References of "Scheen, André"
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See detailAttempt to improve glucose control in type 2 diabetic patients by education about real-time glucose monitoring.
Thielen, Vinciane ULg; Scheen, André ULg; Bringer, J. et al

in Diabètes & Métabolism (2010), 36(3), 240-3

The effectiveness of a specific educational programme involving the use of a real-time glucose-sensor system (Guardian RT) to improve glucose control was investigated in patients with poorly controlled ... [more ▼]

The effectiveness of a specific educational programme involving the use of a real-time glucose-sensor system (Guardian RT) to improve glucose control was investigated in patients with poorly controlled type 2 diabetes despite insulin therapy. Ten patients participated in a randomized crossover study comparing two 3-month periods, during which glucose levels were monitored by either self-monitoring of blood glucose (SMBG) alone or by Guardian RT (restricted to 1 week per month) in addition to SMBG. Only four of the enrolled patients completed both periods, while dropouts were mainly due to technical difficulties in using the device. All six patients who completed the first 3-month period showed a reduction in glycated haemoglobin (HbA(1c)) level whatever the mode of glucose monitoring (study effect). A further reduction in HbA(1c) level was observed in two of the three patients using the Guardian RT during the second period. Less frequent symptomatic hypoglycaemic episodes were noted during the 3-month period with the device in the four patients who completed both study periods. These limited, but promising, results of this pilot study appear to justify the initiation of a larger study to assess the use of a real-time glucose sensor in carefully selected patients with type 2 diabetes. [less ▲]

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See detailControversy about the cardiovascular safety of sibutramine.
Scheen, André ULg

in Drug Safety : An International Journal of Medical Toxicology & Drug Experience (2010), 33(7), 615-8

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See detailCost effectiveness of atorvastatin in patients with type 2 diabetes mellitus: a pharmacoeconomic analysis of the collaborative atorvastatin diabetes study in the belgian population.
Annemans, L.; Marbaix, S.; Webb, K. et al

in Clinical Drug Investigation (2010), 30(2), 133-42

BACKGROUND AND OBJECTIVE: Patients with type 2 diabetes mellitus have a high risk of developing cardiovascular (CV) disease. The clinical benefit of use of statins in patients with type 2 diabetes has ... [more ▼]

BACKGROUND AND OBJECTIVE: Patients with type 2 diabetes mellitus have a high risk of developing cardiovascular (CV) disease. The clinical benefit of use of statins in patients with type 2 diabetes has been demonstrated in several randomized, controlled trials, including the CARDS clinical trial. Based on the clinical CARDS data, the favourable cost effectiveness of atorvastatin 10 mg in patients with type 2 diabetes has been demonstrated in countries such as the UK and France. This study aimed to estimate the cost effectiveness in the Belgian setting of atorvastatin 10 mg compared with no treatment for the primary prevention of CV events in type 2 diabetes patients without a history of CV disease. METHODS: A Markov model with 1-year cycles was developed to simulate the CV event and death risk according to the therapeutic approach initiated. The transition probabilities for CV events in the 'no statin treatment' group were derived from the risk equations reported from the large UKPDS. Risk reductions from the CARDS clinical trial were used to adjust these CV event probabilities in the atorvastatin 10 mg treatment group. The characteristics of type 2 diabetes patients without a CV history were derived from the Belgian OCAPI survey. The public healthcare payers' perspective was taken into account for costing. The direct medical costs of CV events were based on the Public Health Authorities' hospital database for acute care costs and on the literature for the follow-up costs. The impact on the reimbursement system of generic entry to the market was considered in the drug cost. Costs were valued as at year 2009; costs and outcomes were discounted at 3% and 1.5%, respectively. RESULTS: Based on a 5-year time horizon, atorvastatin was demonstrated to be cost effective with an incremental cost/quality-adjusted life-year (QALY) of euro 16,681. Over a lifetime horizon (25 years), atorvastatin was demonstrated to be a cost-saving therapeutic intervention. At a threshold of euro 30,000/QALY, atorvastatin had a 98.8% probability of being cost effective. CONCLUSION: Compared with 'no treatment', use of atorvastatin 10 mg as a primary prevention intervention in Belgian type 2 diabetes patients not only improves CV outcomes, but also appears to be cost saving over a lifetime horizon. [less ▲]

