) inhibitors (gliptins) play an increasing role in the management of type 2 diabetes. Such incretin-based therapies offer some advantages over other glucose ... [more ▼]

Introduction: Dipeptidyl peptidase-4 (DPP-4) inhibitors (gliptins) play an increasing role in the management of type 2 diabetes. Such incretin-based therapies offer some advantages over other glucose-lowering agents, but might be associated with an increased risk of acute pancreatitis. Areas covered: An extensive literature search was performed to analyze clinical cases of acute pancreatitis reported in the literature or to the Food and Drug Administration (FDA), in randomized clinical trials, and in observational studies with five DPP-4 inhibitors: sitagliptin, vildagliptin, saxagliptin, alogliptin, and linagliptin. Expert opinion: An increased risk of pancreatitis has been reported in diabetic versus nondiabetic patients. Several anecdotal clinical cases of pancreatitis have been reported with sitagliptin and vildagliptin and an increased relative risk reported to the FDA with sitagliptin versus other comparators, but reporting bias cannot be excluded. In rather short-term clinical trials with well-selected diabetic patients, no increased risk of acute pancreatitis has been observed with any of the five commercialized DPP-4 inhibitors: sitagliptin, vildagliptin, saxagliptin, alogliptin, and linagliptin. Similarly, real-life cohort studies showed no increased incidence of pancreatitis with gliptins compared with other glucose-lowering agents, a finding recently challenged by a case- control study. These results must be confirmed in postmarketing surveillance programs and in ongoing large prospective trials with cardiovascular outcomes. [less ▲]

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See detailLes gliptines, une nouvelle mode?
SCHEEN, André ULg

in Revue du Praticien (La) (2013), 63(3), 304-5

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See detailCardiovascular effects of dipeptidyl peptidase-4 inhibitors: From risk factors to clinical outcomes.
SCHEEN, André ULg

in Postgraduate Medicine (2013), 125(3), 7-20

Dipeptidyl peptidase-4 (DPP-4) inhibitors (gliptins) are oral incretin-based glucose-lowering agents with proven efficacy and safety in the management of type 2 diabetes mellitus (T2DM). In addition ... [more ▼]

Dipeptidyl peptidase-4 (DPP-4) inhibitors (gliptins) are oral incretin-based glucose-lowering agents with proven efficacy and safety in the management of type 2 diabetes mellitus (T2DM). In addition, preclinical data and mechanistic studies suggest a possible additional non-glycemic beneficial action on blood vessels and the heart, via both glucagon-like peptide-1-dependent and glucagon-like peptide-1-independent effects. As a matter of fact, DPP-4 inhibitors improve several cardiovascular risk factors: they improve glucose control (mainly by reducing the risk of postprandial hyperglycemia) and are weight neutral; may lower blood pressure somewhat; improve postprandial (and even fasting) lipemia; reduce inflammatory markers; diminish oxidative stress; improve endothelial function; and reduce platelet aggregation in patients with T2DM. In addition, positive effects on the myocardium have been described in patients with ischemic heart disease. Results of post hoc analyses of phase 2/3 controlled trials suggest a possible cardioprotective effect with a trend (sometimes significant) toward lower incidence of major cardiovascular events with sitagliptin, vildagliptin, saxagliptin, linagliptin, or alogliptin compared with placebo or other active glucose-lowering agents. However, the definite relationship between DPP-4 inhibition and better cardiovascular outcomes remains to be proven. Major prospective clinical trials involving various DPP-4 inhibitors with predefined cardiovascular outcomes are under way in patients with T2DM and a high-risk cardiovascular profile: the Sitagliptin Cardiovascular Outcome Study (TECOS) on sitagliptin, the Saxagliptin Assessment of Vascular Outcomes Recorded in Patients With Diabetes Mellitus-Thrombolysis in Myocardial Infarction (SAVOR-TIMI) 53 trial on saxagliptin, the Cardiovascular Outcomes Study of Alogliptin in Subjects With Type 2 Diabetes and Acute Coronary Syndrome (EXAMINE) trial on alogliptin, and the Cardiovascular Outcome Study of Linagliptin Versus Glimepiride in Patients With Type 2 Diabetes (CAROLINA) on linagliptin. If these trials confirm that a DPP-4 inhibitor can reduce the cardiovascular burden of T2DM, it would be major progress that would dramatically influence the management of the disease. [less ▲]

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See detailL'hypotension orthostatique: 2eme partie. Epidemiologie, complications et traitements.
Tyberghein, M.; Philips, J.-C.; Krzesinski, Jean-Marie ULg et al

in Revue Médicale de Liège (2013), 68(4), 163-70

Orthostatic hypotension (OH) is a rather common phenomenon in clinical practice. It may occur in 5-10 % of normal individuals, but its prevalence increases with age and various pathologies, so that it may ... [more ▼]