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See detailL'etude clinique du mois. NAVIGATOR: essai de prevention des complications cardio-vasculaires et du diabete de type 2 par le valsartan et/ou le nateglinide.
Scheen, André ULg

in Revue Médicale de Liège (2010), 65(4), 217-23

NAVIGATOR ("Nateglinide And Valsartan in Impaired Glucose Tolerance Outcomes Research") is a large international placebo-controlled trial that randomised 9,031 individuals at high risk because of impaired ... [more ▼]

NAVIGATOR ("Nateglinide And Valsartan in Impaired Glucose Tolerance Outcomes Research") is a large international placebo-controlled trial that randomised 9,031 individuals at high risk because of impaired glucose tolerance and established cardiovascular disease or cardiovascular risk factors. This trial aimed at investigating whether valsartan (a selective AT1 receptor antagonist) and/or nateglinide (a short-acting insulin-secreting agent) are able to reduce the incidence of type 2 diabetes and cardiovascular events. After a median follow up of 6.5 years, neither valsartan nor nateglinide improved cardiovascular prognosis in the tested population, which already benefited from a protective pharmacotherapy at baseline and a reinforcement of lifestyle modification throughout the trial. Nateglinide did not diminish the risk of new onset diabetes. In contrast, valsartan reduced the incidence of type 2 diabetes by 14%, confirming the potential interest of the blockade of the renin-angiotensin system in this high-risk population. [less ▲]

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See detail"Fitness" versus "fatness": impacts cardio-metaboliques respectifs aux differents ages de la vie.
Esser, N.; Paquot, Nicolas ULg; Scheen, André ULg

in Revue Médicale de Liège (2010), 65(4), 199-205

Almost 35% of overweight or obese individuals are free of any metabolic disorder. This may be explained by a favourable fat distribution. However, those individuals also have a higher level of physical ... [more ▼]

Almost 35% of overweight or obese individuals are free of any metabolic disorder. This may be explained by a favourable fat distribution. However, those individuals also have a higher level of physical fitness. Therefore, deleterious cardiometabolic effects of excessive fat mass ("fatness") might be counterbalanced by regular physical activity leading to high cardiorespiratory fitness ("fitness"). The present article first analyzes the various pathophysiological mechanisms explaining why muscular exercise has beneficial effects and second, describes the relationship between "fitness" and "fatness" and their respective cardiometabolic consequences at various ages: adolescents, adults and elderly people. [less ▲]

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See detailPoor glycaemic control in secondary care insulin treated patients correlates with bad process indicators
DEBACKER, N.; VAN CROMBRUGGE, P.; MATHIEU, C. et al

in Diabetologia (2010), 53(s407), 1018

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See detailMaladie cardiovasculaire et diabète chez les personnes atteintes d'une maladie mentale sévère 2ème partie : Evaluation du risque et stratégie de prise en charge
Scheen, André ULg; Gillain, Benoit; De Hert, Marc

in Médecine des Maladies Métaboliques (2010), 4(2), 223-230

Nous avons insisté, dans un premier article, sur le fait que les personnes souffrant de maladies mentales sévères telles que la schizophrénie, la dépression ou le trouble bipolaire sont en moins bonne ... [more ▼]

Nous avons insisté, dans un premier article, sur le fait que les personnes souffrant de maladies mentales sévères telles que la schizophrénie, la dépression ou le trouble bipolaire sont en moins bonne santé physique et ont une espérance de vie moindre que la population générale. Ils sont notamment exposés à de multiples facteurs de risque métabolique et cardiovasculaire conduisant à une surmortalité coronarienne et cérébrovasculaire. Ces patients peuvent avoir un accès restreint à la médecine générale, avec des opportunités de dépistage et de prévention du risque cardiovasculaire inférieures à celles que l'on est en droit d’attendre dans une population non-psychiatrique. L'European Psychiatric Association (EPA), soutenue par l'European Association for the Study of Diabetes (EASD) et l'European Society of Cardiology (ESC), a publié récemment une déclaration de position dans le but d'améliorer la prise en charge des patients atteints de maladies mentales sévères. L'intention est d'amorcer une coopération et une prise en charge partagée entre les différents professionnels de la santé et de sensibiliser les psychiatres et les médecins de première ligne qui s'occupent de patients souffrant de maladies mentales sévères au dépistage et au traitement des facteurs de risque cardiovasculaire et du diabète. Après avoir décrit l’épidémiologie des maladies cardiovasculaires et du diabète dans la population atteinte de maladies mentales sévères et analysé l’impact des médicaments psychotropes en termes de risques métabolique et cardiovasculaire dans une première publication, le présent article décrit comment évaluer le risque de maladies cardiovasculaires et donne des conseils quant à la prise en charge des facteurs de risque cardiovasculaire et du diabète dans cette population psychiatrique. [less ▲]

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See detailMaladie cardiovasculaire et diabète chez les personnes atteintes d'une maladie mentale sévère 1ère partie : Epidémiologie et influence des médicaments psychotropes
Scheen, André ULg; Gillain, Benoit; De Hert, Marc

in Médecine des Maladies Métaboliques (2010), 4

People with severe mental illnesses, such as schizophrenia, depression or bipolar disorder, have worse physical health and reduced life expectancy compared to the general population. The excess ... [more ▼]

People with severe mental illnesses, such as schizophrenia, depression or bipolar disorder, have worse physical health and reduced life expectancy compared to the general population. The excess cardiovascular mortality associated with schizophrenia and bipolar disorder is attributed in part to an increased risk of the modifiable coronary heart disease risk factors : obesity, smoking, diabetes, hypertension and dyslipidaemia. Antipsychotic medication and possibly other psychotropic medication like antidepressants can induce weight gain or worsen other metabolic cardiovascular risk factors. Patients may have limited access to general healthcare with less opportunity for cardiovascular risk screening and prevention than would be expected in a non-psychiatric population. The European Psychiatric Association (EPA), supported by the European Association for the Study of Diabetes (EASD) and the European Society of Cardiology (ESC) recently published a statement with the aim of improving the care of patients suffering from severe mental illness. This first paper summarizes the epidemiological data of coronary heart disease and stroke in this special population as well as the potential cardiometabolic consequences of psychotropic medications. A second article will explain how to evaluate the cardiovascular risk and give recommendations concerning the appropriate management of risk factors and diabetes in the psychiatric population. [less ▲]

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See detailAddition of incretin therapy to metformin in type 2 diabetes.
Scheen, André ULg; Radermecker, Régis ULg

in Lancet (2010), 375(9724), 1410-2

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See detailModuler l'exposition tissulaire au cortisol, nouvelle perspective pour reduire le risque metabolique associe a l'obesite.
Iovino, A.; Scheen, André ULg

in Revue Médicale de Liège (2010), 65(3), 140-6

Pharmaceutical research is looking for new alternatives to manage the metabolic disorders associated with obesity. In this context, 11beta hydroxysteroid dehydrogenase type 1 (11HSD1) represents an ... [more ▼]

Pharmaceutical research is looking for new alternatives to manage the metabolic disorders associated with obesity. In this context, 11beta hydroxysteroid dehydrogenase type 1 (11HSD1) represents an interesting target. Indeed, this enzyme activates the transformation of inactive cortisone into active cortisol in various tissues. Therefore, it may be responsible for a local hypercortisolism, in adipose tissue and/or liver, which may be implicated in the pathogenesis of abdominal obesity, metabolic syndrome and type 2 diabetes. Thus, the inhibition of 11HSD1 may represent a potential pharmacological target and an innovative therapeutic goal. Several studies in both animals and humans led to the development of specific 11HSD1 inhibitors, with promising preliminary results. Indeed, a reduction in insulin resistance and significant improvements in carbohydrate and lipid profiles have been reported. The present article describes the rationale that led to the development of specific 11HSD1 inhibitors and briefly reports the first results obtained with these molecules, which may become a new class of antidiabetic agents in the future. [less ▲]