Orthostatic hypotension (OH) is a rather common phenomenon in clinical practice. It may occur in 5-10 % of normal individuals, but its prevalence increases with age and various pathologies, so that it may rise above 35 % in certain subgroups of patients. OH is associated with various comorbidities, in particular cardio-cerebro-vascular accidents and falls (especially in the elderly), and may even increase mortality. It is, however, difficult to determine whether OH is simply a marker of frailty or whether it is really a risk factor. OH treatment involves physical manoeuvres or medications, which aim at inducing a peripheral vasoconstriction (midodrine, etilefrine) or an increase of circulating blood volume (9-alpha-fluohydrocortisone). However, their use should be cautious, because of a risk of arterial hypertension in supine position. [less ▲]

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See detailLa vignette diagnostique de l'etudiant. Diagnostic d'un diabete gestationnel.
Philips, J.-C.; SCHEEN, André ULg

in Revue Médicale de Liège (2013), 68(4), 201-7

Gestational diabetes (GD) is a common complication of pregnancy. Its prevalence depends on the strategy used for screening and the studied population. Pregnant women with GD are at increased risk for ... [more ▼]

Gestational diabetes (GD) is a common complication of pregnancy. Its prevalence depends on the strategy used for screening and the studied population. Pregnant women with GD are at increased risk for maternal and fetal complications. The relationship between maternal blood sugar and complications is linear, without a clear threshold defining GD. Therefore, the diagnostic criteria for GD have been the subject of several controversies since many years. The choice of the one-step or two-step method, the test to be used and the cut-off levels validated to define GD are still debated. The same is true regarding a universal versus a at-risk population screening. International experts have recently proposed the use of a one-step approach with a 2-hour oral glucose tolerance test for a universal screening. The need for a better harmonization regarding the diagnosis of GD is indeed mandatory. The present article discusses both the advantages and disadvantages of the various approaches used for GD screening. [less ▲]

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See detailComment je traite ... par metformine un patient diabetique avec insuffisance renale moderee.
SCHEEN, André ULg

in Revue Médicale de Liège (2013), 68(4), 190-5

Numerous patients with type 2 diabetes have renal impairment, especially in the elderly population. Metformin, the first choice oral glucose-lowering agent, is classically contraindicated in case of ... [more ▼]

Numerous patients with type 2 diabetes have renal impairment, especially in the elderly population. Metformin, the first choice oral glucose-lowering agent, is classically contraindicated in case of chronic kidney disease of stages 3-5 (creatinine clearance < 60 ml/min/1.73 m2), because of a risk of accumulation of the biguanide that may lead to lactic acidosis. Hence numerous patients with some degree of renal impairment are being treated with metformin in clinical practice, apparently without any harm. In contrast, several observational studies have shown that they may clinically benefit from this therapy, including with a significant reduction of all-cause mortality when compared to patients not receiving metformin. Thus, an increasing number of physicians plea for revisiting the official criteria of contraindication to the use of metformin in case of renal insufficiency. The present paper discusses this controversy and insists upon the mandatory cautions to be taken when using metformin in a diabetic patient with moderate (stage 3) chronic kidney disease (metformin being contraindicated in case of severe renal impairment - stages 4-5). [less ▲]

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See detailRegard sur la peau diabétique et ses méhins.
PIERARD, Gérald ULg; RADERMECKER, Régis ULg; SCHEEN, André ULg

in Revue de l'Association Belge du Diabète (2013), 56

La peau exprime certains changements qui sont souvent proportionnels à la durée et la sévérité du diabète. La plupart des composants de la peau sont affectés à des degrés divers, parfois cliniquement ... [more ▼]

La peau exprime certains changements qui sont souvent proportionnels à la durée et la sévérité du diabète. La plupart des composants de la peau sont affectés à des degrés divers, parfois cliniquement imperceptibles, parfois très sévères et invalidants. [less ▲]

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See detailL'Hypotension orthostatique: 1ere partie: definition, symptomatologie, evaluation et physiopathologie.
Tyberghein, Maelle; PHILIPS, Jean-Christophe ULg; Krzesinski, Jean-Marie ULg et al

in Revue Médicale de Liège (2013), 68(2), 65-73

Orthostatic hypotension (OH) is defined by a drop in arterial blood pressure (BP) of at least 20 mmHg for systolic BP and 10 mmHg for diastolic BP after standing. Symptoms are generally quite typical, but ... [more ▼]

Orthostatic hypotension (OH) is defined by a drop in arterial blood pressure (BP) of at least 20 mmHg for systolic BP and 10 mmHg for diastolic BP after standing. Symptoms are generally quite typical, but may also be rather vague. Diagnosis may be easily made by the physician in his/ her office, and confirmed, if necessary, by more sophisticated measurements. Pathophysiology is generally rather complex, but mostly involves a defect in the autonomic nervous system, in its sympathetic component. Failure of peripheral vasoconstriction seems to play a more important role than the defect in reflex tachycardia. Causes of OH are multiples. OH may occur in healthy subjects, when exposed to exceptional circumstances, but is more generally associated with various diseases, either neurological disorders or pathologies characterized by hypovolemia. Medications can also aggravate the risk of OH, among which some antihypertensive or psychotropic agents. Elderly people, especially frailty subjects, are exposed to a high risk of OH, whose origin is often multifactorial, and this complication may have serious medical consequences. [less ▲]

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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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