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See detailSUGAR: resultats d'une etude observationnelle belge concernant l'utilisation de la sitagliptine chez des patients diabetiques de type 2.
Scheen, André ULg; Van Gaal, L. F.

in Revue Médicale de Liège (2010), 65(3), 127-32

Sitagliptin (Januvia), the first selective inhibitor of dipeptidylpeptidase-4, has been assessed in a large Belgian prospective observational study. The aim of the SUGAR study was to evaluate the efficacy ... [more ▼]

Sitagliptin (Januvia), the first selective inhibitor of dipeptidylpeptidase-4, has been assessed in a large Belgian prospective observational study. The aim of the SUGAR study was to evaluate the efficacy of sitagliptin, at a dose of 100 mg once daily, when it was added in patients with uncontrolled type 2 diabetes followed in real life conditions. In the intent-to-treat population (n = 605), mean glycated haemoglobin level decreased from 8.41 +/- 1.18% to 7.29 +/- 0.86% after a follow up averaging 110 days (p < 0.0001). Similarly, mean fasting plasma glucose level decreased from 180 +/- 50 mg/dl to 141 +/- 37 mg/ dl (p < 0.0001). The improvement of these two parameters was observed independently of basal demographic characteristics, but was directly influenced by baseline initial corresponding values. The vast majority of patients included in SUGAR were initially treated by metformin as monotherapy (current criterion for sitagliptin reimbursement in Belgium); metformin daily dose slightly decreased when sitagliptin was added (from 1975 +/- 681 mg to 1919 +/- 667 mg; p = 0.033). Patients receiving other glucose-lowering agents, as single or combined therapies, had also a significant alleviation of their treatment when sitagliptin was added. After 3-6 months of follow up, more than 95% of patients still received sitagliptin, arguing for both the efficacy and the good tolerance of this new oral antidiabetic agent in clinical practice. [less ▲]

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See detailEffect of valsartan on the incidence of diabetes and cardiovascular events.
McMurray, John J; Holman, Rury R; Haffner, Steven M et al

in New England Journal of Medicine [=NEJM] (2010), 362(16), 1477-90

BACKGROUND: It is not known whether drugs that block the renin-angiotensin system reduce the risk of diabetes and cardiovascular events in patients with impaired glucose tolerance. METHODS: In this double ... [more ▼]

BACKGROUND: It is not known whether drugs that block the renin-angiotensin system reduce the risk of diabetes and cardiovascular events in patients with impaired glucose tolerance. METHODS: In this double-blind, randomized clinical trial with a 2-by-2 factorial design, we assigned 9306 patients with impaired glucose tolerance and established cardiovascular disease or cardiovascular risk factors to receive valsartan (up to 160 mg daily) or placebo (and nateglinide or placebo) in addition to lifestyle modification. We then followed the patients for a median of 5.0 years for the development of diabetes (6.5 years for vital status). We studied the effects of valsartan on the occurrence of three coprimary outcomes: the development of diabetes; an extended composite outcome of death from cardiovascular causes, nonfatal myocardial infarction, nonfatal stroke, hospitalization for heart failure, arterial revascularization, or hospitalization for unstable angina; and a core composite outcome that excluded unstable angina and revascularization. RESULTS: The cumulative incidence of diabetes was 33.1% in the valsartan group, as compared with 36.8% in the placebo group (hazard ratio in the valsartan group, 0.86; 95% confidence interval [CI], 0.80 to 0.92; P<0.001). Valsartan, as compared with placebo, did not significantly reduce the incidence of either the extended cardiovascular outcome (14.5% vs. 14.8%; hazard ratio, 0.96; 95% CI, 0.86 to 1.07; P=0.43) or the core cardiovascular outcome (8.1% vs. 8.1%; hazard ratio, 0.99; 95% CI, 0.86 to 1.14; P=0.85). CONCLUSIONS: Among patients with impaired glucose tolerance and cardiovascular disease or risk factors, the use of valsartan for 5 years, along with lifestyle modification, led to a relative reduction of 14% in the incidence of diabetes but did not reduce the rate of cardiovascular events. (ClinicalTrials.gov number, NCT00097786.) [less ▲]

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See detailEffect of nateglinide on the incidence of diabetes and cardiovascular events.
Holman, Rury R; Haffner, Steven M; McMurray, John J et al

in New England Journal of Medicine [=NEJM] (2010), 362(16), 1463-76

BACKGROUND: The ability of short-acting insulin secretagogues to reduce the risk of diabetes or cardiovascular events in people with impaired glucose tolerance is unknown. METHODS: In a double-blind ... [more ▼]

BACKGROUND: The ability of short-acting insulin secretagogues to reduce the risk of diabetes or cardiovascular events in people with impaired glucose tolerance is unknown. METHODS: In a double-blind, randomized clinical trial, we assigned 9306 participants with impaired glucose tolerance and either cardiovascular disease or cardiovascular risk factors to receive nateglinide (up to 60 mg three times daily) or placebo, in a 2-by-2 factorial design with valsartan or placebo, in addition to participation in a lifestyle modification program. We followed the participants for a median of 5.0 years for incident diabetes (and a median of 6.5 years for vital status). We evaluated the effect of nateglinide on the occurrence of three coprimary outcomes: the development of diabetes; a core cardiovascular outcome that was a composite of death from cardiovascular causes, nonfatal myocardial infarction, nonfatal stroke, or hospitalization for heart failure; and an extended cardiovascular outcome that was a composite of the individual components of the core composite cardiovascular outcome, hospitalization for unstable angina, or arterial revascularization. RESULTS: After adjustment for multiple testing, nateglinide, as compared with placebo, did not significantly reduce the cumulative incidence of diabetes (36% and 34%, respectively; hazard ratio, 1.07; 95% confidence interval [CI], 1.00 to 1.15; P=0.05), the core composite cardiovascular outcome (7.9% and 8.3%, respectively; hazard ratio, 0.94, 95% CI, 0.82 to 1.09; P=0.43), or the extended composite cardiovascular outcome (14.2% and 15.2%, respectively; hazard ratio, 0.93, 95% CI, 0.83 to 1.03; P=0.16). Nateglinide did, however, increase the risk of hypoglycemia. CONCLUSIONS: Among persons with impaired glucose tolerance and established cardiovascular disease or cardiovascular risk factors, assignment to nateglinide for 5 years did not reduce the incidence of diabetes or the coprimary composite cardiovascular outcomes. (ClinicalTrials.gov number, NCT00097786.) [less ▲]

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See detailActivite anticancereuse de la metformine: nouvelles perspectives pour une vieille molecule.
Beck, Emmanuel ULg; Scheen, André ULg

in Revue Médicale Suisse (2010), 6(260), 1601-7

Le diabète de type 2 est associé à un risque accru de cancer, d’autant plus évident qu’on maîtrise mieux la mortalité cardio-vasculaire. Tous les traitements antidiabétiques n’ont pas le même impact sur ... [more ▼]

Le diabète de type 2 est associé à un risque accru de cancer, d’autant plus évident qu’on maîtrise mieux la mortalité cardio-vasculaire. Tous les traitements antidiabétiques n’ont pas le même impact sur le cancer : le risque est accru avec les sulfonylurées et diminué avec la metformine (et les glitazones). De nombreuses études épidémiologiques observationnelles et cas-témoins récentes révèlent qu’un traitement par metformine est associé à une nette réduction de l’incidence de néoplasies et de la mortalité par cancer. Il existe une relation doseréponse et une relation entre la durée préalable du traitement par metformine et l’effet protecteur observé. Les mécanismes invoqués sont l’activation de l’enzyme AMPK et l’inhibition de la voie mTOR. Des études avec la metformine sont en cours en oncologie, notamment dans le cancer du sein. [less ▲]

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